Chondrosarcoma of the toe:A case report and literature review

BACKGROUND Chondrosarcoma of the foot is a rare malignant bone tumour,and it is even rarer when it originates in a toe bone.Surgical excision is the only effective treatment.The osteolytic destruction of the tumour severely affects limb function and carries the risk of distant metastasis.Most such tumours are removed surgically to minimize local recurrence and distant metastases,maximize limb function,and prolong the patient’s tumour-free survival time.The main objective of this article is to present the case of a chondrosarcoma that invaded the first phalanx of the left foot and formed a large phalangeal mass with osteolytic destruction of the distal bone.CASE SUMMARY A 74-year-old man suffered from swelling of his left toe for six months,with pain and swelling for two months.Computed tomography and magnetic resonance imaging showed that the tumour on the first phalanx of the left foot was approximately 54.9 mm×44.6 mm,surrounded by a significant soft tissue signal mass,with osteolytic destruction of the distal phalanx and a speckled bone-like highdensity shadow within it.CONCLUSION Chondrosarcoma occurring in a toe bone is extremely rare.In this case,extensive surgical resection of the large low-grade chondrosarcoma,which showed osteolytic destruction and invaded the distal metatarsal bone,was safe and effective.

Adult Sex Discrimination Using Metric Measurements of Hand Digital Radiographs in Egyptian Population

Objective: The aim of the present study is to discriminate functions for sex determination in a subjected sample of the Egyptian population using the morphology of metacarpals and phalanges for gender comparison. Furthermore, the measurements discussed in this study will aid in predicting the differentiation independently and guaranteeing sex determination in the subjected population individually. Methods: Forty measurements were taken from the right metacarpals and phalangeal bones of 100 subjects, whose ages ranged from 19 to 60. Moreover, the measurements of nine metacarpals and four phalangeal bones were used for sex discrimination in each sample population. Results: Males had significantly greater mean values (P < 0.05) for the lengths of the metacarpals and the proximal phalangeal bones of all right-hand fingers than females. The cut-off value and the accuracy percentage for precise sex classification of males and females using individual and grouped bones showed that a value higher than the marking point classified an individual as male and that a lower value suggested female. Besides, the multiple stepwise discriminant functional analysis of the most predictable internal variables of the metacarpals revealed a cross-validated sex classification accuracy of 100%. In contrast, the most predictable internal variables of the phalanges showed a cross-validated sex classification accuracy of 93%. Conclusion: The results revealed a new forensic suggestion for the determination of sex based on the measurements of the metacarpals and the phalanges. Moreover, various discriminant equations were applied for the declaration of this conceivable recommendation.

Unusual presentation of metastatic adenocarcinoma of the lung

On September 2013, a 62-year-old man with metastatic adenocarcinoma of the lung complained tenderness and pain of the first terminal phalange of his right hand. The biopsy confirmed metastatic adenocarcinoma of the lung to the finger. A single 8-Gy fraction of palliative radiotherapy was delivered to the patient's right hand. The patient received magnetic resonance-guided focused ultrasound surgery treatment to the phalange because he showed few improvement of clinical symptoms and persistence of moderate pain after radiotherapy. After magnetic resonance-guided focused ultrasound surgery, the clinical symptoms improved significantly. No serious adverse effects were reported and the patient compliance was very high. Our patient showed improvement of clinical symptoms after combined treatment. The patient remains in good health conditions.

Low serum vitamin D among community-dwelling healthy women in Sri Lanka

Background: Although hypovitaminosis D is prevalent among healthy adults in Asia and other regions, available data among Sri Lankans are not consistent with this finding. We studied vitamin D level among healthy community-dwelling women and examined its effects on parathyroid hormone (PTH) level and bone mineral status. Methods: Females of 20-40 years (n = 434) who were employed in southern Sri Lanka were recruited to the study. Bone mineral density and content (pBMD and pBMC) of the middle phalanx of the middle finger of the non-dominant hand were measured in all subjects and 5.0 ml of venous blood was collected from each subject after an overnight fast for biochemical assessment of serum vitamin D, parathyroid hormone and total alkaline phosphatase. Results: Mean (SD) pBMD of the women studied was 0.493 (0.060) g/cm2 and pBMC was 1.49 (0.28) g. Severe vitamin D deficiency (jects, whereas 19.1% subjects had moderate (12.5-25.0 nmol/L) and 15.7% had mild (25.1 -35.0 nmol/L) vitamin D deficiency. Serum vitamin D showed significant positive correlations with pBMD (r = 0.13, p = 0.008) and pBMC (r = 0.12, p = 0.01). In regression analysis, vitamin D showed a positive association with pBMD (regression coefficient 0.0003, SEM 0.0001, p = 0.007). Conclusions: Vitamin D insufficiency/deficiency is prevalent among healthy young and middle-aged women in this study group selected from southern Sri Lanka. The accompanying rise of PTH indicates the biological significance of low vitamin D level. The negative effects observed on bone mineral status suggest the clinical importance of this finding.

Computational Comparison of One Piece Metacarpo-Phalangeal/Phalangeal-Phalangeal Total Joint Replacements

Trauma, osteoarthritis and rheumatoid arthritis can destroy the articulating cartilage in small and large joints, especially in the metacarpo [tarso] phalangeal (MCP/MTP) and phalangeal-phalangeal (PIP) joints. Single piece finger prosthetic designs can reduce pain and correct aesthetic issues, with problems on contemporary designs including decreased stability, lack of fixation and loss of functionality. The examined implants are representative models of currently available total joint replacement (TJR) designs for MCP replacement, such as the Swanson one piece implant. These implants have been shown clinically to have a high failure rate (up to 90%), but the cause of failure is unknown. Compressive studies using a 50 N force and medial-lateral loads of 50 N perpendicular to the longitudinal axis of the arms of the implant were individually applied. Due to material failings, lower values had to be used in some cases. Maximum stress values were found for flexion loading;the Swanson approximation had a peak stress of 8.71 GPa at the interface of the joint arm and the flexion center, Neuflex had 0.188 GPa peak stress at the fixation center of the arm, and in the center of the joint, and the Avanta design had a 5.20 GPa peak stress at the flexion center. The location and concentration of stresses on the models correspond to literature searches for clinical data, showing that the main failure mechanism for these implants is due to primary flexion-extension natural movement of the joint.

Treatment of type III middle phalangeal neck fractures through a palmar approach： a case report

Phalangeal neck fractures occur almost exclusively in children. We present the case of a 49 years old man with a dislocated fracture of the neck of the middle phalanx with the distal fragment rotated at 180~, due to a traumatic circular saw injury to the left index, which was solved by anatomical reduction and bone fixation with two 1.5 mm Synthes screws and a temporary transarticular K- wire at the distal interphalangeal joint. Zone I flexor digitorum profundus repair was performed using a modification of the Kessler 4-strands core suture and a full-thickness skin graft from the hypothenar eminence was taken to cover the skin gap. At 6-month follow-up the patient was pain-free and with a total active movement equivalent to 190~. No radio-logical signs of avascular necrosis of the head of the middle phalanx or nonunion of the distal fragment was detectable with recovery to the previous manual work. Owing to the position of the phalangeal head maintained in position by the collateral ligaments an anatomic reduction from dorsal approach is difficult to be performed and a longitudinal trac- tion can render the reduction harder too. The volar approach permits an easier reduction of the fracture through a derotation of the distal fragment facing palmar.