1
|
Agdoğan Ö. Congenital three generation wide familial non-syndromic polydactyly. Congenit Anom (Kyoto) 2024. [PMID: 38970409 DOI: 10.1111/cga.12578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/14/2024] [Accepted: 06/23/2024] [Indexed: 07/08/2024]
Abstract
Polydactyly is typically observed as isolated and sporadic occurrences, although familial cases do exist, albeit with lower frequency, manifesting in various inheritance patterns. In around 30% of polydactyly cases, there exists a familial history, suggesting the probable involvement of a single gene. Given its potential for hereditary transmission, thorough investigation of the patients' parents, first-degree relatives, grandparents, and even great-grandparents for similar disorders becomes imperative. In our clinic, we conducted an analysis focusing on patients presenting with foot polydactyly, along with occurrences of polydactyly among their first- and second-degree relatives spanning two to three generations of family history. The study encompassed three patients and their respective families, including a pair of siblings. We speculate that the inheritance type in our cases was autosomal dominant. Among our patients, one presented with central polydactyly, while the remaining patients and all familial cases displayed postaxial polydactyly. In terms of morphologic classification, one patient had a Y-shaped metatarsal, another had a T-shaped metatarsal, and the third patient exhibited a duplicated ray-shaped anomaly. In our review of the literature, we haven't come across a case spanning three generations like the ones we encountered. Additionally, the presence of a transverse accessory extensor tendon between both extensor tendons in cases with T- and Y-shaped metatarsals intrigued us from an anatomical perspective. Our goal is to present these rare cases of congenital familial polydactyly spanning three generations, highlighting the anatomical variations observed and aiming to contribute to the existing body of literature on the subject.
Collapse
Affiliation(s)
- Özgür Agdoğan
- Department of Plastic Reconstructive and Aesthetic Surgery, Tekirdağ Namık Kemal University Faculty of Medicine, Tekirdağ, Turkey
| |
Collapse
|
2
|
Oeckenpöhler S, Langer MF, Wichmann A, Glasbrenner J, Riesenbeck O. An Alternative Treatment Option for Blauth III B Thumb Hypoplasia-Thumb Stabilization with Iliac Crest Bone Graft and Intermetacarpal Arthrodesis. J Clin Med 2023; 12:5977. [PMID: 37762917 PMCID: PMC10532303 DOI: 10.3390/jcm12185977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Thumb hypoplasia modified Blauth III B is usually treated by pollicization or, less commonly, by toe transfer. Both procedures always result in the resection of a body part, but with good cosmesis and acceptable function. We describe an intermetacarpal I/II arthrodesis with autologous bone graft augmentation to lengthen and stabilize the loose thumb. Clinical data were collected from nine patients, median age at surgery 3 years 8 months, with more than 7 years of follow-up. The results showed a grip strength on the Jamar dynamometer of approximately 61% of the unoperated hand. The Quick-DASH score was 11. The reconstructed thumb was 0.8 cm thinner and 1.9 cm shorter. Overall satisfaction on the VAS, with an average of 1.5 out of 10, is excellent with a partially usable thumb on a hand with five rays. The described procedure is a reliable treatment option with satisfactory results. In addition, none of the patients lost pincer grip between the second and third digit, but their thumb gained new function. Especially in environments where physical integrity has a high value, thumb construction instead of replacement could be considered.
Collapse
Affiliation(s)
| | - Martin Franz Langer
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyer Str. 1, 48149 Münster, Germany; (S.O.)
| | | | | | | |
Collapse
|
3
|
Tonni G, Grisolia G, Bonasoni MP, Rizzo G, Werner H, Sepulveda W, Ruano R, Araujo Júnior E. Fetal Hands: A Comprehensive Review of Prenatal Assessment and Diagnosis Over the Past 40 Years. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:657-676. [PMID: 36526543 DOI: 10.1016/j.ultrasmedbio.2022.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 06/17/2023]
Abstract
Fetal skeletal dysplasias involving limbs and hands are rare congenital malformations. Prenatal two-dimensional ultrasound diagnosis of fetal limb defects has a sensitivity of about 30%; however, an increased detection rate may be obtained using three-dimensional (3-D) ultrasound in the rendering mode. 3-D ultrasound may be used as a complementary method providing additional information. Currently, magnetic resonance imaging (MRI), with the emergence of ultrafast imaging techniques and new sequences, allows for better diagnosis of several fetal skeletal dysplasias such as limb reduction defects and neuromuscular disorders. 3-D volumetric images from ultrasound or MRI scan data allow 3-D ultrasound reconstructions of virtual/physical models, and virtual reality can help researchers to improve our understanding of both normal and abnormal fetal limb/hand anatomy. In this article, we review the embryological development of fetal hands and their main anomalies including prenatal diagnostic methods, genetic counseling, the role of orthopedic and plastic surgery reconstruction, and new perspectives in fetal surgery.
