OBJECTIVE: The aim of the present study was to illustrate the (potential) diagnostic role of high resolution US images in assessing the elementary lesions of dactylitis. METHODS: Using high-frequency US machines/probes, we matched the micro-anatomical cadaveric architecture of the digit with multiple sonographic findings of dactylitis. High-sensitive color/power Doppler assessments have also been performed to evaluate the digital microvasculature. DISCUSSION: Modern US equipment/features guarantee prompt and in-depth B-mode and color/power Doppler imaging of tiny anatomical structures of the digit which are usually not properly visible with standard US machines. More specifically, hypervascularization of the digital subcutaneous tissue, fibrous pulleys of flexor tendons, dorsal synovial pads as well as pathological changes of the distal entheseal anchorage network can be accurately detected. CONCLUSION: In clinical practice, high-end US equipment can be used to accurately assess the digits in patients with dactylitis. This way, simple and convenient sonographic diagnosis of different elementary lesions can be timely established.
- MeSH
- Finger Joint diagnostic imaging MeSH
- Humans MeSH
- Cadaver MeSH
- Fingers * diagnostic imaging blood supply MeSH
- Ultrasonography, Doppler, Color methods MeSH
- Ultrasonography methods MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
OBJECTIVES: The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system. METHODS: The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis. RESULTS: 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes). CONCLUSIONS: We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.
- MeSH
- Delphi Technique MeSH
- Adult MeSH
- Enthesopathy diagnostic imaging MeSH
- Finger Joint * diagnostic imaging pathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Cadaver MeSH
- Observer Variation MeSH
- Fingers diagnostic imaging pathology MeSH
- Arthritis, Psoriatic * diagnostic imaging MeSH
- Reproducibility of Results MeSH
- Aged MeSH
- Feasibility Studies MeSH
- Severity of Illness Index * MeSH
- Synovitis diagnostic imaging pathology MeSH
- Tenosynovitis diagnostic imaging MeSH
- Ultrasonography * methods MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Validation Study MeSH
The best treatment for mallet fingers is still a matter of debate. Numerous splints with different designs to keep the distal interphalangeal (DIP) joint in extension have been described in literature. The outcomes of splint treatment are generally good with occasional reports of minor skin complications. Percutaneous Kirschner-wire pinning of the DIP joint for closed tendinous mallet finger represents a alternative treatment modality that reliably immobilises the joint and does not need much patient compliance or use of an external splint. We report a rare but devastating complication of percutaneous pinning of the DIP joint for closed tendinous mallet finger. Level of Evidence: Level V (Therapeutic).
INTRODUCTION: Fractures of the base of the middle phalanx of the hand include the entire spectrum of injuries. They can be divided into fractures of the volar part of the base of the phalanx at the place where the metacarpophalangeal volar plate is attached, fractures of the dorsal part of the base of the phalanx at the insertion point of the central extensor band, or complex fractures of the pilon. The paper presents case reports that point to possible errors in diagnosis and treatment. Furthermore, an overview of current therapeutical concepts is presented. DISCUSSION: The treatment method is based on the evaluation of the stability of the proximal interphalangeal joint. Stable injuries are treated conservatively, unstable fractures require surgical treatment. For conservative treatment, functional therapy is preferred. Possibilities of treatment of unstable injuries include open reduction and osteosynthesis, closed reduction and stabilization by dynamic external fixation, or more advanced methods of reconstruction, such as volar plate arthroplasty and hemi-hamate arthroplasty. CONCLUSION: Quality diagnostics, surgeon‘s erudition and material equipment are essential for successful treatment. Despite proper treatment, full functional recovery is usually not achieved. The aim of therapy is the patient´s functional and painless finger.
- MeSH
- Arthroplasty, Replacement, Finger methods MeSH
- Diagnostic Errors MeSH
- Medical Errors MeSH
- Internal Fixators MeSH
- Finger Joint surgery diagnostic imaging MeSH
- Middle Aged MeSH
- Humans MeSH
- Finger Injuries * diagnostic imaging MeSH
- Fracture Fixation, Internal methods MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
ÚVOD: Zlomeniny baze středního článku prstů ruky zahrnují celé spektrum poranění. Lze je rozdělit na zlomeniny volární části baze článku v místě, kde se upíná volární ploténka, zlomeniny dorzální části baze článku v místě úponu centrálního pruhu extenzoru, případně komplexní zlomeniny pilonu. V práci jsou prezentovány kazuistiky, které poukazují na možné chyby při diagnostice a léčbě. Dále je podán přehled současných přístupů k terapii. DISKUZE: Způsob léčby se odvíjí od zhodnocení stability proximálního interfalangeálního kloubu. Stabilní poranění léčíme konzervativně, nestabilní zlomeniny vyžadují operační řešení. Při konzervativní terapii je preferována funkční léčba. Mezi možnosti ošetření nestabilních poranění patří otevřená repozice a osteosyntéza, zavřená repozice a stabilizace dynamickou zevní fixací, případně pokročilejší metody rekonstrukce, kam se řadí artroplastika volární ploténkou a hemi-hamátní artroplastika. ZÁVĚR: Kvalitní diagnostika, erudice chirurga a materiální vybavení je nezbytné pro úspěšnou léčbu. I přes správný léčebný postup nebývá dosaženo plné obnovy funkce. Cílem terapie je funkční a nebolestivý prst.
- MeSH
- Arthroplasty, Replacement, Finger methods MeSH
- Diagnostic Errors MeSH
- Medical Errors MeSH
- Internal Fixators MeSH
- Finger Joint surgery diagnostic imaging MeSH
- Middle Aged MeSH
- Humans MeSH
- Finger Injuries * diagnostic imaging MeSH
- Fracture Fixation, Internal methods MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
