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PubMed1988

Capillary permeability to endogenous macromolecules in the equine digit.

Microvascular permeability characteristics were evaluated in digits of 7 adult horses. After capillaries were isolated and an extracorporeal perfusion circuit for the digit was established, a lymphatic vessel draining the distal portion of the phalangeal region was cannulated at the level of the coronary band. Venous pressure was increased in a stepwise manner, and lymph flow, lymph protein concentration (Cl), and plasma protein concentration (Cp) were determined after measured variables were allowed to reach steady state. Lymph-to-plasma protein concentration ratios (Cl/Cp) and lymph and plasma oncotic pressures were determined from samples collected during steady state. The osmotic reflection coefficient was determined after Cl/Cp became constant, regardless of increasing lymph flow, and was expressed as 1--Cl/Cp. The osmotic reflection coefficient for the digit was 0.67. Seemingly, the microvasculature bed of the digit was relatively permeable and could maintain only 67% of the endogenous macromolecules within the vasculature.

Animals↗

PubMed2004

The duplicated longitudinal epiphysis or "kissing delta phalanx": evolution and variation in three different disorders.

BACKGROUND: The delta phalanx, also known as the delta bone, or longitudinal epiphyseal bracket (LEB), has been described in a variety of syndromes and dysplasias. However, the "kissing delta phalanx" is not as well recognized in the literature; it consists of a duplicated longitudinal bracketed epiphysis, or a complex of two adjacent delta bones, with opposing convex portions facing each other. Magnetic resonance imaging of the kissing delta phalanx has not been previously described. OBJECTIVE: To describe the evolution, variation and associated osseous anomalies of the kissing delta phalanx in three patients with distinct distal limb malformations using both plain films and magnetic resonance imaging. RESULTS: Patient 1 had Rubinstein-Taybi syndrome and, in addition to a kissing delta phalanx in both feet, had corresponding delta metatarsals (MT1). Patient 2 had Cenani-Lenz syndactyly with distinct variation of the kissing delta phalanx in each hand. He had a disorganized appearance to the phalanges, metacarpal fusions and carpal coalitions. Patient 3 had an isolated oligosyndactyly of the left hand with metacarpal fusions and carpal coalitions. All three patients were followed over time. We describe two types of kissing delta phalanges: separated (without fusion of the corresponding epiphyseal brackets) and nonseparated (with fusion of the corresponding epiphyseal brackets). Both types can be seen in the same patient and are a reflection of the relative degree of segmentation of the two delta bones. CONCLUSION: The appearance of this rare osseous abnormality changes with time and can be found in a limited number of uncommon disorders. It can also be found in association with other osseous anomalies of the distal extremities; therefore magnetic resonance imaging early in life can greatly assist in surgical planning. Recognition of the kissing delta phalanx may be an important radiological clue to diagnosis of these rare disorders.

Child, Preschool↗

PubMed1994

Use of an ultrasonic Doppler flow detector for determining tissue viability in a dog.

An 8-month-old sexually intact female Boxer was examined because of an almost complete disarticulation of the right thoracic limb at the level of the proximal phalanges. Viability of the tissue distal to the injury was considered questionable. An ultrasonic Doppler flow detector was used to determine that circulation to the portion of the digits distal to the injury had been preserved on the palmar aspect of the foot. Orthopedic repair of the fractures of the third and fourth digits and primary skin closure of the wound was performed. Infection and instability at the fracture sites resulted in pseudoarthrosis and a valgus deformity of the digits distal to the injury. The ultrasonic Doppler flow detector provided a simple noninvasive method for determining tissue viability in the severely traumatized foot of this dog.

Animals↗

PubMedDate not supplied

Morphological considerations of the first metatarsophalangeal joint.

