Disseminated tuberculosis presenting with finger swelling in a patient with tuberculous osteomyelitis: a case report.
BACKGROUND: Extrapulmonary manifestations of tuberculosis have become increasingly important in the era of HIV/AIDS. CASE PRESENTATION: We describe a case of tuberculosis (TB) dactylitis in a patient with AIDS who originated from the Ivory Coast. The diagnosis was established by direct visualization of acid-fast bacilli on joint fluid and bone biopsy of the proximal phalanx. Imaging of the chest revealed multiple bilateral nodules. Confirmation of the diagnosis was made by isolation of Mycobacterium tuberculosis from sputum and bone cultures. CONCLUSION: Tuberculosis should be considered in patients with unusual soft tissue or skeletal lesions, especially when an immunosuppressive condition is present. Ziehl-Neelsen staining and culture of tissue obtained via surgical biopsy offer the most direct approach to diagnosis. (+info)
Analysis of stress and displacements of phalanx bone with the finite element method.
In this paper analyze of phalanx bone supposed at compression, torsion and bending is made. We know that the bones are one of the most important natural composite materials. The finite element method offers the possibility for the study of the stress and the displacements which appears in different solicitations cases. We realized that the most solicited parts of the bone which will be the next broken parts, so the fracture are the once from the meeting of the bone's body with its hand. The observations made by studying 74 cases of fractures caused by torsion and compression and also made by the testing of 23 phalanx bones confirm these conclusions. (+info)
Phalangeal bone ultrasound is of limited value in patients with juvenile idiopathic arthritis.
OBJECTIVE: In children with juvenile idiopathic arthritis (JIA), alterations of the skeletal system have been described. The aim of this cross-sectional study was to evaluate a phalangeal bone ultrasound device in the assessment of the skeletal status in children with active JIA. METHODS: In 49 children with oligoarticular, polyarticular or systemic JIA, the speed of an ultrasound signal (Ad-SOS) through the phalanges of the dominant hand was measured using the Igea 1200. RESULTS: Children in all subgroups were significantly smaller than those in the reference population, but there were no significant deficits in Ad-SOS. The finger width was reduced only in patients with polyarticular JIA. The Ad-SOS correlated highly with height, but no correlation between the finger width and Ad-SOS, and no correlation between the standard deviation scores of body height and Ad-SOS were seen. CONCLUSIONS: Phalangeal ultrasound is strongly dependent on body and therefore bone size, but other parameters of bone and soft tissues influence the measurements as well. It is not possible to differentiate as to which extent the various components of bone and soft tissue influence the measurement results. Ultrasound might therefore be of limited value in the assessment or screening of the skeletal system in children with JIA. (+info)
A molecular and clinical study of Larsen syndrome caused by mutations in FLNB.
BACKGROUND: Larsen syndrome is an autosomal dominant osteochondrodysplasia characterised by large-joint dislocations and craniofacial anomalies. Recently, Larsen syndrome was shown to be caused by missense mutations or small inframe deletions in FLNB, encoding the cytoskeletal protein filamin B. To further delineate the molecular causes of Larsen syndrome, 20 probands with Larsen syndrome together with their affected relatives were evaluated for mutations in FLNB and their phenotypes studied. METHODS: Probands were screened for mutations in FLNB using a combination of denaturing high-performance liquid chromatography, direct sequencing and restriction endonuclease digestion. Clinical and radiographical features of the patients were evaluated. RESULTS AND DISCUSSION: The clinical signs most frequently associated with a FLNB mutation are the presence of supernumerary carpal and tarsal bones and short, broad, spatulate distal phalanges, particularly of the thumb. All individuals with Larsen syndrome-associated FLNB mutations are heterozygous for either missense or small inframe deletions. Three mutations are recurrent, with one mutation, 5071G-->A, observed in 6 of 20 subjects. The distribution of mutations within the FLNB gene is non-random, with clusters of mutations leading to substitutions in the actin-binding domain and filamin repeats 13-17 being the most common cause of Larsen syndrome. These findings collectively define autosomal dominant Larsen syndrome and demonstrate clustering of causative mutations in FLNB. (+info)
Intraosseous epidermoid cyst of the finger phalanx: a case report.
