UNASSIGNED: Metastatic lesions to the hand or wrist are rare and can mimic inflammatory and benign processes such as gout and infections. This often leads to misdiagnosis, underreporting, and delays in treatment. The purpose of this study was to examine all known cases of metastasis to the hand or wrist available in the literature and to analyze demographic trends, metastasis characteristics, and clinical course, and provide recommendations for management.
UNASSIGNED: An online systematic review of MEDLINE, Embase, PubMed, and the Cochrane Library from inception to January 7, 2022, was completed. Studies outlining the care of a patient with acrometastases of the hand were included. Data extracted included age, sex, site of primary tumor and metastasis, presence of other metastases, time from primary diagnosis to acrometastasis diagnosis, misdiagnosis, treatment, and survival.
UNASSIGNED: Between 1889 and present, 871 lesions were described in 676 patients who met the inclusion criteria. There was no predilection for hand dominance or site of previous trauma. The mean age among patients was 59.5 (1.5-91) years, and male sex was more common (64.6%). The most common primary cancer source was the lung (39.2%), followed by the kidney (10.8%). The distal phalanx was the most frequently cited tumor location (33.7%). Mean survival after diagnosis of acrometastasis was 6.3 months (0.25-50) ± 11.5 months.
UNASSIGNED: Acrometastasis remains an uncommon presentation of metastatic disease with poor prognosis. Treatment currently focuses on pain management and optimizing functional outcomes. Our review led to the development of 7 treatment recommendations when managing these patients.

UNASSIGNED: Although the digit-in-noise (DIN) test is simple and quick, little is known about its key factors. This study explored the considerable components of the DIN test through a systematic review and meta-analysis.
UNASSIGNED: After six electronic journal databases were screened, 14 studies were selected. For the meta-analysis, standardized mean difference was used to calculate effect sizes and 95% confidence intervals.
UNASSIGNED: The overall result of the meta-analysis showed an effect size of 2.224. In a subgroup analysis, the patient\'s hearing status was found to have the highest effect size, meaning that the DIN test was significantly sensitive to screen for hearing loss. In terms of the length of the presenting digits, triple digits had lower speech recognition thresholds (SRTs) than single or pairs of digits. Among the types of background noise, speech-spectrum noise provided lower SRTs than multi-talker babbling. Regarding language variance, the DIN test showed better performance in the patient\'s native language(s) than in other languages.
UNASSIGNED: When uniformly developed and well validated, the DIN test can be a universal tool for hearing screening.

Infantile digital fibromatosis (IDF), also called inclusion body fibromatosis is an uncommon benign tumour occurring in the digits of young children. In about a third of cases, it is congenital and the diagnosis is based on the presence of peculiar intracytoplasmic inclusions on histology. Recurrence rate post-surgery is high. However, spontaneous regression has been reported. We present a case of a 5-month-old infant who had excision of a right second toe mass, which has been present from birth. Histological examination revealed this to be infantile digital fibromatosis. To the best of our knowledge, no report of this has been made in Nigeria. It is important that this diagnosis be entertained in young children with masses on the digits as this will influence the management instituted.

Inclusion body fibromatosis (IBF) also called the \"Reye tumor\" is a rare spindle cell proliferation with distinct clinicopathological features. This is a report of four cases of IBF from a single institute. Typical location, age, size of the lesion, bland histology, and paranuclear inclusions are the distinguishing features of this entity. Medical literature search reveals very few series of cases of IBF, the remaining cases being in the form of case reports. The aim of this report is to highlight the typical features of this rare entity.

UNASSIGNED: Pachydermodactyly is an uncommon or under diagnosed variant of digital fibromatosis. It is a benign disease, described by symmetric proximal interphalangeal (PIP) involvement, progressive swelling, absence of inflammation or pain, and without limitation of function. It has been linked in some cases with psychiatric disorders such as obsessive-compulsive disorder or repetitive mechanical stimulation.
UNASSIGNED: We aim to report a case of pachydermodactyly that was diagnosed in a young 17-year-old male patient with painless swelling of the digits mainly at PIP joints with hyperkeratosis that was treated conservatively.
UNASSIGNED: Pachydermodactyly is an under diagnosed and underestimated entity; the recognition of a case in clinical practice can prove to be challenging. A high index of suspicion must be kept at all times when no reason for the swelling is found.