This study was designed to examine the external morphology of the metatarsophalangeal joint and of the hallux. Approximately 187 first metatarsals and their associated proximal phalanges where measured for ten linear variables from human skeletal specimens housed in the Cleveland Museum of Natural History. The variables represented seven articular characteristics of the head of the first metatarsal, the length of first metatarsal, and the height and width of the base of the first proximal phalanx. Descriptive statistics for each of the variables are presented along with comparisons on gender and race. Strong differences comparing the means of the males and females were found; however, only minor differences were found between the blacks and whites. Correlation coefficients between all variables were found to be statistically significant; however, some relationships were more distinct than others. These data are presented as an aid in the accurate sizing of future prosthetic first metatarsophalangeal joint designs.

Female↗

PubMed1993

Modification of the phalangeal pattern of the digits in the chick embryo leg bud by local microinjection of RA, staurosporin and TGF beta's.

Many experimental studies show that in the avian chick limb the digits are specified at early stages of development by characteristic concentrations within the limb mesoderm of a still unidentified morphogen diffusing from the posterior margin of the bud, linked with a specific pattern of homeobox gene expression. In all these studies, digits are distinguished by their size, morphology and phalangeal pattern rather than by their position within the autopodium. In this work we report the induction of digits that have otherwise normal morphology but lack an interphalangeal joint. This suggests that the patterning of these joints is not necessarily linked to the control of the outgrowth of the digital rays. Missing interphalangeal joints were induced by microinjection into the third interdigital space of the leg bud of stage 28 to 31 chick embryos of retinoic Acid (RA), staurosporine and TGF beta 1 and beta 2, but not by microinjection of FGF or EGF. Our results also suggest that the pattern of insertion of the long tendons and the formation of the flexor cutaneous pad at the plantar surface of the digits are both linked to the establishment of the interphalangeal joints.

Alkaloids↗

PubMedDate not supplied

Preossified longitudinal epiphyseal bracket of the foot: treatment by partial bracket excision before ossification.

The longitudinal epiphyseal bracket is a rare ossification defect of tubular bones in the hand and foot. This deformity contains an abnormal secondary ossification center, which may lead to progressive shortening and angular deformity of involved bones. This article describes the results from early treatment of this deformity before the secondary ossification center ossifies. Four patients with seven involved bones (5 metatarsals and 2 phalanges) were treated with surgical excision of the longitudinal epiphyseal brackets, without corrective osteotomy. The average age at surgery was 16 months (range, 6-20 months), and the average follow-up period was 55 months (range, 31-80 months). All five metatarsal patients demonstrated progressive improvement in the deformity. Of the two phalanx patients, one improved and the other did not. Early treatment of the longitudinal epiphyseal bracket before ossification of the secondary center with excision is effective in correcting this deformity. Long-term follow-up assessment until skeletal maturity is necessary to assess the final results of surgery because corrective osteotomy may be necessary for patients who do not have adequate correction.

Bone Diseases, Developmental↗

PubMed1997

Surgical removal of infected phalanges from an Asian elephant (Elephas maximus).

A 40-yr-old female Asian elephant (Elephas maximus) developed cellulitis and became lame in her left front leg. A draining tract behind the lateral nail of her left front foot was discovered. This lesion was treated by aggressive irrigation using a variety of disinfectant solutions. Radiographically, there was degeneration and fragmentation of the distal phalanx of the fifth digit and patterns suggestive of osteomyelitis of the second (middle) phalanx. The fragments of the distal phalanx and the affected portion of the second phalanx were removed surgically. Six months after surgery the incision had healed but a fistulous tract remained on the palmar surface of the foot. The tract extended to the second phalanx, and there was radiographic evidence of osteomyelitis in the second phalanx and the distal portion of the proximal phalanx. The remainder of the second phalanx and the distal portion of the proximal phalanx were surgically removed. Aggressive aftercare allowed complete wound closure by second intention.

Animals↗

PubMed2000

[Tendon transfers in postoperative hallux varus. Apropos of 12 cases].

