This document describes a case report of a rare congenital anomaly called ulnar dimelia in a 1.5 year old male patient. Ulnar dimelia is characterized by double ulnae in the forearm, polydactyly, absence of the radius and thumb. The patient presented with restricted elbow and wrist movement and an unacceptable cosmetic appearance. Management would require multiple staged surgeries but the parents neglected further treatment after the initial visit. Ulnar dimelia results from imbalanced signals during embryonic development leading to abnormalities in the forearm, hand and digits. Surgical management aims to improve function and cosmesis but often requires several procedures and long-term follow up.
The role of radiation diagnostic methods in pathological changes of the hip j...SubmissionResearchpa
Endoprosthesis replacement-operational treatment of diseases and damages of hip joint. The problem of prevention of complications and their negative effects is extremely actual today. However the role of different beam techniques in identification of adverse effects and complications of endoprosthesis replacement of joints is studied insufficiently. Results of clinic and diagnostic and beam researches of 40 patients with pathology of hip joint are analyzed. The used beam methods of research - roentgenography, multispiral computed tomography. At presurgical stage the main objective was detection of pathology of joint, definition of indications and planning of operative measure. Situation and relationship of components of endoprosthesis, condition of bone tissue, and also bone cement round cup and leg of prosthesis were key parameters of radiological assessment of outcomes of endoprosthesis replacement. Complex use of radiological techniques (roentgenography and spiral computed tomography) allows to specify and add semiotics of changes of bone tissue at the level of acetabular hollow and proximal department of femur after endoprosthesis replacement. by Janibekov J. J 2020. The role of radiation diagnostic methods in pathological changes of the hip joint before and after endoprosthetics. International Journal on Integrated Education. 3, 11 (Dec. 2020), 203-205. DOI:https://doi.org/10.31149/ijie.v3i12.918. https://journals.researchparks.org/index.php/IJIE/article/view/918/866 https://journals.researchparks.org/index.php/IJIE/article/view/918
Crimson Publishers-Management of Heterotopic Ossification of the Elbow in Pat...CrimsonPublishersOPROJ
Management of Heterotopic Ossification of the Elbow in Patients with Elbow and Brain Injury a Retrospective Study by V Psychoyios in Orthopedic Research Online Journal
Study of current pattern of Cervical Spondylotic Myelopathy and to evaluate t...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Safe surgical dislocation[ssd] for avascular necrosis hip[ avn]drashraf369
presenting a novel technic to treat avascular necrosis of hip.AVN hip is a challenge for any orthopaedic surgeon especially in precollapse stage. here dr mohamed ashraf and dr jyothis george from govt TD medical college alleppey kerala india demonstrate a novel and effective method to arrest the progression of disease to collapse.instead of performing a conventional core decompression they do multiple micro core decompression through safe surgical dislocation of GANTZ .in addition they are supplementing the procedure with intralesional infiltration of zolidronic acid to prevent structural collapse.
Quantitative analysis of patellar tendon size and structure in asymptomatic ...Medical_Lab
Risultati dello studio ecografico in relazione all'analisi quantitativa della dimensione e della struttura del tendine rotuleo in un giocatore professionista asintomatico.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The role of radiation diagnostic methods in pathological changes of the hip j...SubmissionResearchpa
Endoprosthesis replacement-operational treatment of diseases and damages of hip joint. The problem of prevention of complications and their negative effects is extremely actual today. However the role of different beam techniques in identification of adverse effects and complications of endoprosthesis replacement of joints is studied insufficiently. Results of clinic and diagnostic and beam researches of 40 patients with pathology of hip joint are analyzed. The used beam methods of research - roentgenography, multispiral computed tomography. At presurgical stage the main objective was detection of pathology of joint, definition of indications and planning of operative measure. Situation and relationship of components of endoprosthesis, condition of bone tissue, and also bone cement round cup and leg of prosthesis were key parameters of radiological assessment of outcomes of endoprosthesis replacement. Complex use of radiological techniques (roentgenography and spiral computed tomography) allows to specify and add semiotics of changes of bone tissue at the level of acetabular hollow and proximal department of femur after endoprosthesis replacement. by Janibekov J. J 2020. The role of radiation diagnostic methods in pathological changes of the hip joint before and after endoprosthetics. International Journal on Integrated Education. 3, 11 (Dec. 2020), 203-205. DOI:https://doi.org/10.31149/ijie.v3i12.918. https://journals.researchparks.org/index.php/IJIE/article/view/918/866 https://journals.researchparks.org/index.php/IJIE/article/view/918
Crimson Publishers-Management of Heterotopic Ossification of the Elbow in Pat...CrimsonPublishersOPROJ
Management of Heterotopic Ossification of the Elbow in Patients with Elbow and Brain Injury a Retrospective Study by V Psychoyios in Orthopedic Research Online Journal
Study of current pattern of Cervical Spondylotic Myelopathy and to evaluate t...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Safe surgical dislocation[ssd] for avascular necrosis hip[ avn]drashraf369
presenting a novel technic to treat avascular necrosis of hip.AVN hip is a challenge for any orthopaedic surgeon especially in precollapse stage. here dr mohamed ashraf and dr jyothis george from govt TD medical college alleppey kerala india demonstrate a novel and effective method to arrest the progression of disease to collapse.instead of performing a conventional core decompression they do multiple micro core decompression through safe surgical dislocation of GANTZ .in addition they are supplementing the procedure with intralesional infiltration of zolidronic acid to prevent structural collapse.