Collapse
Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy.
| | - Gianpaolo Grisolia
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Carlo Poma Hospital, Mantua, Italy
| | - Maria Paola Bonasoni
- Human Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI-DASA), Rio de Janeiro, Brazil
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| |
Collapse
|
4
|
Emerging of new bioartificial corticospinal motor synergies using a robotic additional thumb. Sci Rep 2021; 11:18487. [PMID: 34531441 PMCID: PMC8445932 DOI: 10.1038/s41598-021-97876-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022] Open
Abstract
It is likely that when using an artificially augmented hand with six fingers, the natural five plus a robotic one, corticospinal motor synergies controlling grasping actions might be different. However, no direct neurophysiological evidence for this reasonable assumption is available yet. We used transcranial magnetic stimulation of the primary motor cortex to directly address this issue during motor imagery of objects’ grasping actions performed with or without the Soft Sixth Finger (SSF). The SSF is a wearable robotic additional thumb patented for helping patients with hand paresis and inherent loss of thumb opposition abilities. To this aim, we capitalized from the solid notion that neural circuits and mechanisms underlying motor imagery overlap those of physiological voluntary actions. After a few minutes of training, healthy humans wearing the SSF rapidly reshaped the pattern of corticospinal outputs towards forearm and hand muscles governing imagined grasping actions of different objects, suggesting the possibility that the extra finger might rapidly be encoded into the user’s body schema, which is integral part of the frontal-parietal grasping network. Such neural signatures might explain how the motor system of human beings is open to very quickly welcoming emerging augmentative bioartificial corticospinal grasping strategies. Such an ability might represent the functional substrate of a final common pathway the brain might count on towards new interactions with the surrounding objects within the peripersonal space. Findings provide a neurophysiological framework for implementing augmentative robotic tools in humans and for the exploitation of the SSF in conceptually new rehabilitation settings.
Collapse
|
5
|
Abstract
Our body is central to our sense of self and personal identity, yet it can be manipulated in the laboratory in surprisingly easy ways. Several multisensory illusions have shown the flexibility of the mental representation of our bodies by inducing the illusion of owning an artificial body part or having a body part with altered features. Recently, new studies showed we can embody additional body parts such as a supernumerary finger. Newport et al. recently reported a novel six-finger illusion using conflicting visual and tactile signals induced with the mirror box to create the illusory perception of having a sixth finger for a brief moment. In this study, we aimed to replicate this result and to investigate whether the experience of embodiment of a sixth finger could be prolonged for an extended duration by applying continuous visual-tactile stimulation. Results showed that a continuous illusion of having a sixth finger can be clearly induced. This shows that the six-finger illusion does not reflect merely a momentary confusion due to conflicting multisensory signals but can reflect an enduring representation of a supernumerary finger.
Collapse
Affiliation(s)
- Denise Cadete
- Department of Psychological Sciences, Birkbeck, University of London, United Kingdom
| | - Matthew R Longo
- Department of Psychological Sciences, Birkbeck, University of London, United Kingdom
| |
Collapse
|
6
|
Qualitative analysis of impact of congenital hand differences on children visiting a tertiary care hospital. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
7
|
Abstract
BACKGROUND Congenital hand anomalies are numerous and markedly variant. Their significance is attributed to the frequent occurrence and their serious social, psychological and functional impacts on patient's life. PATIENTS AND METHODS This is a follow-up study of 64 patients with hand anomalies of variable severity. All patients were presented to Plastic Surgery Department of Sohag University Hospital in a period of 24 months. RESULTS This study revealed that failure of differentiation and duplication deformities were the most frequent, with polydactyly was the most common anomaly encountered. The mean age of presentation was 6 years and female to male ratio was 1.46:1. Hand anomalies were either isolated, associated with other anomalies or part of a syndrome. CONCLUSION Incidence of congenital hand anomalies in Upper Egypt is difficult to be estimated due to social and cultural concepts, lack of education, poor registration and deficient medical survey. Management of hand anomalies should be individualised, carefully planned and started as early as possible to achieve the best outcome.
Collapse
Affiliation(s)
- Tarek Abulezz
- Department of Plastic Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohamed Talaat
- Department of Plastic Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Asem Elsani
- Department of General Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Karam Allam
- Department of Plastic Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
| |
Collapse
|
8
|
Mehring C, Akselrod M, Bashford L, Mace M, Choi H, Blüher M, Buschhoff AS, Pistohl T, Salomon R, Cheah A, Blanke O, Serino A, Burdet E. Augmented manipulation ability in humans with six-fingered hands. Nat Commun 2019; 10:2401. [PMID: 31160580 PMCID: PMC6547737 DOI: 10.1038/s41467-019-10306-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 04/05/2019] [Indexed: 01/03/2023] Open
Abstract
Neurotechnology attempts to develop supernumerary limbs, but can the human brain deal with the complexity to control an extra limb and yield advantages from it? Here, we analyzed the neuromechanics and manipulation abilities of two polydactyly subjects who each possess six fingers on their hands. Anatomical MRI of the supernumerary finger (SF) revealed that it is actuated by extra muscles and nerves, and fMRI identified a distinct cortical representation of the SF. In both subjects, the SF was able to move independently from the other fingers. Polydactyly subjects were able to coordinate the SF with their other fingers for more complex movements than five fingered subjects, and so carry out with only one hand tasks normally requiring two hands. These results demonstrate that a body with significantly more degrees-of-freedom can be controlled by the human nervous system without causing motor deficits or impairments and can instead provide superior manipulation abilities.
Collapse
Affiliation(s)
- C Mehring
- Bernstein Center Freiburg, University of Freiburg, Freiburg im Breisgau, 79104, Germany.
