Displaced fractures of the base of the proximal phalanx (PP) remain a challenging surgical problem. Regardless of the osteosynthesis material chosen (K-wires, screws, plates), when open reduction is required, the surgical approaches typically used are either dorsal or lateral. These approaches inevitably cause surgical trauma to the extensor apparatus which, via the intrinsic system, envelops the dorsal and lateral surfaces of PP at this level. To preserve the extensor apparatus, the authors propose a palmar approach combined with anterior plate fixation. This is a retrospective, single-center study conducted between September 2022 and October 2025. Patients presenting with displaced fractures of the base of PP were included. The surgical approach was a palmar Bruner-type incision. The flexor apparatus was retracted laterally after subcapsular-periosteal elevation. Osteosynthesis was performed using a palmar T-plate or grid plate, 1 or 1.3 mm thick (Medartis®). The flexor apparatus was repositioned after secure pulley fixation to the periosteum. Under the supervision of the physiotherapy team, patients were instructed to achieve full immediate mobilization with syndactyly and nighttime extension splinting. Patients were reviewed with radiographic assessment at 3 weeks, 6 weeks, and 12 weeks, along with clinical evaluation: wound healing, pain (VAS), active finger mobility (TAM), and active extension deficit of the PIP joint (digital goniometer). The study included 15 patients, 8 women and 7 men, with a mean age of 52 years (range 23-83). 19 displaced fractures of the base of PP were treated using this technique. Two patients had fractures involving the last three digits. Consolidation was achieved at 6 weeks in all cases without any displacement. At 12 weeks, pain had resolved (VAS 0), mean TAM was 256° (range 210°-280°), PIP extension was complete in 12 cases, and in 7 cases the PIP extension deficit was less than 20°. No complication were observed in any of the 19 cases, and no hardware removal was required. The excellent mobility results are likely attributable to the palmar approach. By sparing the extensor apparatus from any trauma, adhesions are avoided. Cross-sectional examination at the base of PP reveals that the extensor apparatus envelops PP over three-quarters of its circumference. Only the palmar approach and palmar fixation truly spare the extensor apparatus. The disadvantage is the elevation of the flexor apparatus and the need to secure the A2 pulley. Osteosynthesis of fractures of the base of PP using a palmar approach and palmar plate offers a new strategy for these surgically challenging fractures. Greater experience and longer follow-up are needed to confirm these preliminary results.
Anatomical variations of the palmar digital arteries are reported less frequently than variations of the superficial and deep palmar arches, particularly regarding their precise topographic relationships within the intermetacarpal spaces. The common palmar digital arteries are classically described as running volar to the deep transverse metacarpal ligament. During routine anatomical dissection of a cryopreserved upper limb from an adult donor injected with red latex, the arterial pattern of the palm was examined with particular attention to the vessels supplying the fourth intermetacarpal space. The fourth common palmar digital artery was absent. A branch arising from the ulnar proper palmar digital artery of the little finger coursed from the hypothenar region toward the fourth intermetacarpal space, passed deep to the flexor digitorum profundus tendon of the little finger, and crossed beneath the deep transverse metacarpal ligament. Distal to the ligament, the vessel divided into the ulnar proper palmar digital artery of the fourth finger and the radial proper palmar digital artery of the fifth finger. This arterial configuration represents an uncommon topographic relationship between the palmar digital arteries and the deep transverse metacarpal ligament and differs from standard anatomical descriptions. Awareness of such variations contributes to anatomical knowledge and may be clinically relevant during surgical procedures involving the fourth web space of the hand.
Scaphoid dislocations are extremely rare injuries that typically occur in association with carpal fractures or complex carpal dissociation patterns. Isolated scaphoid dislocations, particularly palmar dislocations without associated fractures, are exceptionally uncommon. Early recognition and prompt management are essential to prevent complications such as persistent carpal instability or degenerative changes. We report the case of a 47-year-old female who sustained an isolated palmar dislocation of the scaphoid following a fall onto the ulnar side of the left wrist. Initial plain radiography suggested abnormal scaphoid alignment without fracture; computed tomography confirmed an isolated palmar scaphoid dislocation. Closed reduction under locoregional anesthesia was achieved by applying palmar-to-dorsal directed pressure on the scaphoid tubercle. Percutaneous Kirschner wire (K-wire) fixation was subsequently performed to maintain reduction. Immobilization in an open scaphoid cast was maintained for six weeks. After six weeks, the K-wires were removed and the patient started physiotherapy. This case highlights the importance of recognizing this rare injury pattern and supports early reduction with temporary fixation as an effective management strategy. A brief review of the literature is provided.