PURPOSE OF THE STUDY: Iatrogenic hallux varus deformity after bunion surgery is a post-operative condition in which the great toe is oriented in medial deviation in relation to the first metatarsal head. This overcorrection can be a disabling complication with poor cosmetic appearance. A review of the surgical literature showed a reported hallux varus incidence range of 2 p. 100 to 13 p. 100. Various surgical interventions to treat hallux varus are described in the literature and we present here our experience in operative management of acquired hallux varus based on the results of surgical repair with the Johnson (extensor hallucis longus tendon) EHLT transfer procedure and the Hawkins (abductor hallucis tendon) procedure in 12 patients. MATERIAL AND METHODS: All of the patients suffered from painful iatrogenic hallux varus and conservative treatment was unsuccessful in all cases. The mean duration of follow-up was 42 months (range 8-96). The average age was 37 years (range: 17 to 58). The index procedure in eleven patients was a Mc Bride bunionectomy and in one case a Petersen procedure. On physical examination, a claw deformity of the hallux characterized by extension of the metatarsophalangeal joint and flexion of the interphalangeal joint was noted in all feet. Eight transfers of the abductor hallucis tendon and four complete transfers of the extensor hallucis longus tendon with interphalangeal joint fusion were done. At the time of the final follow-up, patients were interviewed and graded using a standardized questionnaire based on pain, metatarso-phalangeal range of motion, alignment of the hallux, footwear requirements, walking capabilities and first ray rest. RESULTS: Eleven patients reported satisfactory results and one patient a fair result. Overcorrection was a potential complication and in this retrospective study, one bunion deformity recurred but was asymptomatic. On radiographic evaluation the hallux abductus angle was improved by a mean 26.6 degrees and the average first intermetatarsal angle was 7 degrees (range: 3 degrees to 12 degrees ). A narrowing of the metatarso-phalangeal joint was observed in four cases (2 Johnson and 2 Hawkins). DISCUSSION: The addition of a tendon transfer to the medial soft tissue release is recommanded in most cases of hallux varus in active patients without osteoarthritis of the metatarso-phalangeal joint. Our experience with the EHLT transfer or the abductor hallucis tendon transfer demonstrated excellent correction of the hallux varus deformity; however metatarso-phalangeal joint stiffness was frequently observed. As originally described by Johnson et Spiegl, the entire extensor hallucis longus tendon was used in conjunction with an interphalangeal joint arthrodesis in the presence of a fixed and painful deformity of the hallux interphalangeal joint. If no fixed claw deformity was present an abductor hallucis tendon transfer was preferred. Onset of degenerative disease involving the metatarso-phalangeal joint in four cases may jeopardize long term survival of these surgical results.

Adolescent↗

PubMed1989

Alignment of the first metatarsal-phalangeal joint: important criteria for a new joint replacement.

Joint replacement is one of many options for the treatment of the first metatarsophalangeal (MTP) joint. Studies of the geometry of that joint have shown that it consists of two distinct articulations, the metatarsophalangeal and the MT-sesamoidal. Both are important, but the MT-sesamoidal tolerates only small deviations from an ideal alignment. The aim of this study was to investigate the alignment of the first MTP joint of a potential patient population, in order to design an optimal surface replacement. One measurement, the extension angle between the MT and the proximal phalanx was found to be the most important alignment criterion for the successful design of an implant and the necessary instruments. This angle controls the delicate interplay between the metatarsal head and the sesamoids and tolerates only small deviations from the normal range before the chance of sesamoidal subluxation increases significantly. The pre-operative knowledge of this and other alignment criteria is important for the ideal placement of an anatomical implant.

Humans↗

PubMed1999

[Evaluation of post-menopausal osteoporosis using ultrasound].

Quantitative ultrasound (QUS) has recently been proposed for evaluating bone mineral density. Several QUS units are now commercially available. They measure both the attenuation and velocity of the US beam, in a transmission mode, mainly at the calcaneum and phalanges. These parameters are mainly related to bone density, but may also, in theory, be affected by non-quantitative properties of bone such as elasticity and anisotropy. Values measured at QUS are lowered in osteoporotic patients compared to normal control subjects. The predictive value for hip fracture in an elderly population is similar for QUS measurements and conventional techniques of bone mineral density measurements. The reproducibility of measurements with QUS is good, but the variation to be measured is only minimal. Thus, QUS cannot yet be recommended for follow up of patients or evaluation of response to treatment. Technical advances are to be expected. Because this technique is non-invasive and simple, it represents a promising tool for the screening of patients at risk for osteoporosis.