- Faculty of Biology, University of Freiburg, Freiburg im Breisgau, 79104, Germany.
| | - M Akselrod
- Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, 1005, Switzerland
- Cognition, Motion and Neuroscience Unit, Minded Programme, Fondazione Istituto Italiano di Tecnologia, Genova, 16152, Italy
| | - L Bashford
- Bernstein Center Freiburg, University of Freiburg, Freiburg im Breisgau, 79104, Germany
| | - M Mace
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, SW7 2AZ, UK
| | - H Choi
- Bernstein Center Freiburg, University of Freiburg, Freiburg im Breisgau, 79104, Germany
| | - M Blüher
- Bernstein Center Freiburg, University of Freiburg, Freiburg im Breisgau, 79104, Germany
| | - A-S Buschhoff
- Bernstein Center Freiburg, University of Freiburg, Freiburg im Breisgau, 79104, Germany
| | - T Pistohl
- Bernstein Center Freiburg, University of Freiburg, Freiburg im Breisgau, 79104, Germany
| | - R Salomon
- Gonda Brain Research Center, Bar Ilan University, Ramat Gan, 5290002, Israel
| | - A Cheah
- Department of Hand & Reconstruction Microsurgery, National University Hospital, Singapore, 119228, Singapore
| | - O Blanke
- Center for Neuroprosthetics, Swiss Federal Institute of Technology of Lausanne (EPFL), Geneva, 1202, Switzerland
| | - A Serino
- Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, 1005, Switzerland
| | - E Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, SW7 2AZ, UK.
| |
Collapse
|
9
|
Abstract
Polydactyly is one of the most common congenital hand deformities managed by orthopaedic surgeons. It is most often found in isolation; however, rarely, it may be associated with genetic syndromes. Polydactyly is classified as postaxial, preaxial, or central depending on the radioulnar location of the duplicated digits. Postaxial polydactyly, which affects the ulnar side of the hand, is most common and is typically managed with excision or suture ligation of the supernumerary digit. Preaxial polydactyly, which affects the thumb or radial side of the hand, often requires reconstructive techniques to ensure a functional, stable thumb. Central polydactyly is much less common, and reconstruction can be challenging.
Collapse
|
10
|
Winfeld MJ, Otero H. Radiographic assessment of congenital malformations of the upper extremity. Pediatr Radiol 2016; 46:1454-70. [PMID: 27306656 DOI: 10.1007/s00247-016-3647-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/17/2016] [Accepted: 05/17/2016] [Indexed: 02/07/2023]
Abstract
Congenital and developmental malformations of the upper extremity are uncommon and their diagnosis can challenge radiologists. Many complex classification systems exist, the latest of which accounts for the complex embryology and pathogenetic mechanisms that govern the formation of these anomalies. Using appropriate descriptors allows for more specific diagnosis and improved consultation with referring pediatricians and surgeons, helping to guide medical and surgical interventions and, if indicated, further investigation for associated abnormalities and underlying syndromes. We review the imaging characteristics of upper limb malformations to help pediatric radiologists better understand the classification and workup necessary in these cases.
Collapse
Affiliation(s)
- Matthew J Winfeld
- Department of Radiology, Musculoskeletal Division, Penn Medicine University City, Perelman School of Medicine at the University of Pennsylvania, 3737 Market St., 7th floor, Philadelphia, PA, 19104, USA.
| | - Hansel Otero
- Department of Radiology, Children's National Medical Center, Washington, DC, USA
| |
Collapse
|
11
|
Hand Function and Appearance following Reconstruction for Congenital Hand Differences. Plast Reconstr Surg 2016; 138:73e-81e. [DOI: 10.1097/prs.0000000000002286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Abstract
Physicians who specialize in pediatric orthopedics and hand surgery frequently encounter congenital hand abnormalities, despite their relative rarity. The treating physician should be aware of the associated syndromes and malformations that may, in some cases, be fatal if not recognized and treated appropriately. Although these congenital disorders have a wide variability, their treatment principles are similar in that the physician should promote functional use and cosmesis for the hand. This article discusses syndactyly, preaxial polydactyly and post-axial polydactyly, and the hypoplastic thumb.
Collapse
Affiliation(s)
- Kevin J Little
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, 3333 Burnet Avenue, ML 2017, Cincinnati, OH 45229, USA.
| | - Roger Cornwall
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, 3333 Burnet Avenue, ML 2017, Cincinnati, OH 45229, USA
| |
Collapse
|
13
|
Cortez M, Silva RFD, Gilbert A, Brandt CT, Valenti P. NOSOLOGY OF HAND DISEASES IN CHILDREN AND ADOLESCENTS OPERATED IN PROVISIONAL FACILITIES IN A MODEL HOSPITAL - PERNAMBUCO STATE, BRAZIL. Rev Bras Ortop 2015; 45:445-52. [PMID: 27022593 PMCID: PMC4799119 DOI: 10.1016/s2255-4971(15)30434-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To report the frequencies of congenital hand diseases in patients who underwent surgery on a collective mobilization basis at SOS Hand, Recife, Pernambuco, between 2005 and 2009. Methods: Information was collected from 833 children and adolescents who were examined in eight missions. Results: Among the patients, 306 (36.7%) underwent surgery: 240 (78.4%) because of congenital malformation and 66 (21.6%) because of acquired lesions. The most frequent congenital malformations were: syndactyly, 72 cases (30.0%); polydactyly, 30 cases (12.5%); bifid thumb, 19 cases (7.9%); complex hand malformation, 14 cases (5.8%); cleft hand, 13 cases (5.4%); trigger finger, 12 cases (5.0%); camptodactyly, 11 cases (4.6%); and brachysyndactyly, 9 cases (3.7%). The most frequently acquired injuries were: obstetric traumatic lesions, 26 cases (39.4%); hand trauma sequelae, 18 cases (27.3%); cerebral paralysis sequelae, 7 cases (10.6%); electric shock sequelae, 5 cases (7.6%); and burn sequelae, 4 cases (6.1%). Conclusion: The nosology of hand diseases is similar to that of large series of elective surgery, especially regarding congenital deformities. The frequency of acquired hand lesions seems to be higher than the frequency in international series. The collective mobilization system for hand surgery is important for decreasing the need for this activity in public institutions, and it has been shown to be very efficient. The success of the project may provide support for the Brazilian National Health System to enroll hand surgeons in the on-call system, in emergency units.