To evaluate the effects of wrist dorsiflexion/palmar flexion on median nerve displacement and cross-sectional area in patients with carpal tunnel syndrome. From November 2019 to December 2021, a total of 85 patients (110 affected wrists) diagnosed with carpal tunnel syndrome (CTS) in our department were enrolled, including 15 males and 70 females, with an age range of 24 to 78 years old with a mean of (51.04±8.37 ) years old. According to the severity of the condition, the wrists were classified into a mild group (38 wrists), a moderate group (30 wrists), and a severe group (42 wrists). During the same period, 25 healthy controls were recruited, comprising 50 healthy wrists. All patients and healthy volunteers underwent high-frequency ultrasound examination to measure the vertical displacement of the median nerve relative to the transverse carpal ligament during wrist dorsiflexion/palmar flexion, as well as the changes in the cross-sectional area (CSA) of the median nerve at the pisiform level. All CTS patients also underwent electrophysiological testing to measure the sensory conduction velocity (SCV), sensory latency, and sensory nerve action potential (SNAP) amplitude of the median nerve. In the carpal tunnel syndrome (CTS) group, the distance from the proximal end of the median nerve to the transverse carpal ligament [2.59(2.24, 2.79) mm], the distance from the distal end to the transverse carpal ligament [2.11 (1.82, 2.31) mm], and the cross-sectional area[ 0.16(0.12, 0.19) cm2] during palmar flexion were all significantly lower than those during wrist dorsiflexion [2.62(2.27, 2.82) mm, 2.14(1.85, 2.34) mm, and 0.18(0.14, 0.21) cm2, respectively (P<0.01)]. Similarly, in the control group, the distance from the proximal end of the median nerve to the transverse carpal ligament [2.88(2.54, 3.38) mm], the distance from the distal end to the transverse carpal ligament[2.33(1.99, 2.75) mm], and the cross-sectional area [0.06(0.02, 0.09) cm2] during palmar flexion were all significantly lower than those during wrist dorsiflexion[2.94(2.60, 3.44) mm, 2.39(2.05, 2.84) mm, and 0.10(0.07, 0.12) cm2, respectively (P<0.01)]. Overall, there were statistically significant differences in the vertical distances from the proximal and distal ends of the median nerve to the transverse carpal ligament, as well as in the cross-sectional area, among the mild, moderate, severe, and control groups(P<0.01). The vertical distances from the proximal and distal ends of the median nerve to the transverse carpal ligament showed a significant positive correlation with sensory latency (r=0.468, 0.430, P<0.01) and a significant negative correlation with sensory conduction velocity(r=-0.449, -0.449, P<0.01). Wrist dorsiflexion and palmar flexion significantly affect the displacement and cross-sectional area of the median nerve in patients with CTS. High-frequency ultrasonography is an effective tool for detecting these changes and assessing the severity of CTS, warranting its clinical application.
Despite the high surgical success rate, postoperative compensatory hyperhidrosis (CH) remains a persistent concern in the treatment of primary palmar hyperhidrosis using endoscopic thoracic sympathectomy (ETS). This study aims to compare the early clinical outcomes of two surgical techniques-T3 ganglionectomy and R4 sympathicotomy-to determine which approach minimizes CH occurrence and enhances patient satisfaction. A retrospective analysis of medical records was conducted on patients who underwent either T3 ganglionectomy or R4 sympathicotomy for primary palmar hyperhidrosis at Gangnam Severance Hospital from January 2023 to December 2023. Demographic data and postoperative outcomes were evaluated. CH and degree of satisfaction were assessed during outpatient visits at 3 weeks and 3 months after surgery. In this study, 44 patients underwent T3 ganglionectomy and 225 patients underwent R4 sympathicotomy. There were no statistically significant differences in baseline characteristics (age, sex, body mass index, smoking history, and family history) or operative complications between the two groups. However, CH at 3 weeks and 3 months after surgery was significantly lower in T3 ganglionectomy group [4 (9.1%) vs. 143 (63.6%); P<0.001, 5 (11.4%) vs. 150 (66.7%); P<0.001]. Additionally, patient satisfaction was significantly higher in the T3 ganglionectomy group compared to the R4 sympathicotomy group (P<0.001). T3 ganglionectomy exhibited superior surgical outcomes in terms of both CH and patient satisfaction for primary palmar hyperhidrosis when compared to R4 sympathicotomy. Nonetheless, a larger prospective study with long-term follow-up is necessary to validate these findings.