Aged↗

PubMed1975

The form and function of retractile claws in the Felidae and other representative carnivorans.

Recent behavioral studies have shown the primary organ of prehension used in capturing prey to be the claw equipped forelimbs. In light of its functional importance, the claw retractile mechanism for 15 felid species is described and its function studied . The anatomy of the claw retractile mechanism for felids is then compared to that of other carnivorans. For felids,claw retraction is mechanically possible due to the unique shape of the middle and distal phalanges. Claw retraction, however, is a function of the dorsal elastic ligaments and not of the forearm extensor muscles. The resistance provided by these ligaments allows for flexion of the wrist and digital joints without claw protrusion. Moreover, co-contraction of both forearm flexor and extensor muscles is necessary to produce claw protrusion. The functional anatomy of claw retraction for felids differs considerably from that of most other carnivorans. However, the claw retractile mechanism for some advanced viverrids is structurally similar to that of the felids. For these viverrids prey seizing, as in the felids, has become a function of the forelimbs. For the other families of carnivorans, the jaws and not the forelimbs are used as the primary organ of prehension and the anatomy of the claw retractile mechanism reflects functional demands placed on it other than grasping and holding prey.

Animals↗

PubMed1985

Magnocellular red nucleus activity during different types of limb movement in the macaque monkey.

Three hundred and thirty-four neurones located in the magnocellular division of red nucleus (r.n.m.) were studied in three alert macaque monkeys. These cells had low discharge rates at rest and produced high frequency bursts during movement. Single cells were selectively active for movement of one body part, and a motor somatotopy was evident. From dorsal to ventral we encountered cells related to movements of the face, contralateral upper limb, contralateral lower limb and, in one case, the tail. Free-form tests indicated that 76% of upper-limb cells were preferentially related to hand and finger movements, and 84% of lower limb cells were preferentially related to foot and toe movements. Quantitative tests of movement relations were based on depths of modulation in discharge rate recorded while the monkeys operated several devices that served as manipulanda in a tracking task; each device elicited a different movement. We conducted 220 tests on eighty-one cells using eleven devices. The modulation in discharge rate exceeded a 50 pulses/s criterion level in seventy-nine cases; eleven were well related to proximal movements, twenty-two to movements of the digits and forty-six to a co-ordinated hand movement elicited by a device called the twister. Both unidirectional and bidirectional patterns of bursting were frequent. A few cells showed reciprocal patterns consisting of a large increase in rate for one direction of movement and a small decrease for the other. The bursts in discharge preceded movement onset (97% of 132 cases) by an average of 135 ms. Electromyographic activity in forearm muscles preceded movement by about 55 ms. In some cases we recorded from a single cell while the monkey operated two, three or four devices. Depth of modulation on the twister device was twice that on a proximal device in nine cases whereas one case showed a proximal device preference; five cases showed overlap. Comparison between twister and digits yielded ten cases of twister preference, four of digit preference and twenty cases of overlap. A directional preference was found for ten out of eleven cells responsive during active movement restricted to the metacarpo-phalangeal joints, and in all cases the preferred direction was extension. Responses to natural somatosensory stimulation were weak or absent for the majority of cells. When present, sensory fields were confined to the same limb but were frequently out of register with motor fields.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗

PubMed1995

Use of facilitated ankylosis in the treatment of septic arthritis of the distal interphalangeal joint in cattle: 12 cases (1987-1992).