Collapse
Affiliation(s)
- Mauri Cortez
- Adjunct Professor in the Federal University of Pernambuco; Director of SOS Hand, Recife, PE
- Correspondence: Rua Minas Gerais 147, Ilha do Leite, 50070-700 Recife, PECorrespondence: Rua Minas Gerais 147Ilha do LeiteRecifePE50070-700
| | | | - Alain Gilbert
- Hand Surgeon, La Chaîne de L'Espoir, Hand Institute, Jouvenet Clinic, 6 Square Jouvenet, Paris
| | | | - Philippe Valenti
- Hand Surgeon, La Chaîne de L'Espoir, Hand Institute, Jouvenet Clinic, 6 Square Jouvenet, Paris
| |
Collapse
|
14
|
|
15
|
Applying the Patient-Reported Outcomes Measurement Information System to Assess Upper Extremity Function among Children with Congenital Hand Differences. Plast Reconstr Surg 2015. [PMID: 26218394 DOI: 10.1097/prs.0000000000001444] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Few studies have evaluated self-assessment tools among children with congenital hand differences. The authors compared three upper extremity disability instruments with the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Upper Extremity Item Bank. METHODS Thirty-three children (aged 6 to 17 years) with congenital hand differences completed the Pediatric Outcomes Data Collection Instrument; the Michigan Hand Outcomes Questionnaire; the Disabilities of the Arm, Shoulder, and Hand questionnaire; and the PROMIS Upper Extremity short form and computerized adaptive test. Hand function was also assessed, and construct validity and feasibility were examined. RESULTS PROMIS demonstrated good construct validity. Short form and computerized adaptive test were highly correlated with Disabilities of the Arm, Shoulder, and Hand questionnaire scores (r = 0.80, p < 0.001) and Pediatric Outcomes Data Collection Instrument domains (r = 0.70, p < 0.001). PROMIS was moderately correlated with the Michigan Hand Outcomes Questionnaire (r = 0.40, p < 0.05). PROMIS scores also correlated with grip (r = 0.60, p < 0.001) and pinch strength (r = 0.50, p < 0.001). Compared with the Pediatric Outcomes Data Collection Instrument and the Disabilities of the Arm, Shoulder, and Hand and Michigan Hand Outcomes questionnaires, PROMIS required the least time to complete with fewer children requiring assistance. CONCLUSION The Patient-Reported Outcomes Measurement Information System is highly correlated with both functional assessment and self-reported function among children with congenital hand differences.
Collapse
|
16
|
Abstract
This article reviews treatment and presents complications seen in the treatment of 7 common congenital hand differences, including syndactyly, camptodactyly, ulnar and radial polydactyly, thumb hypoplasia, radial longitudinal deficiency, and epidermolysis bullosa. The management of these conditions is challenging but has evolved over the last several decades with refined understanding of the disease processes and treatments. The goal of this article is to synthesize prior knowledge and provide further insights into these conditions that will help the surgeon avoid treatment complications.
Collapse
Affiliation(s)
- Garet C Comer
- Department of Orthopedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion C, Redwood City, CA 94063, USA
| | - Amy L Ladd
- Department of Orthopedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion C, Redwood City, CA 94063, USA.
| |
Collapse
|
17
|
Peng H, Wang X, Duan Y, Frey SH, Gu X. Brain Morphometry on Congenital Hand Deformities based on Teichmüller Space Theory. COMPUTER AIDED DESIGN 2015; 58:84-91. [PMID: 27158152 PMCID: PMC4855530 DOI: 10.1016/j.cad.2014.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Congenital Hand Deformities (CHD) are usually occurred between fourth and eighth week after the embryo is formed. Failure of the transformation from arm bud cells to upper limb can lead to an abnormal appearing/functioning upper extremity which is presented at birth. Some causes are linked to genetics while others are affected by the environment, and the rest have remained unknown. CHD patients develop prehension through the use of their hands, which affect the brain as time passes. In recent years, CHD have gain increasing attention and researches have been conducted on CHD, both surgically and psychologically. However, the impacts of CHD on brain structure are not well-understood so far. Here, we propose a novel approach to apply Teichmüller space theory and conformal welding method to study brain morphometry in CHD patients. Conformal welding signature reflects the geometric relations among different functional areas on the cortex surface, which is intrinsic to the Riemannian metric, invariant under conformal deformation, and encodes complete information of the functional area boundaries. The computational algorithm is based on discrete surface Ricci flow, which has theoretic guarantees for the existence and uniqueness of the solutions. In practice, discrete Ricci flow is equivalent to a convex optimization problem, therefore has high numerically stability. In this paper, we compute the signatures of contours on general 3D surfaces with surface Ricci flow method, which encodes both global and local surface contour information. Then we evaluated the signatures of pre-central and post-central gyrus on healthy control and CHD subjects for analyzing brain cortical morphometry. Preliminary experimental results from 3D MRI data of CHD/control data demonstrate the effectiveness of our method. The statistical comparison between left and right brain gives us a better understanding on brain morphometry of subjects with Congenital Hand Deformities, in particular, missing the distal part of the upper limb.