To determine whether dexamethasone sodium phosphate (dexamethasone SP) prolongs the sensory blockade produced by perineural bupivacaine during medial and lateral palmar digital nerve blocks in horses. 8 healthy adult horses were enrolled in a blinded, randomized 4 X 4 crossover trial. Each horse received 1 of 4 perineural treatments over the palmar digital nerves of the left forelimb: bupivacaine, bupivacaine + dexamethasone SP, dexamethasone SP alone, or saline. A minimum 7-day washout was used between treatments. Mechanical nociceptive threshold (MNT) was measured at baseline and at prespecified intervals for up to 12 hours. Duration of sensory blockade was defined as the time during which MNT remained at the maximal measurable value (3.5 kg/cm2). Time-to-event analyses were performed using Kaplan-Meier curves and Gehan-Breslow-Wilcoxon tests (α = 0.05). Bupivacaine and bupivacaine + dexamethasone SP both increased MNT relative to saline and dexamethasone SP alone (P < .05). Dexamethasone SP alone had no detectable effect on MNT. Contrary to the study hypothesis, the addition of dexamethasone SP did not prolong bupivacaine's duration of sensory blockade. Median duration was 4.5 hours for bupivacaine alone and 2.5 hours for bupivacaine + dexamethasone SP. No adverse local or systemic effects occurred. Perineural dexamethasone SP did not enhance, and may reduce, the duration of sensory blockade produced by bupivacaine in palmar digital nerve blocks in healthy horses. These findings warrant further investigation into potential pharmacologic interactions and clinical implications for equine analgesic protocols. Contrary to strong translational clinical data, the addition of dexamethasone does not prolong the duration of nerve blocks in horses. These findings highlight a clear interspecies difference and suggest that the effect seen in human and murine models does not correlate to the effect in equids.
Digital defects requiring soft tissue reconstruction are still challenging. There is no first-choice free flap for digital reconstruction, although various free flaps were used to reconstruct the defects to provide functional and aesthetically acceptable results. The aim of this study is to evaluate the functional, aesthetic, and sensory results of medial sural artery perforator, medial plantar artery perforator, and superficial palmar branch radial artery free flap techniques in digital tissue defects. This retrospective institutional study was conducted in accordance with the STROBE guidelines. Between 2022 and 2023, 28 patients underwent free tissue transfer for their digital soft tissue defects, which were reconstructed with MSAP, MPAP, and SPBRA flaps. The age, sex, etiology of the trauma, and the defect size were noted. The flaps' sizes, recipient vessels, donor site complications, and follow-up durations were also documented. Patient and observer scar assessment scale (POSAS) was used to assess aesthetic satisfaction. To evaluate the functional results, Sollerman hand function test (SHFT) was used. To determine the sensorial improvements, static-2PD test and Cold intolerance scoring scale (CISS) were applied. The average ages of the patients were 42.3 ± 13.1, 44.4 ± 14, and 42.5 ± 13.9, respectively. The tests were administered to the patients at an average of 25.3 ± 2.3 months. According to the POSAS scores, patients reported the SPBRA flap to be more comfortable and aesthetically acceptable, and the MSAP flap was associated with drawbacks such as increased thickness and surface irregularity. SHFT scores were comparable among groups (MSAP: 70.56 ± 7.60, MPAP: 70.22 ± 6.61, SPBRA: 71.40 ± 4.67; p > 0.05). The 2PD test showed significantly better results in SPBRA (8.10 ± 1.20) compared to MPAP (11.78 ± 1.39) and MSAP (15.00 ± 2.18) (p < 0.05). CISS scores were significantly higher in SPBRA (48 ± 10.97) than in MPAP (19.56 ± 13.07) and MSAP (15.00 ± 12.58) (p < 0.05). As a result of the correlation analysis, a statistically significant and moderately negative relationship was found between the 2PD and CISS scores (r = -0.536, p = 0.003). The flaps showed relative strengths depending on the parameters evaluated. Therefore, it is not possible to identify a single flap as the definitive first-choice option.