Quantitative analysis of patellar tendon size and structure in asymptomatic ...Medical_Lab
Risultati dello studio ecografico in relazione all'analisi quantitativa della dimensione e della struttura del tendine rotuleo in un giocatore professionista asintomatico.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Reconstruction of The Hand in Congenital Polydactylysuppubs1pubs1
A new method of surgical treatment of polydactyly of the hand, the most common pathology among congenital malformations of the upper limb, is proposed.
Abstract
Objective: To assess the outcome of arthroscopic release in patients with cronicalchronic lateral epicondylitis. Materials and methods: Arthroscopic release in three patients with lateral epicondylitis was performed. The Mayo Elbow Performance Index (or Mayo Elbow Performance score) was used pre and post surgical treatment. Sample: Two females and one male. The patients were principal labourers and not athletes. Patients had significant pain and pain was the principal symptom that affected the score of the performance index.
Results: Scores on the performance index improved after surgery. No neurological complications were reported and early return to normal daily activities was noted.
Conclusion: Arthroscopic treatment was an alternative safe and effective method for treating chronic lateral epicondiyitis in three cases. This method makes it possible to simultaneously scan the articulation to diagnostic and treatment associated diseases. It is necessary most wide assays and comparative studies for establish sure treatment protocols.
Orthopedic Clinical Manifestations of Ectodermal Dysplasia. Case Presentationkomalicarol
Ectodermal dysplasias represent a heterogeneous group of alterations, characterized by the abnormal development of embryological derivatives of the ectoderm.We present a patient who, upon
examination of the osteomyoarticular system, presents intense
rotation of the lower limbs with the toes backwards, which the
patient performed without difficulty, in an unforced, voluntary and
painless way. Orthopedic clinical manifestations are infrequent in
skeletal dysplasias, lower limb disorders even rarer, which is why
we present these striking alterations, a fundamental objective of
the study
Shoulder dislocations are the most common joint dislocations, and only 2% of these are seen as posterior shoulder dislocations. The floating elbow was first described in children, after that shown in adults. Floating elbow cases are very rare, and usually seen with high-energy trauma. Classical definition is the coexistence of the humeral diaphyseal and forearm fracture, but there are other definitions as well.
Bilateral Varus Deformity Correction and Leg Lengthening with an Ilizarov Fixator in a Female with Trichorhinophalangeal Syndrome Type 1 (TRPS I) – Case Report
Guided Growth for Angular Knee Deformities in Nutritional Rickets ChildrenTamer El-Sobky
Nutritional rickets in children is a global health concern. It manifests in generalized skeletal deformities including angular or coronal plane knee deformities. Guided growth surgery is a recognized treatment option for angular knee deformities in general. However, there is insufficient citations on its use in the treatment of angular knee deformities in children with nutritional rickets. Rachitic lower limb deformities can be complex. They are usually multiostotic, multiapex and multiplane and require extensive corrective osteotomies. However osteotomies are fraught with complications and can be technically demanding. In this presentation we present our experience with the use of surgical guided growth as a minimally invasive treatment option to correct angular knee deformities in children with nutritional rickets.