Collapse
Affiliation(s)
- Hao Peng
- Department of Computer Science, Stony Brook University, Stony Brook, NY 11794
| | - Xu Wang
- Department of Computer Science, University of Missouri, Columbia, MO 65211
| | - Ye Duan
- Department of Computer Science, University of Missouri, Columbia, MO 65211
| | - Scott H. Frey
- Department of Psychological Sciences, Brain Imaging Center, University of Missouri, Columbia, MO 65211
| | - Xianfeng Gu
- Department of Computer Science, Stony Brook University, Stony Brook, NY 11794
| |
Collapse
|
18
|
Biswas S, Kundu P, Meyur R, Adhikari A, Mondal GC. Congenital upper limb anomaly as a cause of physical handicap. J ANAT SOC INDIA 2014. [DOI: 10.1016/j.jasi.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
|
20
|
Malik S. Polydactyly: phenotypes, genetics and classification. Clin Genet 2013; 85:203-12. [PMID: 24020795 DOI: 10.1111/cge.12276] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 12/20/2022]
Abstract
Polydactyly is one of the most common hereditary limb malformations featuring additional digits in hands and/or feet. It constituted the highest proportion among the congenital limb defects in various epidemiological surveys. Polydactyly, primarily presenting as an additional pre-axial or post-axial digit of autopod, is a highly heterogeneous condition and depicts broad inter- and intra-familial clinical variability. There is a plethora of polydactyly classification methods reported in the medical literature which approach the heterogeneity in polydactyly in various ways. In this communication, well-characterized, non-syndromic polydactylies in humans are reviewed. The cardinal features, phenotypic variability and molecular advances of each type have been presented. Polydactyly at cellular and developmental levels is mainly a failure in the control of digit number. Interestingly, GLI3 and SHH (ZRS/SHH enhancer), two antagonistic factors known to modulate digit number and identity during development, have also been implicated in polydactyly. Mutations in GLI3 and ZRS/SHH cause overlapping polydactyly phenotypes highlighting shared molecular cascades in the etiology of additional digits, and thus suggesting the lumping of at least six distinct polydactyly entities. However, owing to the extreme phenotypic and clinical heterogeneity witnessed in polydactyly a substantial genetic heterogeneity is expected across different populations and ethnic groups.
Collapse
Affiliation(s)
- S Malik
- Human Genetics Program, Department of Animal Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| |
Collapse
|
21
|
Abstract
Pollicization substitutes a functioning finger for a deficient thumb. The most indication is thumb hypoplasia with absence or instability of the carpometacarpal joint. However, there are additional causes that may negate thumb function, such as trauma, macrodactyly, multi-fingered hand, and a mirror hand. The technique of pollicization represents a consolidation of contributions from surgeons over the last 100 years. A meticulous stepwise approach from incision to closure is necessary to optimize outcome. Following pollicization, cortical plasticity and motor relearning play a pivotal role in function following pollicization with connections and adjacent sprouting from nearby cortical and/or subcortical territories. Occupational therapy is necessary to encourage large object acquisition followed by smaller objects and ultimately fine pinch. Pollicization is more reliable in patients with isolated thumb hypoplasia and a mobile index finger with robust extrinsic and intrinsic muscle-tendon units compared to and patients with radial forearm deficiencies and diminished index mobility.
Collapse
Affiliation(s)
- Scott H Kozin
- Department of Orthopaedic Surgery, Temple University, Philadelphia, PA 19140, USA.
| |
Collapse
|
22
|
Abstract
Pollicization substitutes a functioning finger for a deficient thumb. The most indication is thumb hypoplasia with absence or instability of the carpometacarpal joint. However, there are additional causes that may negate thumb function, such as trauma, macrodactyly, multi-fingered hand, and a mirror hand. The technique of pollicization represents a consolidation of contributions from surgeons over the last 100 years. A meticulous stepwise approach from incision to closure is necessary to optimize outcome. Following pollicization, cortical plasticity and motor relearning play a pivotal role in function following pollicization with connections and adjacent sprouting from nearby cortical and/or subcortical territories. Occupational therapy is necessary to encourage large object acquisition followed by smaller objects and ultimately fine pinch. Pollicization is more reliable in patients with isolated thumb hypoplasia and a mobile index finger with robust extrinsic and intrinsic muscle-tendon units compared to and patients with radial forearm deficiencies and diminished index mobility.
Collapse
Affiliation(s)
- Scott H Kozin
- Department of Orthopaedic Surgery, Temple University, Philadelphia, PA 19140, USA.
| |
Collapse
|
23
|
Knight JB, Pritsch T, Ezaki M, Oishi SN. Unilateral congenital terminal finger absences: a condition that differs from symbrachydactyly. J Hand Surg Am 2012; 37:124-9. [PMID: 22051235 DOI: 10.1016/j.jhsa.2011.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 09/16/2011] [Accepted: 09/16/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe a type of nonhereditary unilateral transverse deficiency, which we have named hypodactyly, that is distinct from symbrachydactyly or amniotic disruption sequence. METHODS We identified 19 patients with unilateral congenital anomalies consisting of absent or short bulbous fingers that lack terminal ectodermal elements. Medical records and radiographs were retrospectively reviewed and contrasted with the typical findings of symbrachydactyly and amniotic disruption sequence. RESULTS No associated syndromes or potentially causative diagnoses were identified in the hypodactyly patients. The digital absences were of a truncated pattern with thickened, tubular soft tissue coverage. Radiographs revealed a pattern of severity progression that is different from that of symbrachydactyly. Distal phalanges were the bony elements absent most frequently, followed sequentially by the middle phalanx and proximal phalanx. In all cases, metacarpals were present. Unlike symbrachydactyly, the ulnar 2 digits were more involved than the index and long fingers, and the thumb was the least involved digit. CONCLUSIONS Hypodactyly appears to be a congenital hand anomaly that is clinically and radiographically different from symbrachydactyly or amniotic disruption sequence and is presumed to be caused by a distinct pathomechanism. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
Collapse
|
24
|
Seitz WH, Shimko P, Patterson RW. Long-term results of callus distraction-lengthening in the hand and upper extremity for traumatic and congenital skeletal deficiencies. J Bone Joint Surg Am 2010; 92 Suppl 2:47-58. [PMID: 21123591 DOI: 10.2106/jbjs.j.01106] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- William H Seitz
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio 44113, USA.