Pyogenic granuloma (PG) is a benign vascular lesion that commonly occurs in the oral cavity during pregnancy, whereas cutaneous involvement of the hand is rare. I report a 33-year-old gravida 3 para 2 who presented at 39 weeks of gestation with a rapidly enlarging palmar mass measuring ~3 cm. The lesion became friable and interfered with hand function. Magnetic resonance imaging demonstrated a well-defined exophytic lesion confined to the superficial tissues without deep involvement. Surgical excision was performed four weeks postpartum under local anesthesia with sedation. Histopathological examination confirmed lobular capillary hemangioma with focal ulceration, granulation tissue, and reactive epithelial changes; immunohistochemistry for HHV-8 was negative. The postoperative course was uneventful, and no recurrence was observed at eight-week follow-up.
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If no palmar digital artery or subcutaneous vein is available for anastomosis in the amputated distal fingertip tissue, conventional replantation methods cannot effectively restore blood circulation. This study introduces a surgical approach and evaluates its outcomes for replantation of distal fingertip amputated tissue when the palmar digital artery is unavailable for anastomosis. In such cases, the proximal subungual arch artery is anastomosed as an alternative to the palmar digital artery to restore arterial supply, while standard anastomosis of the dorsal subcutaneous vein is performed to restore venous drainage. When the subcutaneous vein is unavailable, the proximal nail bed vein is anastomosed as an alternative to the subcutaneous vein to restore venous drainage, while standard anastomosis of the palmar digital artery is performed to restore arterial supply. The aim is to improve the replantation rate, survival rate, and survival quality of amputated distal fingertip tissue. From January 2019 to December 2025, our institution performed replantation surgery on three patients with three digits of distal fingertip amputated tissue lacking a palmar digital artery for anastomosis. In these cases, the proximal subungual arch artery was anastomosed as an alternative to the palmar digital artery to restore arterial supply, while standard anastomosis of the dorsal subcutaneous vein was performed to restore venous drainage. Additionally, replantation surgery was performed on nine patients with nine digits of distal fingertip amputated tissue lacking a subcutaneous vein for anastomosis. In these cases, the proximal nail bed vein was anastomosed as an alternative to the subcutaneous vein to restore venous drainage, while standard anastomosis of the palmar digital artery was performed to restore arterial supply. Intraoperative measurements included the diameter of the proximal subungual arch artery or proximal nail bed vein used as an alternative vessel, and the duration of finger ischemia as well as the operative time were recorded. Postoperatively, the survival of the replanted tissue was observed, and complications such as vascular crisis, wound infection, nonunion of the fracture, and tissue necrosis were assessed. At the final follow-up, the function of the affected finger was evaluated using the Fingertip Injuries Outcome Score (FIOS). In the 3 patients (3 digits) who underwent anastomosis of the proximal subungual arch artery as an alternative to the palmar digital artery, the arterial diameters were 0.2 mm, 0.3 mm, and 0.3 mm (mean: 0.27 mm). In the 9 patients (9 digits) who underwent anastomosis of the proximal nail bed vein as an alternative to the subcutaneous vein, the venous diameters ranged from 0.6 mm to 1.0 mm (mean: 0.72 mm). The mean warm ischemia time for the 12 amputated digits was 4.75 h (range: 3-11 h). The mean operative time for the 12 replantations was 1.97 h (range: 0.5-2.83 h). All 12 replanted digits survived, with no cases of vascular crisis, wound infection, fracture nonunion, or tissue necrosis. At a mean follow-up of 12.17 months (range: 3-43 months).The function scores of the affected fingers ranged from 11 to 15, with an average of 12.5. The results were rated as excellent in 6 cases and good in 6 cases. The proximal subungual arch artery and nail bed vein can be anastomosed under microscopic visualization. Anastomosis of the proximal subungual arch artery can replace the palmar digital artery to restore arterial supply to the distal amputated tissue block, while anastomosis of the proximal nail bed vein can replace the subcutaneous vein to restore venous drainage of the distal amputated tissue block. For patients with distal fingertip amputation injuries lacking a palmar digital artery or subcutaneous vein available for anastomosis, replantation can be performed by intraoperatively anastomosing the proximal subungual arch artery as an alternative to the palmar digital artery or the proximal nail bed vein as an alternative to the subcutaneous vein to restore arterial supply or venous drainage. This approach effectively improves the replantation rate, survival rate, and survival quality of the replanted tissue, and is worthy of widespread clinical application.