Squamous cell carcinoma (SCC) is one of the most common primary malignancies affecting the upper limb. A range of treatment options exist for its management; amputation being indicated under certain instances. This is the first comprehensive case series and review of the literature reporting outcomes following amputation of the affected region for treatment of upper extremity SCC. We present a series of six patients with squamous cell carcinoma of the upper limb that required amputation alongside that of data from literature review. Patient demographics, risk factors, tumour characteristics and rates of recurrence, metastasis and mortality were recorded. A total of 45 patients with 49 histologically confirmed squamous cell carcinomas were identified from case series and literature review. Patients presenting with upper limb SCC were predominantly male and in their sixth decade of life. Mean follow up time was 30.5 months and the overall recurrence and metastatic rates were 8.2% and 14.3%, respectively. Mortality was 14.3% however only 6.1% was related to SCC metastasis. Rates of recurrence and metastasis are higher for SCCs affecting the hand as compared to other body sites. Furthermore, different regions of the hand appear to behave differently. SCC affecting the nail unit has a high recurrence and a low metastatic rate, whereas, SCC involving the palm and webspaces are aggressive and this is true despite amputation of the affected site.

Background: Treatment of proximal interphalangeal joint (PIPJ) fracture-dislocations is difficult given the potential long-term complications of the involved finger and entire hand. Several surgical methods have been utilized for management of these injuries, none of which have shown consistently favorable results. The purpose of this systematic review of the literature is to report the post-operative outcomes of multiple treatment modalities for PIPJ fracture-dislocations in various studies. Methods: A literature review of PubMed and EMBASE databases was performed for all articles on PIPJ fracture-dislocations. Outcomes of interest included PIPJ range of motion, grip strength (% of contralateral hand), and quick disabilities of arm, shoulder, hand (QuickDASH). Articles were distributed into 5 groups by surgical method: open reduction, percutaneous fixation, dynamic external fixation, extension-block pinning, and hemi-hamate arthroplasty. Results: Forty-eight of 1679 total screened articles were included. The weighted means of post-operative range of motion (ROM; degrees) at final follow-up were open reduction 84.7 (n = 146), percutaneous fixation 86.5 (n = 32), dynamic external fixation 81.7 (n = 389), extension-block pinning 83.6 (n = 85), and hemi-hamate arthroplasty 79.3 (n = 52). Dorsal fracture-dislocations, regardless of surgical method, had an average ROM of 83.2 (n = 321), grip strength 91% (n = 132), and QuickDASH of 6.6 (n = 59) while pilon injuries had an average ROM of 80.2 (n = 48), grip strength 100% (n = 13), and QuickDASH of 11.4 (n = 13). Conclusion: Percutaneous fixation yielded the highest post-operative ROM at final follow-up while extension-block pinning resulted in the greatest grip strength. While dorsal fracture-dislocations produced higher average ROM and lower QuickDASH score, pilon fractures produced a higher grip strength. No treatment method or fracture type yielded consistently better outcomes than another.

Background: The purpose of this study was to evaluate the demographics and early radiographic treatment outcome of patients with carpometacarpal (CMC) injuries at our institution over a 10-year period. Methods: We conducted a retrospective review of all patients who sustained CMC injuries of the second to fifth digits between 2005 and 2015. We recorded demographic data, mechanisms of and associated injuries, treatment methods, and complications. Injury and intraoperative and postoperative radiographs were evaluated, and the adequacy of reduction was determined on lateral radiographs of the hand using a grading system that we developed. Results: Eighty patients were included in this study. Delivering a blow with a closed fist was the most common mechanism of injury; however, high-energy mechanisms also made up a large percentage of those included. Injuries to the fourth and fifth CMC joints were most common, and these were frequently associated with fractures of the metacarpal bases and distal carpal row. Closed reduction and percutaneous pinning offered a higher percentage of patients with concentric reduction at the time of pin removal. Time to surgery was significantly different between those with concentric reduction and those with residual subluxation. Conclusion: The most common mechanism of CMC injuries was blow with a closed fist; however, these injuries can be associated with high-energy mechanisms. Fractures of the metacarpal base and distal carpal row are commonly seen with these injuries. With early diagnosis, closed reduction and percutaneous pinning achieved concentric radiographic reduction. Delayed diagnosis makes closed reduction difficult and was associated with less favorable radiographic outcome.