| | | | | |
Collapse
|
25
|
Schmelzer-Schmied N, Jung M, Ludwig K. Radiological and clinical outcome after operations in patients with congenital deficiencies of the wrist and hand. Eur J Radiol 2010; 77:261-8. [PMID: 21087835 DOI: 10.1016/j.ejrad.2010.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/12/2010] [Accepted: 10/20/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the incidence, therapy results, complications and radiologic workup of operatively treated congenital disorders of the hand and wrist in a large university center during a 10-year period. METHODS The institutional database was retrospectively analysed for patients with congenital disorders of the hand and wrist treated operatively during a 10-year period (1998-2007). Disorders were classified according to Van Schoonhoven into 11 different entities. For each entity the incidence, the patients' age at the time of operation, the pre- and postoperative clinical and radiological workup and the frequency of complications and reoperations were evaluated. RESULTS A total of 278 patients was treated operatively for congenital disorders of the hand and wrist with syndactyly being present in 112, thumb hypoplasia in 15, polydactyly in 11, radial clubhand in 7, radioulnar synostosis in 6, clinodactyly in 6, thumb duplication in 6, brachydactyly in 4 and macrodactyly in 4 cases. Patients' age at the time of operation varied substantially between the different entities with a mean age between 0.9 and 6.2 years. There were 9 complications (3%, n = 278)--all of them infections. There were 28 reoperations (10%, n = 278), 13 of them (5%, n = 278) due to reoccurring webs in syndactyly. CONCLUSION Congenital disorders of the hand and wrist include various rare diseases with syndactyly and thumb hypoplasia being the most frequent entities. As a rule, diagnosis is obtained clinically. Radiologic workup typically consists of plain radiography. Complications are rare, whereas reoperations are frequent, mostly due to reoccurring webs in syndactyly.
Collapse
|
26
|
Lumenta DB, Kitzinger HB, Beck H, Frey M. Long-term outcomes of web creep, scar quality, and function after simple syndactyly surgical treatment. J Hand Surg Am 2010; 35:1323-9. [PMID: 20638200 DOI: 10.1016/j.jhsa.2010.04.033] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 04/27/2010] [Accepted: 04/30/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE Syndactyly is the second most common congenital malformation of the hand, and reports of the incidence of web creep after surgery vary. To evaluate our outcomes of simple syndactyly surgical release, we conducted a retrospective analysis of patients treated between January 1965 and December 2007. METHODS After matching for inclusion criteria, we recruited 19 patients with 26 affected web spaces for clinical examination. Outcomes evaluation included grading of web creep, Vancouver Scar Scale, assessment of complications and subjective patient analysis, range of motion, degree of finger abduction, power, and 2-point discrimination. Mean age at follow-up was 18 years (range, 6-50 y), with a mean age of 4.4 years (range, 7 mo to 15 y) at surgery and mean follow-up of 11.5 years (range, 5-35 y). Surgical management consisted of palmar and dorsal triangular skin flaps for creation of the new commissure, and multiple zigzag incisions for separation of digits. For tension-free closure, full-thickness skin grafts were harvested as needed. RESULTS We observed web creep up to the proximal third of the distance between palmar metacarpophalangeal and proximal interphalangeal joint crease in 2 web spaces. All other web spaces had either a soft web equivalent to the contralateral (unaffected) side (n = 13) or no web advancement with thickening of the interdigital space (n = 11). The scar quality as assessed with the Vancouver Scar Scale revealed a height below 2 mm in 24 of 26 web spaces, with close to normal to supple pliability in 20 of 26 web spaces. There were no considerable differences for range of motion, degree of finger abduction, power, or 2-point discrimination between the affected and unaffected sides. In 17 of 24 cases in which full-thickness skin grafts from the groin region were used, patients reported commissural hair growth in the grafted region. CONCLUSIONS Evaluation of the long-term outcomes of surgical treatment for simple syndactyly at our institution demonstrated a low incidence of web creep. When choosing the groin as a donor area for full thickness skin grafts, we recommend harvesting from the lateral third of the inguinal crease, to avoid esthetic compromise associated with the beginning of hair growth in puberty. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- David B Lumenta
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
| | | | | | | |
Collapse
|
27
|
Abstract
The most common thumb duplication is a Wassel type IV with duplication of the proximal and distal phalanges. The term "split-thumb" seems more appropriate as neither element is as robust as a normal thumb. The split parts may share bony elements, tendons, ligaments, joints, neurovascular structures, and nails. The surgical principles are preservation and augmentation of the dominant thumb and ablation of the lesser counterpart. The soft tissue(s) from the ablated thumb are used to augment the retained thumb. This article will discuss the indications, timing, and technique of surgical reconstruction for the Wassel type IV thumb duplication.