The periarticular ligament anatomy of the scaphotrapeziotrapezoid (STT) joint varies in the literature, complicating standardization. Preservation of this ligamentous array is critical in preventing intracarpal malalignment. This study aims to map ligament insertion sites on the bony components of the STT joint and define resection margins for the scaphoid, trapezium, and trapezoid during arthroplasty. We examined 26 cadaveric wrists. Needles marked the STT joint before arthrotomy, allowing precise observation of ligament positioning intact. Ligament insertion sites on the scaphoid, trapezium, and trapezoid were measured with micrometric calipers. We recorded STT arthritis presence and distribution on the scaphoid, trapezium, and trapezoid articular surfaces. Each surface was divided into four quadrants voloulnar (VU), voloradial (VR), dorsoulnar (DU), and dorsoradial (DR). The dorsal intercarpal ligament (DIC) was the only extrinsic dorsal ligament of the STT joint. The average insertion distance from the articular surface was 3.033 mm (standard deviation [SD] = 0.693) on the trapezium and trapezoid, compared to 1.918 mm (SD = 0.329) on the scaphoid. This difference was statistically significant ( p  < 0.001). The palmar ligament organization resembled a rigid tripod anchored by the RS (radioscaphoid), ST (scaphotrapezial), and SC (scaphacapitate) ligaments around the scaphoid tubercle. Palmar ligament insertion points averaged 0.58 mm (SD = 0.32) from the articular surface, with no significant difference between the scaphoid and the trapezoid-trapezium complex ( p  = 0.558). STT arthritis was present in 80.8% of wrists. The VU sides of the STT were most affected, particularly the volar side of the trapezoid. The DIC ligament and palmar ligamentous tripod, formed by the RS, SC, and ST ligaments, could acts as a mechanical lock preventing dorsal scaphoid translation. While distal scaphoid pole resection is standard, our findings suggest prioritizing proximal trapezium and trapezoid resections in arthroplasty to avoid instability.
Touch DNA recovery from handled objects is influenced by donor, substrate, transfer, persistence, and collection-related factors; however, the role of short-term physiological activation during contact remains poorly understood. This pilot crossover study evaluated whether competitive gaming was associated with differences in Touch DNA deposition and STR profile quality on computer input devices compared with routine computer browsing. Twenty-four adult participants completed both 30-min activity conditions in randomized order, separated by a 30-min washout period. Heart rate and palmar moisture were measured before and after each activity, and Touch DNA was collected from predefined keyboard and mouse regions, generating 96 experimental samples. Samples were processed using a standardized forensic DNA workflow comprising extraction, quantification, GlobalFiler™ STR amplification, capillary electrophoresis, and profile assessment. Baseline physiological measures were comparable between conditions. Competitive gaming elicited significantly greater physiological activation than browsing, including higher post-activity heart rate (89.6 ± 10.7 bpm vs. 75.8 ± 8.4 bpm; p < 0.001) and palmar moisture scores (48.9 ± 7.4 vs. 36.2 ± 5.6; p < 0.001). Gaming was also associated with significantly greater recovered DNA quantity (p < 0.001, Cohen's d = 1.64) and detected autosomal alleles (p < 0.001, Cohen's d = 1.37) than browsing. STR profile quality was similarly improved, with higher profile completeness (p < 0.001, Cohen's d = 2.12) and mean profile RFU (p < 0.001, Cohen's d = 2.46) following gaming. At the participant-condition level, changes in palmar moisture showed strong positive associations with mean DNA recovery across devices (r = 0.89, p < 0.001), device-averaged profile completeness (r = 0.83, p < 0.001), and device-averaged mean RFU (r = 0.90, p < 0.001), whereas change in heart rate showed a more moderate association with mean DNA recovery (r = 0.49, p < 0.001). These findings indicate that activity-associated physiological and behavioural conditions, particularly local hand-surface moisture, may contribute to variation in Touch DNA deposition and STR profile quality on high-contact computer devices. However, the independent contributions of physiological activation and intensified manual interaction could not be separated. The results support a more contextual approach to Touch DNA interpretation in which activity intensity and local hand-surface conditions are considered alongside donor variability, substrate characteristics, transfer mechanisms, and case circumstances. This study provides preliminary evidence that the physiological and behavioural conditions accompanying an activity may represent underappreciated contributors to Touch DNA variability and activity-level interpretation.