Epidermoid cysts of the finger phalanx are rare pseudotumours. They are benign lesions with a satisfactory outcome after excision. We describe a case of an epidermoid cyst in the distal phalanx of the ring finger. It was treated successfully and the patient had excellent functional results and radiological healing at one-year follow-up. (+info)
Does a bone deformity of the distal phalanx undergo remodeling after removal of a congenital ectopic nail?: A case with periodic radiographic follow-up.
BACKGROUND: Congenital ectopic nails are rare and are characterized by the presence of nail-like tissue mainly at the tip of a finger or toe. OBJECTIVE: Although the accompanying bone deformity might undergo remodeling after removal of the ectopic nail, it remains unknown whether complete bone remodeling can be eventually achieved, and whether such remodeling is necessary to improve the final cosmetic appearance of the concerned fingertip. METHODS AND RESULTS: Follow-up with periodic radiographic examination for 1 year after surgery in a child with congenital ectopic nail revealed no bone remodeling, despite the satisfactory cosmetic result. CONCLUSION: We conclude that residual bone deformity does not affect the final appearance. (+info)
Handgun injuries with metacarpal and proximal phalangeal fractures: early definitive treatment.
Most gunshot injuries to the hand involve a combination of tissue types. The goal of this study is to report the results of early definitive treatment in extra-articular metacarpal and proximal phalangeal fractures due to low velocity gunshot wounds and to analyse their outcomes. A retrospective analysis of 51 metacarpal and 41 proximal phalangeal fractures of 76 patients due to low velocity gunshot wounds treated between January 2001 and December 2004 was carried out. We applied acute fixation in the first 24 hours. The patients were evaluated with total active motion scores, radiographic control, complication rate and the need for revision surgery. The infection frequency was 10.5% and the need for a revision surgery was 7%. The plate fixation group had significantly higher total active motion scores than the external fixation group. The K wire group had the highest revision rate. The bone grafting group was associated with good total active motion scores and low complication rates. The majority of the low velocity gunshot injuries are surgically clean wounds which allow not only early fracture fixation, but also early bone grafting and soft tissue reconstruction. Plate and screw fixation is associated with significantly better functional outcomes than the minimal fixation group. (+info)
Rheumatoid arthritis bone erosion volumes on CT and MRI: reliability and correlations with erosion scores on CT, MRI and radiography.
OBJECTIVES: To investigate intramodality and intermodality agreements of CT and MRI erosion volumes in metacarpophalangeal (MCP) joints in rheumatoid arthritis (RA), and to compare the volumes with erosion scores for CT, MRI and radiography. METHODS: In total, 17 patients with RA and four healthy controls underwent unilateral CT, MRI and radiography of second to fifth MCP joints in one hand. Erosion volumes (using OSIRIS software) and scores were determined from CT, MRI and radiography (scores only). RESULTS: CT, MRI and radiography detected 77, 62 and 12 erosions, respectively. On CT, the mean erosion volume was 26 mm(3) (median 10; range 0 to 248) and 30 mm(3) (18; 1 to 163) on MRI. Total erosion volumes (per patient/control) were 97 mm(3) (29; 0 to 485) on CT and 90 mm(3) (46; 0 to 389) on MRI. For volumes, Spearman correlation coefficients were 0.96 to 0.99 (CT vs CT), 0.95 to 0.98 (MRI vs MRI) and 0.64 to 0.89 (CT vs MRI), all p<0.01. MRI erosion volumes correlated with the Outcome Measures in Rheumatology Clinical Trials/Rheumatoid Arthritis Magnetic Resonance Imaging Score (OMERACT RAMRIS) erosion scores (0.91 to 0.99; p<0.01) and the Sharp/van der Heijde erosion score (0.49 to 0.63; p<0.01). CONCLUSION: Very high intramodality and high intermodality agreements of CT and MRI erosion volumes were found, encouraging further testing in longitudinal studies. A close correlation with CT and MRI erosion volumes supports the OMERACT RAMRIS erosion score as a valid measure of joint destruction in RA. (+info)