Collapse
Affiliation(s)
- Scott H Kozin
- Department of Orthopaedic Surgery, Temple University Health Sciences Center, Shriners Hospitals for Children, Philadelphia, PA 19140, USA.
| |
Collapse
|
28
|
Abstract
Of the 1% to 2% of newborns that are born with congenital defects, 10% of these are born with upper extremity malformations. Although many classification systems have been developed, the most widely used classification system was developed by Swanson. This system categorizes the congenital upper extremity malformations according to the embryonic process that has failed to develop. Congenital hand malformation is a broad category that is broken down into 7 subclasses. This review will focus on congenital hand defects and their associated craniofacial syndromes. The topics will include failure of formation, failure of differentiation, duplication, overgrowth, undergrowth, constriction band syndromes, and generalized skeletal abnormalities.
Collapse
|
29
|
Bae DS, Barnewolt CE, Jennings RW. Prenatal diagnosis and treatment of congenital differences of the hand and upper limb. J Bone Joint Surg Am 2009; 91 Suppl 4:31-9. [PMID: 19571065 DOI: 10.2106/jbjs.i.00072] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Donald S Bae
- Department of Orthopaedic Surgery, Children's Hospital Boston, Hunnewell 2, Boston, MA 02115, USA.
| | | | | |
Collapse
|
30
|
Abstract
Given the complexity and diversity of congenital differences, a separate and broad category of generalized skeletal abnormalities was proposed to include all conditions that are unable to be neatly packaged into the other categories. Some of the conditions included in this category are obscure, whereas others are more common. Some conditions listed in this section may fit into other categories but may be considered as part of the overall classification scheme. This article presents congenital trigger finger, congenital clasped thumb, Madelung's deformity, and other skeletal hand deformities that are characteristic of generalized bone and connective tissue disorders, including achondroplasia and Marfan syndrome.
Collapse
Affiliation(s)
- Andrew J Watt
- Department of Surgery, Stanford University Hospitals & Clinics, Palo Alto, CA 94304, USA
| | | |
Collapse
|
31
|
Abstract
Congenital limb duplications include pre- and post-axial polydactyly, central polydactyly, and the mirror-hand spectrum. Treatment of these duplications constitutes a significant functional and aesthetic challenge for the reconstructive hand surgeon. This article provides an inclusive review of the embryologic and molecular mechanisms underlying these deformities and focuses on their clinical treatment. The anatomic variation, classification, surgical treatment, and outcomes of surgical intervention are reviewed for each of the disorders of duplication.
Collapse
Affiliation(s)
- Andrew J Watt
- Department of Surgery, Stanford University Hospitals and Clinics, Palo Alto, CA 94304, USA
| | | |
Collapse
|
32
|
Netscher DT, Lewis EV. Technique of nonvascularized toe phalangeal transfer and distraction lengthening in the treatment of multiple digit symbrachydactyly. Tech Hand Up Extrem Surg 2008; 12:114-120. [PMID: 18528239 DOI: 10.1097/bth.0b013e3181632d78] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A combination of nonvascularized multiple toe phalangeal transfers, web space deepening, and distraction lengthening may provide excellent function in the child born with the oligodactylous type of symbrachydactyly. These techniques may reconstruct multiple digits, maintaining a wide and stable grip span with good prehension to the thumb. We detail the techniques of each of these 3 stages in reconstruction and describe appropriate patient selection. Potential complications are discussed. However, with strict attention to technical details, these complications can be minimized.
Collapse
Affiliation(s)
- David T Netscher
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA.
| | | |
Collapse
|
33
|
Gazarian A, Abrahamyan DO. Allogreffe de main chez le nouveau-né agénésique: étude de faisabilité. ANN CHIR PLAST ESTH 2007; 52:451-8. [PMID: 17688993 DOI: 10.1016/j.anplas.2007.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Accepted: 05/22/2007] [Indexed: 11/22/2022]
Abstract
Would a newborn with a single hand benefit from hand allograft? Transantebrachial aplasia is the chosen clinical form of agenesia in our interrogation. The feasibility study presents several aspects: 1) ethical and psychological aspects. Is this a desired surgery for agenesic population? Which are the functional, psychological and social situations of agenesic patient? Is the hand transplantation in newborn ethically acceptable? What is the parents' attitude toward agenesia? Can we envisage organ donation in neonatal period? 2) immunological aspects. The non-vital character of this condition and its' good functional tolerance cannot make accepting the risk of adverse effects of hand allotransplantation. Hence, one may consider this surgery only without immunosuppression. Can the peculiarities of the neonate "immature" immune system represent an opportunity of easier tolerance obtaining, avoiding immunosuppression? 3) anatomical and technical aspects. The proximal tissues at the level of amputation are all hypoplastic in agenesic patients. Can we efficaciously suture those structures with donor eutrophic tissues? 4) cognitive aspects. Is a neonate born with only one hand is able to use two? A feasibility study on such a subject needs to take into account all these aspects. This research is useful because, even if hand allograft in agenesic newborn will never be done, the provided information will allow to progress in the vaster domain of composite tissue allotransplantation in perinatology.
Collapse
Affiliation(s)
- A Gazarian
- Chirurgie de la main et du membre supérieur, clinique du Parc, hôpital Debrousse, pavillons Tbis (orthopédie pédiatrique) et V (transplantation), hôpital Edouard-Herriot, 86, boulevard des Belges, 69006 Lyon, France.
| | | |
Collapse
|
34
|
|
35
|
Abstract
A case is discussed in which a young male was born with symbrachydactyly of multiple digits in whom nonvascularized proximal toe phalanges were transferred to the aphalangic digits when he was an infant. This initial surgical procedure was later followed by webspace deepening and ultimately by distraction lengthening of the digits. At 8 years of age, he has a very functional hand with mobile metacarpophalangeal joints in all reconstructed fingers. In fact, he uses this reconstructed right hand as his dominant extremity. The case is discussed in context of phalangeal growth potential, specific indications for this type of reconstruction, and final long-term outcome. This case also helps to recommend rational treatment protocols for similar congenital hand anomalies.