Diffusible iodine-based contrast-enhanced microCT (DiceCT) enables three-dimensional visualization of mineralized and soft tissues while preserving their spatial relationships in situ. We present a DiceCT-based digital atlas of a human hand from a consented female donor through the University of Missouri Gift of Body program, scanned at 48.8 μm resolution following Lugol's iodine staining. Bones, tendons, intrinsic muscles, neurovascular structures, the flexor retinaculum and carpal tunnel, and dorsal digital expansions were manually segmented to generate labeled multiplanar sections and three-dimensional reconstructions. The dataset resolves epidermal ridge detail on the palmar surface while capturing structures, including the carpal tunnel contents, extensor mechanism, neurovasculature, palmar fat pads, and metacarpophalangeal sesamoids. Reconstructions demonstrate relevant relationships among the median nerve, flexor tendons, and flexor retinaculum, the ulnar nerve within Guyon's canal and the radial artery within the anatomical snuffbox. Distal digital arterial anastomoses are visible near the terminal tufts, and radial artery branches supplying the dorsal and distal scaphoid poles provide context for scaphoid vascular vulnerability. Muscle volumes and physiological cross-sectional areas were calculated using all fascicles within each intrinsic muscle. Flexor pollicis brevis and adductor pollicis exhibited comparatively large relative physiological cross-sectional areas, whereas the lumbricals had the smallest values, consistent with previous architectural estimates. By documenting whole-hand anatomy and within-individual muscle architecture non-destructively, this atlas provides a high-fidelity resource for anatomical education, documentation of anatomical variation, clinical interpretation, and generation of anatomically consistent biomechanical models. These results support DiceCT as a platform bridging anatomical research, clinical translation, and pedagogical access to donor-specific human anatomy.
Gorlin syndrome (GS, MIM #109400) is a cancer predisposition syndrome characterized by macrocephaly, odontogenic keratocysts, calcification of the falx cerebri, basal cell carcinoma, and medulloblastoma. It is caused by pathogenic variants in the PTCH1 and SUFU genes. We evaluated the clinical and molecular features of 11 patients with GS using single-gene testing, multigene panel analysis, and clinical exome sequencing. All patients exhibited characteristic craniofacial features. Macrocephaly was observed in 10 patients (90.9%) and odontogenic keratocysts in nine patients (81.8%). Palmar pits and falx cerebri calcification were observed in eight patients (72.7%). Basal cell carcinoma occurred in four patients (36.3%), and medulloblastoma in two (18.2%). GS was clinically suspected based on the observed clinical and radiological findings in all patients. Seven distinct heterozygous pathogenic PTCH1 variants were identified, four of which were novel. One patient had a dual diagnosis of L-2-hydroxyglutaric aciduria. These findings underscore the marked phenotypic variability of PTCH1-related GS. Due to age-dependent clinical manifestations, patients require regular long-term surveillance and comprehensive clinical assessment. Molecular confirmation of the diagnosis is important for the provision of genetic counselling, consideration of preimplantation genetic diagnosis, and appropriate patient follow-up and treatment planning. Das Gorlin-Syndrom (GS, MIM #109400) ist ein Krebsprädispositionssyndrom, das durch Makrozephalie, odontogene Keratozysten, Verkalkung der Falx cerebri, Basalzellkarzinome und Medulloblastome gekennzeichnet ist. Es wird durch pathogene Varianten in den Genen PTCH1 und SUFU verursacht.Wir untersuchten die klinischen und molekularen Merkmale von 11 Patienten mit GS unter Verwendung von Einzelgenanalysen, Multigen-Panel-Untersuchungen und klinischer Exomsequenzierung.Alle Patienten zeigten charakteristische kraniofaziale Merkmale. Eine Makrozephalie wurde bei 10 Patienten (90,9%) und odontogene Keratozysten bei neun Patienten (81,8%) festgestellt. Palmare Grübchen und Verkalkungen der Falx cerebri wurden bei acht Patienten (72,7%) beobachtet. Basalzellkarzinome traten bei vier Patienten (36,3%) und Medulloblastome bei zwei Patienten (18,2%) auf. Bei allen Patienten wurde aufgrund der klinischen und radiologischen Befunde der Verdacht auf ein GS gestellt. Es wurden sieben unterschiedliche heterozygote pathogene Varianten im PTCH1-Gen identifiziert, von denen vier neu waren. Bei einem Patienten wurde zusätzlich eine L-2-Hydroxyglutarazidurie diagnostiziert.Diese Ergebnisse unterstreichen die ausgeprägte phänotypische Variabilität des PTCH1-assoziierten GS. Aufgrund altersabhängiger klinischer Manifestationen benötigen die Patienten eine regelmäßige Langzeitüberwachung sowie eine umfassende klinische Beurteilung.Die molekulare Bestätigung der Diagnose ist wichtig für die genetische Beratung, die Erwägung einer Präimplantationsdiagnostik sowie eine angemessene Nachsorge und Therapieplanung.