Medical records were reviewed for 12 cattle with septic arthritis of the distal interphalangeal joint that were treated by use of facilitated ankylosis. Information on signalment, clinical signs, digit affected, radiographic findings, and type and duration of treatment were compiled. Owners were contacted for information about the convalescent period, reasons for culling, productivity, and outcome. Outcome was classified as successful or unsuccessful on the basis of lameness, growth pattern, and whether the cattle were subsequently productive. Cause of the septic arthritis was unknown in 9 of 12 (75%) cattle. Eleven of 12 (92%) cattle represented beef breeds. Cattle were lame for a mean of 5.3 weeks before admission. In 8 of 12 (67%) cattle, a trephine was used in the creation of an arthrostomy, the middle and distal phalanges were curetted, and the joint was lavaged with isotonic solution. A drill bit was used in 4 of 12 (33%) cattle to remove articular cartilage and facilitate ankylosis. Convalescent period after discharge from the hospital was 1 to 7 months (mean, 4 months; median, 4 months). After that period, all cattle had an apparently normal gait. Eight of 12 (67%) cattle were maintained in their herd of origin. None of the cattle were culled because of lameness. Two of 12 (17%) cattle had a deformation of the affected digit. According to the criteria for successful outcome that were used in the study reported here, the success rate was 100%. Treatment of septic arthritis of the distal interphalangeal joint by use of facilitated ankylosis is an alternative to digit amputation and is recommended to promote longevity and productivity.

Animals↗

PubMed1995

A large Turkish kindred with syndactyly type II (synpolydactyly). 1. Field investigation, clinical and pedigree data.

A very large Turkish family with syndactyly type II (synpolydactyly (SPD)) is described, which originated from and is mainly concentrated in the village of Derbent, Afyon. The kindred consists of 425 subjects over seven generations, of whom 182 are affected. It appears that a founder effect in this village has led to this extensive kindred. This condition is inherited as an autosomal dominant trait with variable expressivity and an estimated penetrance of 96%. Penetrance is different between the upper (96%) and lower (69.5%) extremities. No excess of affected males or females or other associated features were documented in this condition. Variations in the involvement of one or both hands, upper or lower extremities, bone and soft tissue, as well as variation in the affected subjects of two successive generations were documented. We also noted that metacarpal and metatarsal involvement and middle phalangeal hypoplasia of the feet are the consistent features of SPD and, therefore, should be considered as characteristic of this phenotype. We observed four different phenotypes in various branches of the Derbent kindred: (1) subjects presenting typical features of SPD; (2) subjects exhibiting both pre- and post-axial polydactyly simultaneously; (3) persons manifesting postaxial polydactyly type A; and (4) subjects born to two affected parents with severe hand and foot deformities that have not been previously described in any other SPD families (that is, homozygotes). A total of 27 affected offspring were born to two such affected parents, of whom seven are expected to be homozygous for the SPD gene. This group is presented in an accompanying paper in this issue of the Journal. A molecular study is currently under way to identify the chromosomal location of the defective gene.

Female↗

PubMed1995

Christian's spondylo-digital syndrome: second familial case.

We studied a mother and daughter with skeletal dysplasia which was characterized clinically by proximal and distal flexion contractures in the phalanges, and by brachydactyly, clinodactyly and ulnar and radial subdislocations of the fingers. Radiologically, the 2nd metacarpal in the daughter was seen to be longer than the other metacarpals, with bone carpal fusion, and flexion contractures of the fingers in both hands. Thoraco-lumbar xyphorotoscoliosis and malformed vertebrae with dyssegmentation of L2-L3, T12 and L1 with cuneiform shape, asymmetry of the pelvic bones and exostotic lesions in the proximal third of the tibia and the distal third of the femur were also noted. The clinical and radiological characteristics were compatible with the syndrome described by Christian et al. in 1975 and called the second metatarsal syndrome. The purpose of this paper was to present a second corroborative familial case and to propose another name: Christian's spondylo-digital syndrome.

Adolescent↗

PubMed1998

Effect of hoof trimming on the occurrence of distal phalangeal palmar process fractures in foals.