Collapse
Affiliation(s)
- David T Netscher
- Division of Plastic Surgery, Baylor College of Medicine, Plastic Surgery Service, Department of Veterans Affairs, Medical Center, Houston, TX, USA.
| | | |
Collapse
|
36
|
Cetik O, Ozsar BK, Eksioglu F, Uslu M, Cetik G. Contrary Intermittent Skin Release of Complete Syndactyly Without Skin Graft in Adults. Ann Plast Surg 2005; 55:359-62. [PMID: 16186698 DOI: 10.1097/01.sap.0000178816.91888.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There are many different surgical treatment techniques of complete syndactyly. Most of them are techniques involving using skin grafts. We developed a surgical technique that does not require skin grafts, which cause problems in the distal nail border pulp and interdigital web space. MATERIALS AND METHODS Syndactyly release was performed in 12 web spaces of 11 adult male patients. The average age was 21. In addition to a zig-zag incision, contrary intermittent skin release was performed. Primary coverage of the interdigital web space and nail border pulp was achieved without skin graft. RESULTS We obtained good results by the contrary intermittent skin release method that we developed, in adult complete syndactyly patients who had no chance for the surgical treatment due to several reasons, previously. CONCLUSION With such a surgical technique, in our cases we obtained successful results, both cosmetic and functional. The presented technique is an alternative method for syndactyly release without using skin graft in adult patients.
Collapse
Affiliation(s)
- Ozgur Cetik
- Department of Orthopedics and Traumatology, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey.
| | | | | | | | | |
Collapse
|
37
|
MESH Headings
- Abnormalities, Multiple/embryology
- Abnormalities, Multiple/genetics
- Abnormalities, Multiple/surgery
- Animals
- Bone Diseases, Developmental/embryology
- Bone Diseases, Developmental/genetics
- Bone Diseases, Developmental/surgery
- Diagnosis, Differential
- Ectromelia/embryology
- Ectromelia/genetics
- Ectromelia/surgery
- Hand Deformities, Congenital/embryology
- Hand Deformities, Congenital/genetics
- Hand Deformities, Congenital/surgery
- Humans
- Polydactyly/embryology
- Polydactyly/genetics
- Polydactyly/surgery
- Referral and Consultation
- Syndrome
- Thumb/abnormalities
- Thumb/embryology
- Thumb/surgery
Collapse
Affiliation(s)
- Scott H Kozin
- Shriners Hospitals for Children, Philadelphia, PA 19140, USA.
| |
Collapse
|
38
|
Carter PR. The embryogenesis of the specialty of Hand Surgery: a story of three great Americans--a politician, a general, and a duck hunter: The 2002 Richard J. Smith memorial lecture. J Hand Surg Am 2003; 28:185-98. [PMID: 12671847 DOI: 10.1053/jhsu.2003.50047] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although the origins of surgery of the hand come from many different countries over several decades, the specialty of Hand Surgery is uniquely American and came out of the experience of the US Army Medical Corps Hand Centers during and immediately after World War II. The circumstances and opportunities that allowed for the development of the specialty, however, were set in motion years before the war. It is a story of friendship, opportunity, ingenuity, and commitment. That embryogenesis of hand surgery was the result of the intersection of the lives of 3 great Americans--President Franklin Delano Roosevelt, Surgeon General of the Army Norman T. Kirk, and Dr. Asa Sterling Bunnell. These men led fascinating lives and each had personal motivations that made it possible for the specialty to flourish.
Collapse
Affiliation(s)
- Peter R Carter
- Texas Scottish Rite Hospital for Children, Dallas 75219-3993, USA
| |
Collapse
|
39
|
Klementiev B, Bichevaja N, Novikova T, Chebotar N, Bock E, Berezin V. A peptide agonist of the neural cell adhesion molecule (NCAM), C3, protects against developmental defects induced by a teratogen pyrimethamine. Int J Dev Neurosci 2002; 20:527-36. [PMID: 12485621 DOI: 10.1016/s0736-5748(02)00086-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The neural cell adhesion molecule, NCAM, not only plays an important role in neuronal migration, differentiation and formation of connections in the developing nervous system, but also in the condensation of the mesodermal mesenchyme of the limb bud. Therefore, NCAM may be regarded as a target molecule for preventive strategies aimed at minimizing the effects of teratogens affecting the prenatal development of the nervous system and the skeleton. Treatment of fetuses with the teratogen pyrimethamine results in a reduced body weight, microcephaly and malformations of the hind limbs and forelimbs, e.g. micromelia, brachydactyly and adactyly. We here show that a peptide agonist of NCAM, C3, partly prevented the defects induced by this treatment. Although intra-amniotic administration of C3 at gestational day 14 had no effect on the pyrimethamine-induced reduction in body weight, it rescued the deficit in brain weight (microcephaly), partly reversed a decrease in thickness of the cortical plate, and significantly reduced the number of malformed fetuses. In vitro, C3 promoted survival of PC12-E2 cells treated with pyrimethamine. Since C3 is a peptide mimetic of NCAM, our data strongly suggest that stimulating of NCAM results in neuroprotection in vivo and in vitro.
Collapse
Affiliation(s)
- Boris Klementiev
- Protein Laboratory, Institute of Molecular Pathology, Panum Institute Building 6.2., University of Copenhagen, Blegdamsvej 3C, Denmark.
| | | | | | | | | | | |
Collapse
|