Hyperhidrosis is a common condition associated with a substantial negative impact on the quality of life. Several studies have described the clinical characteristics and disease burden of patients with hyperhidrosis in Japan. However, comparable real-world clinical data on hyperhidrosis from Hokkaido remain limited. We therefore evaluated real-world clinical practice patterns at our institution before and after the establishment of a specialized outpatient clinic for hyperhidrosis. In this retrospective study, we analyzed the data of 144 patients who presented with hyperhidrosis between November 2013 and March 2025. Patient characteristics, pathways to care, treatment modalities, and treatment continuation were evaluated using data from electronic medical records. The sex distribution, age at presentation, and subtype distribution of hyperhidrosis in our cohort were largely consistent with those reported in a prior nationwide survey. Primary axillary and/or palmar hyperhidrosis accounted for 87.5% of all cases. After launching a specialized clinic in April 2023, we observed a substantial increase in the number of patients who consulted for hyperhidrosis during visits for other dermatologic conditions; this finding may suggest the presence of previously unrecognized patients. However, changes in hospital access policies may also have influenced consultation patterns. The treatment continuation rates for axillary and palmar hyperhidrosis were both approximately 40%. Among the treatments for axillary hyperhidrosis, sofpironium bromide gel was prescribed most frequently, whereas glycopyrronium tosylate hydrate wipes showed a higher treatment continuation rate. In conclusion, the presence of a specialized outpatient clinic may improve access to care for patients with primary focal hyperhidrosis and facilitate the identification of previously unrecognized patients. However, treatment continuation remained suboptimal, highlighting the importance of improving continuity of care in hyperhidrosis management at our institution.
To observe the short-term clinical efficacy of robot-assisted closed reduction for Colles fractures of the distal radius, and to explore a visualized, precise, and programmable fracture reduction protocol. A total of 60 patients with distal radius fractures treated between January 2023 and December 2023 were selected and divided into robot-assisted reduction group and manual reduction group (30 cases each). In the robot-assisted reduction group, there were 13 males and 17 females, with a median age of 59.00 (53.50, 61.75) years. Patients in this group underwent closed reduction of distal radius fractures assisted by a robotic system. The system utilizes X-ray imaging to perform intelligent diagnosis of fracture types and generates an automated reduction plan. After physician review, the operator manipulates the joystick on the control console to guide the robotic arm, achieving visualization, precision, and standardization during fracture reduction. Following reduction, the limb was immobilized using small splints. In the manual reduction group, there were 12 males and 18 females, with a median age of 59.00 (55.00, 63.75) years. Patients underwent reduction using the Wumen Medical School technique for distal radius fractures. The procedure involved massaging the palmar and dorsal muscle groups of the wrist to mobilize displaced fracture fragments, followed by counter-traction to correct shortening displacement. Subsequently, lifting and pressing maneuvers, along with compression, were applied to correct dorsal-palmar and lateral displacement. After reduction, small splints were used for immobilization. The study compared the success rate of primary reduction between the two groups, as well as changes in radiographic parameters before reduction, immediately after reduction, and at 3 months post-reduction. Wrist function was evaluated using the Cooney wrist score. All patients were followed up for more than 3 months. The success rate of primary reduction in the robot-assisted group was 96.67%(29/30), which was significantly higher than that in the manual reduction group[76.67%(23/30), P<0.05]. For the robot-assisted group, the ulnar inclination angle before reduction, immediately after reduction, and at 3 months post-reduction were (8.56±3.01)°, 20.50(17.25, 25.00)°, and (22.13±1.87)°, respectively;the corresponding values for the manual reduction group were (8.52±2.72)°, 24.00(17.43, 26.25)°, and (21.12±2.56)°. Regarding volar tilt, the values for the robot-assisted group at the three time points were (-7.13±5.80)°, 12.30(10.30, 15.43)°, and 12.50(11.63, 14.00)°, respectively;while those for the manual reduction group were(-6.32±2.72)°, 11.25(10.00, 12.60)°, and 12.00(10.88, 13.00)° for radial height, the measurements for the robot-assisted group were 3.70(1.15, 6.08) mm, (8.71±0.85) mm, and (8.83±0.91) mm, respectively;compared to 3.30(1.75, 6.23) mm, (7.90±1.39) mm, and (7.93±1.27) mm in the manual reduction group. Both groups showed statistically significant improvements in ulnar inclination angle, volar tilt, and radial height immediately after reduction and at 3 months post-reduction compared to pre-reduction values (P<0.05). At 3 months post-reduction, the radial height in the robot-assisted group was superior to that in the manual reduction group, with a statistically significant difference (P<0.05). However, no statistically significant differences were observed between the two groups regarding the excellent/good rate of wrist function or complications at 3 months post-reduction (P>0.05). The distal radius fracture reduction robot enables precise, effective, and safe reduction, significantly improving the success rate of primary reduction for distal radius fractures. It provides a visualized, precise, and proceduralized protocol for the treatment of distal radius fractures.