This study sought to determine if extensive trimming of the front hooves of foals results in a higher incidence of palmar process fractures compared to untrimmed foals, and to characterise the clinical course of foals with palmar process fractures with physical findings, hoof measurements and radiography. Twenty foals age 4-8 weeks of multiple breeds were examined every 2 weeks over a 12 week period. Ten foals had both front hooves extensively trimmed every 4 weeks, while 10 foals remained untrimmed. Palmar process fractures occurred in 4 trimmed and 3 untrimmed foals. Four foals with fractures had brief lameness (Grades I-II/V) and hoof tester sensitivity was found inconsistently with fractures. All foals with fractures were sound at the end of the study. Fractures healed based on radiographic evaluations in an average of 8.4 weeks. Two of 3 foals with fractures developed club-footed conformation. None of the measured hoof parameters significantly differed between foals with and without fractures. We conclude that extensive trimming of the heels did not appear to affect the occurrence of palmar process fractures in this group of foals.

Animals↗

PubMed2005

Lameness associated with foot pain: results of magnetic resonance imaging in 199 horses (January 2001--December 2003) and response to treatment.

REASONS FOR PERFORMING STUDY: The diagnosis of foot-related lameness often remains elusive and it can be difficult to offer rational treatment, or to predict outcome. OBJECTIVES: To describe the spectrum of injuries of the foot identified using magnetic resonance imaging (MRI), to determine their relative prevalence among MRI diagnoses and to establish the long-term results of treatment. METHODS: The MR images of horses examined from January 2001--December 2003 were reviewed. Horses were selected for MRI if the pain causing lameness was localised to the foot using perineural analgesia but any clinical, radiological or ultrasonographic abnormalities were insufficient to explain the degree of lameness. The clinical significance of lesions identified using MRI was determined with reference to the results of local analgesia, radiography, ultrasonography and nuclear scintigraphy. Follow-up information was obtained in January 2004 for horses which had been examined 6-36 months previously and the outcome classified as excellent (horse returned to full athletic function without recurrent lameness), moderate (sound, but only in light work), or poor (persistent or recurrent lameness). RESULTS: One hundred and ninety-nine horses underwent MRI examinations. Deep digital flexor (DDF) tendonitis was the most common injury (59%) with primary injury in 65 horses (33%) and a further 27 horses (14%) having lesions of the DDF tendon and navicular bone. Seventeen percent of horses had injuries to multiple structures, including 24 with DDF tendonitis. Desmitis of a collateral ligament (CL) of the distal interphalangeal (DIP) joint was the second most common injury (62 horses, 31%), with primary injuries in 30 horses (15%) and a further 32 horses (16%) that had CL desmitis in conjunction with other injuries. Prognosis was best for horses with traumatic injuries of the middle or distal phalanges, with 5 of 7 horses (71%) having an excellent outcome. Horses with primary lesions of the DDF tendon or CL of the DIP joint had excellent results in only 13 of 47 (28%) and 5 of 17 horses (29%), respectively. Horses with combined injuries of the DDF tendon and navicular bone, or primary navicular bone abnormalities, had a poor outcome, with the majority of horses suffering persistent lameness. CONCLUSIONS: A wide variety of lesions associated with foot pain were identified using MRI, a high proportion of which were primary soft tissue injuries with a guarded prognosis for return to full athletic function. POTENTIAL RELEVANCE: It is now possible to propose more rational treatment strategies for the variety of foot injuries identified using MRI than had previously been possible; however, further information concerning aetiopathogenesis of these injuries is needed to improve their management.

Animals↗

PubMed1999

Brachydactyly type B: clinical description, genetic mapping to chromosome 9q, and evidence for a shared ancestral mutation.

Autosomal dominant brachydactyly type B (BDB) is characterized by nail aplasia with rudimentary or absent distal and middle phalanges. We describe two unrelated families with BDB. One family is English; the other family is Canadian but of English ancestry. We assigned the BDB locus in the Canadian family to an 18-cM interval on 9q, using linkage analysis (LOD score 3.5 at recombination fraction [theta] 0, for marker D9S938). Markers across this interval also cosegregated with the BDB phenotype in the English family (LOD score 2.1 at straight theta=0, for marker D9S277). Within this defined interval is a smaller (7.5-cM) region that contains 10 contiguous markers whose disease-associated haplotype is shared by the two families. This latter result suggests a common founder among families of English descent that are affected with BDB.

Activin Receptors, Type I↗