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We reported a case of trichilemmal cyst in the pulp of the index finger. Histopathological features and unusual MR images are discussed.

Finger tourniquets are widely used in hand surgery. However, they do not provide an estimate of the amount of pressure exerted and can potentially be left in situ with grave consequences. We assessed the pneumatic finger tourniquet in 57 adult patients in operations under local anaesthesia distal to the proximal interphalangeal joint. The average tourniquet time was 12 minutes. The tourniquet maintained its pressure for the length of the operation in 96.5% of cases. This airtight flat tubing is made of synthetic polymer, designed and manufactured by Barloworld Scientific Ltd (Staffordshire, UK). The tourniquet was easy to use and easily located after the operation. No complications were reported. This study supports the use of a pneumatic tourniquet in finger injuries requiring use of a finger tourniquet.

Severe pain in the finger caused by an abnormal Pacinian corpuscle is a rare condition. We have recently encountered three patients diagnosed with a heterotopic Pacinian corpuscle, based on histopathological findings. When making a differential diagnosis of unexplained severe pain in the finger, abnormal Pacinian corpuscles must be taken into account in addition to glomus tumour and other types of painful soft-tissue tumour.

Ten consecutive patients with digital enchondroma were treated by curettage and calcium phosphate bone cement (CPC) injection under digital nerve block. Mean patient age at surgery was 39 years old (range, 26–54), and the mean follow-up period was 19 months (range, 12–31). Two patients had a pathologic fracture at the first visit. Active finger motion was allowed at three days postoperatively and all patients returned to work within four weeks of surgery. The surgical procedures were uneventful in all patients, and no complications were encountered during follow-up. The mean total arc of motion of the PIP joints and MP joints of the affected fingers was 93% of and 99%, respectively, of the arcs of the corresponding joints of the contralateral unaffected fingers at final follow-up. CPC injection is a good option for the treatment of enchondroma of the finger.

Hepatocellular carcinoma (HCC) is a common cancer with a high rate of metastasis to sites, such as, lung, bone, and regional lymph nodes. However, metastasis of HCC to the hand is rare and the majority of reported cases involve hand bones. Here, the authors report a rare case of finger skin metastasis from HCC without bone involvement. This case highlights that patients presenting with a nodule or granuloma-like tumor of the hand should generate a suspicion of metastasis when there is a history of HCC.

We report a case of paradoxical extension phenomenon of the little finger, so called "lumbrical plus deformity" due to repetitive trauma to the ulnar side of the palm. The adhesion between the flexor digitorum profundus tendon and the lumbrical muscle was the cause of this phenomenon. The lumbrical muscle release was sufficient to solve this rare problem.

Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare low-grade sarcoma that occurs in the subcutaneous tissue of the distal extremities.

MIFS was first described in 1998. There are many differential diagnoses, and it can often be mistaken for several different inflammatory and neoplastic processes, which may require different treatment.

There is much literature published for pathologists, but only a few reports for orthopedic surgeons to treat such tumors.

It is significant and important to report this additional case of MIFS that occurred in the right ring finger and to acknowledge the very existence of the tumor as a differential diagnosis to be made by hand surgeons.

Hand surgeons need to be mindful of MIFS, its nature, and the appropriate treatment necessary for this unique tumor.

We report a case of rotatory subluxation of the metacarpophalangeal joint (MCPJ) of the finger. A 40-year-old man sustained an open injury to his index finger following an explosive injury. Radiographs showed rotatory subluxation of the index finger MCPJ. The index finger extensor digitorium was found interposed in the MCPJ, with a complete tear of the radial collateral ligament. Treatment was by open reduction and repair of the collateral ligament and the extensor tendon. A high level of clinical suspicion is needed to diagnose this entity.

Embedded ring injury is rarely encountered in clinical practice, and most of the few reported cases share common features, including deliberate neglect, mental illness, poor social support, female gender, and adult age group. Ischemia has never been reported in such injuries. Here, we report the case of a 16-year-old girl who presented with a completely embedded ring in the right index finger and a partially embedded ring in the left ring finger. Revascularization after ring embedment probably explains the intact vessel that was observed on the outer aspect of the embedded ring during surgical exploration of the right index finger.

A successful replantation of an index fingertip in an 8-month old girl is reported. A literature review of replants in very young children suggests this is one of the youngest patients ever to undergo digital replantation and possibly the youngest finger replant performed.

Finger tourniquets are used in a variety of operative procedures in both the trauma and elective setting. A wide range of methods are used in clinical practise as there is no standardised method. Many of the methods in use have significant drawbacks such as the inability to exsanguinate the digit or the more concerning problem of inadvertently leaving the tourniquet on the digit on completion of the procedure. We discuss two techniques that are quick, cheap and easy that do not have these drawbacks. There is a brief discussion of the literature assessing the various attributes of published methods. We feel that the adoption of these methods could result in easier and safer finger exsanguination and haemostasis.

Intraosseous epidermoid cyst is considered a rare benign inclusion cyst found mainly in the skull and phalanges. Once the cyst is differentiated from other similar lesions, the cyst can be treated with simple curettage, seldom requiring additional managements. We experienced this rare case that had been treated successfully without complication.

Masson's tumour is a rare benign neoplasm of vascular origin characterized histologically by papillary endothelial hyperplasia. Unlike previous scientific articles we report a case of a "rapid growing" lesion in a 73-year-old man underlining the clinical features to distinguish this uncommon lesion from other neoplasms of vascular origin.