We report the outcomes of 25 open dorsal proximal interphalangeal joint dislocations treated without palmar plate reinsertion. Stiffness was frequent, but no residual dorsal instability was observed. These findings suggest that routine palmar plate reinsertion may not be necessary.
To investigate the biomechanical influence of distal screw number in palmar plate fixation of unstable intra-articular distal radius fractures with radiodorsal metaphyseal comminution. Nine matched pairs of cryopreserved human radii were prepared using a standardized AO/OTA 2R3 C2.1 fracture model with a defined radiodorsal metaphyseal defect zone. For each pair, specimens were randomized to palmar fixation using a 2.4-mm variable-angle locking plate with either four or six distal screws. After embedding, constructs were subjected to cyclic axial loading (150 N, 5,000 cycles) simulating early postoperative rehabilitation. Global axial deformation and fragment-specific three-dimensional interfragmentary motion were recorded using an optical motion-tracking system. Statistical analysis was performed using non-parametric tests (p < 0.05). Two specimens from one donor pair were excluded, leaving 16 radii (8 pairs) for analysis. Bone mineral density and initial construct stiffness did not differ between groups. The six-screw configuration showed significantly lower axial deformation after cyclic loading (p = 0.047) and lower radial fragment-shaft translation at both time points (p = 0.028; p = 0.045). Radial fragment-shaft rotation was lower in the six-screw group at baseline (p = 0.018), but no rotational difference remained after cyclic loading. In the overall cohort, axial deformation decreased after cyclic loading (p = 0.015). In this unstable intra-articular fracture model with radiodorsal metaphyseal comminution, six distal screws reduced post-cyclic axial deformation and radial fragment-shaft micromotion compared with four screws. The clinical relevance of these findings remains to be determined.
Paediatric fracture-dislocation of the second (2nd) or third (3rd) proximal interphalangeal (PIP) joint is a rare injury and often associated with growth plate injury. There are few case reports regarding this uncommon injury, and no study has reported on Salter-Harris (SH) -type III injuries. We present the case of a 6-year-old softball player who suffered from irreducible SH-type III fracture-dislocations of the 2nd and 3rd PIP joints at different time points, which were treated by open reduction without internal fixation. The injury mechanism for the fracture-dislocations of the 2nd and 3rd PIP joints was the same when he caught a ball with his right hand in a left-hand softball globe. The palmar epiphysis of the middle phalanx was displaced dorsally in an upside-down position and was interposed within the PIP joint during both surgeries. After reducing the bony fragment gently using an elevator, the fragment remained congruent and stable in the extension of the PIP joint without instability of the collateral ligaments under fluoroscopy. Therefore, internal fixation of the fragment was not performed at both surgeries. At the latest follow-up examinations (7 years after surgery for the 2nd PIP joint and 5 years after surgery for the 3rd PIP joint), the patient showed no pain or restrictions in finger range of motion. However, the plain radiography showed early closure of the growth plate of the 2nd middle phalanx. We herein firstly presented the case of a patient with Salter-Harris type III irreducible fracture-dislocation of the 2nd and 3rd PIP joints that required open reduction without internal fixation. The injury mechanism and the location of the displaced palmar epiphysis of the middle phalanx were specific. At the midterm follow-up examinations, the patient showed no pain or restriction of the finger range of motion, although early closure of the growth plate in the 2nd middle phalanx was found on plain radiography.