Background: Digit replantation affords the opportunity to restore hand function following amputation. To date, however, few studies have evaluated functional outcomes following replantation. Therefore, it was the objective of this study to perform a meta-analysis to better characterize the predictors of hand function. Methods: A literature search was performed using the PubMed database to identify studies that focused on digit amputation/replantation and functional outcomes. Studies were evaluated for patient- and injury-related factors and their respective effects on clinical outcomes of sensation, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Statistical analysis was conducted across the pooled data set to identify significant trends. Results: Twenty-eight studies representing 618 replanted digits were included in this study. We found the average grip strength was 78.7% (relative to contralateral), the average 2-point discrimination (2PD) was 7.8 mm, and the average DASH score was 12.81. After conducting statistical analysis, we found patients with more proximal injuries had lower grip strength scores (P < .05). We found 2PD scores were influenced by age, mechanism of injury, and amputation level (P < .05). Finally, we found DASH scores after replantation were predicted by mechanism of injury and level of amputation (P < .05). The following variables did not influence outcomes: gender, tobacco use, ischemia time, and digit number. Conclusions: Digit replant does not restore premorbid hand function but does result in adequate hand function. Expected functional outcomes following replant should be considered in the decision-making process. These data can help risk-stratify patients, guide postreplant expectations, and influence the decision for replantation.

BACKGROUND: We reviewed the literature to evaluate the demographic, clinical and histological profile of giant cell tumour of tendon sheath of the digits (GCTTSD). The overall recurrence rate and the factors affecting tumour recurrence were also assessed.
METHODS: We searched for published articles regarding the GCTTSD in the English literature the last 30 years using the PubMed search engine. All retrieved papers were analysed and their reference lists were also screened if relevant. Clinical studies with less than five patients and follow-up less than 2 years were excluded from further evaluation. For each report, information was gathered related to trial characteristics and study population. Location and multicentricity of lesions, kind and severity of symptoms, type of applied treatment modality and histopathological features of the excised tumours were additionally recorded. A meta-analysis for estimating the pooled recurrence rate after surgical excision was also conducted. Statistical significance was assumed for p ≤0.05.
RESULTS: We found 21 studies with histological confirmation of GCTTS. However, only 10 studies including 605 patients were reviewed according to selection criteria (average follow-up 36.7 to 79 months). The male-to-female ratio was 1:1.47 (p < 0.005) and the mean age ranged from 32 to 51 years. Pain or sensory disturbances reported only in 15.7% and 4.57% of cases, respectively. A definite history of trauma recorded in 5% of lesions. The most frequent tumour location was the index finger (29.7%). In total, 14.8% of patients had tumour recurrence. Type I tumours (single lesions) were more frequently detected (78.7%) than type II tumours (two or more distinct tumours that were not joined together) (21.3%) but the latter were associated with a higher recurrence rate (p < 0.001). Study design also affected the possibility of recurrence as it was lower in prospective studies compared to retrospective studies (p = 0.003). Even though bone erosion was detected in 28.39%, recurrence was not more common in this group. In addition, recurrence was not significantly associated with a specific finger or phalanx.
CONCLUSIONS: Intrinsic biology of the tumour seems to play a more fundamental role in recurrence than tumour location or local invasiveness. More prospective well-designed studies including a large number of cases are necessary to identify tumours prone to recurrence and determine the proper treatment protocol for each individual patient.