Vascular leiomyoma is a rare soft tissue lesion in the upper limbs. We reported a case of vascular leiomyoma in a 77-year-old female. It presented with a large painless slow growing lesion in the finger, which had grown to size up to 4 × 3 cm. X-ray and MRI were performed pre-operatively. Surgical excision was performed and the histological findings confirm the diagnosis.

We report of a pathological fracture of the middle phalanx of the little finger due to periosteal chondroma. The periosteal chondroma occupied an extensive area of the middle phalanx extending to the proximal interphalangeal joint, and the fracture involved the distal interphalangeal articular surface. The fracture was internally fixed using a strut bone grafting after resection of the chondroma. One year and four months after the operation, remodeling of the phalanx had completed without recurrence and functional loss.

We present a rare case of primary tuberculous tenosynovitis in a young patient with an acute history of non-penetrating traumatic injury. The patient had recently visited Pakistan and presented with sudden onset pain at the base of their right fifth digit after trying to catch a cricket ball. A provisional diagnosis of haematoma was made; however, ultrasonography revealed a mass attached to the A2 pulley. Surgical excision followed by histological examination and culture identified Mycobacterium Tuberculosis infection. This case serves to raise clinical awareness of this rare condition and highlight the importance of obtaining a travel history.

Malunion at the shaft of the middle phalanx yields less functional problems compared with malunion at the shaft of the proximal phalanx and metacarpal bones. In the present report, the patient sustained a minimally displaced fracture at the distal portion of the distal middle phalanx of the ring finger spraining the finger during playing flag football. Fracture was treated conservatively and fracture union was completed. However, the patient complained of functional problems in activities of daily living due to the malrotational deformity of the finger. We treated the malrotational deformity close to the distal interphalangeal joint of the middle phalanx with step-cut osteotomy at the affected bone successfully.

The work presented in this paper deals with the description of an analytic modeling of the neuromusculoskeletal system responsible for the finger movement. This simulation task is complex due to the interacting processes (physiological and biomechanical) represented by muscles, joints and bones. In this study, we focused on the presentation of a complete model for the finger motion decomposed in quasi-static positions. In fact, this model can be considered as a preliminary step before dynamic modeling. The proposed model is composed of several compartments: biomechanical finger model, mechanical muscle model and muscle/neural activation model. The main objective of this study is to estimate, by inverse procedure, the muscle forces, muscle activations and neural activations that are responsible for generating a given finger movement decomposed in successive quasi-static positions. The anatomical model contains six muscles which control the decomposed movement of the three joints of the system. To estimate the model unknowns, an optimization technique is proposed for improving robustness to initial conditions and physiological reliability. After, an experimental protocol for recording surface electromyogram (sEMG) data, from three extrinsic muscles, according to specific finger positions is applied on five subjects to evaluate the model reliability.

From analysis of the obtained results, both in simulation and experiment, the presented model seems to be able to mimic, in a realistic way, the finger movement decomposed in quasi-static positions. Finally, results, model limitations and further developments are discussed.

Simultaneous volar dislocation of distal interphalangeal (DIP) joint and volar fracture-subluxation of proximal interphalangeal (PIP) joint of the same finger has not been reported yet. A 19-year-old man was referred due to pain on the deformed left little finger after a ball injury. Radiographs showed volar dislocation of the DIP joint and dorsal lip fracture of the middle phalanx with volar subluxation of PIP joint of the little finger. This case was unique in terms of the mechanism of injury which was hyperflexion type in two adjacent joints of the same finger. The patient was treated by closed reduction of DIP joint dislocation and open reduction and internal fixation of the PIP joint fracture-subluxation and application of dorsal external fixator due to instability. Finally, full flexion of the PIP joint and full extension of the DIP joint were obtained but with 10 degree extension lag at the PIP joint and DIP joint flexion ranging from 0 degree to 30 degrees. Some loss of motion in small joints of the fingers after hyperflexion injuries should be expected.

Background: Arthroscopy is a widely used minimally invasive technique. Nevertheless, no report describes the arthroscopic anatomy of the proximal interphalangeal (PIP) joint for portal creation. To facilitate arthroscopy, this study elucidated the anatomy of the lateral bands of the extensor mechanism and collateral ligaments of PIP joints.

Methods: A total of 39 fingers from the right hands of 10 cadavers (4 males, 6 females) were evaluated in this study. We defined the extension line from the proximal interphalangeal volar crease as the C-line. We also defined an imaginary line along the distal edge of the proximal phalanx, which is parallel to the C-line, as the J-line. The distance between J-line and C-line was measured. On the C-line and J-line, we measured the following: from the dorsal skin to the lateral edge of the lateral band (LB), the dorsal edge of the collateral ligament (CL) and from the lateral band and the collateral ligament (D), the width of the finger (W). The finger half-width (M) was measured on the J-line. Comparison between the digits and comparison between radial and ulnar distance were measured and statistical analysis was performed.

Results: All PIP joint spaces were distal from the C-line, except for one ring finger. The average distances between the J-line and C-line were 1.8–3.2 mm. On the C-line, only 11 cases (14.1%) showed an interval between the lateral bands and the collateral ligaments, but, on the J-line 72, cases (92.3%) had such an interval. The interval was located 1.6–2.9 mm in a dorsal direction from the midlateral on the J-line.

Conclusions: Portal creation at the J-line is safer than at the C-line. This study revealed that safe portals for arthroscopy of the PIP joint are 2 mm dorsal to the midlateral line of the finger on the J-line.