this is a complete and comprehensive presentation on the congenital hand anomalies. An important object in the field of plastic and reconstructive surgery
Benefits of Mechanical Manipulation of the Sacroiliac Joint: A Transient Syno...CrimsonPublishersOPROJ
Benefits of Mechanical Manipulation of the Sacroiliac Joint: A Transient Synovitis Case Study by Brady Hauser* in Crimson Publishers: Orthopedic Research and Reviews Journal
The International Journal of Engineering and Science (The IJES)theijes
The International Journal of Engineering & Science is aimed at providing a platform for researchers, engineers, scientists, or educators to publish their original research results, to exchange new ideas, to disseminate information in innovative designs, engineering experiences and technological skills. It is also the Journal's objective to promote engineering and technology education. All papers submitted to the Journal will be blind peer-reviewed. Only original articles will be published.
Primary hydatidosis of the tibia is a rare disease. In an endemic area, it should be considered in the differential diagnosis of a
hypolucent osteolytic lesion on x-ray. If not properly managed, anaphylactic shock may occur intraoperatively, as well as increased recurrence of the disease. This is a case report of a primary tibial hydatid cyst, treated fi rst with curettage and phenolizaton, and then after recurrence, with total knee arthroplasty. We will review the literature of the diagnosis and the treatment of a tibial hydatid cyst.
Hallux deformity influence - quality of lifeEDITORIJCRMS
Background: Hallux valgus is a very common deformity of the big toe and can befamilial or acquired. Knowledge of
risk factors of hallux valgus is important in order to prevent or minimize progression of this deformity, since a
surgical intervention is the only treatment to correct this deformity. The objective of this study was to determine the
risk factors of hallux valgus deformity and the influence in quality of life
Material and Methods: This was a cross-sectional study was conducted in Gadarif state, eastern Sudan from January
to June 2021.Structured questionnaires were used to collect data from participants. An informed consent was obtained
before data collection.
Results: A total of 59 subjects from Gadarif state with HA were enrolled in this study. The females were 32
(54.2%).The most common affected age group was > 35 years accounted 44 (74.6%).33 (55.9 %) of study subjects
had normal body weight(statistically not significant p=0. 957).41(69.5%) subjects had a family history of HV
(statistically significant p=0. 000). 20/32 (62.5%) female use high heelShoe.44 (74.6 %) subjects had a weakness
hallux plantar flexion action and abduction(statistically significant p=0. 000).
Conclusion: This study found the prevalence of HV increased with age and was higher in females.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ulnar dimelia – a rare and neglected anomaly of upper extremity
1. Creative Commons 4.0
Ulnar Dimelia – a rare and neglected anomaly of upper extremity
Yasir Salam Siddiqui a, *
, Mazhar Abbas a
, Nusra Rahman b
, Julfiqar a
a Department of Orthopaedic Surgery, Faculty of Medicine, J. N. Medical College, A.M.U., Aligarh 202002, India.
b Department of Anatomy, Faculty of Medicine, J. N. Medical College, A.M.U., Aligarh 202002, India.
* Corresponding author: Yasir Salam Siddiqui
Mailing address: Department of Orthopaedic Surgery, Faculty of
Medicine, J. N. Medical College, A.M.U., Aligarh 202002, India.
E-mail: yassu98@gmail.com
Received: 11 December 2020 / Accepted: 12 January 2021
INTRODUCTION
Ulnar dimelia also referred to as mirror hand syn-
drome is a rare congenital anomaly of the upper ex-
tremity. The condition presents with double ulnae
forearm with complete absence of radius bone. There
is also polydactyly with absence of thumb [1, 2]
. Along
with musculoskeletal deformity, malformation of the
neurovascular structures in the form of doubling of
the ulnar nerve and artery with absence of the radial
artery has also been reported in the literature [1-3]
.
Clinically it presents not only as functional deformity
but also as cosmetic deformity. The broadened elbow,
short forearm, radially deviated wrist, polydactyly and
absent thumb gives a poor unacceptable cosmetic ap-
pearance. The functional deficit with ulnar dimelia is
restricted elbow range of motion, forearm rotations,
and oppositional grasp [4]
.
Most cases of mirror hand syndrome are sporadic,
while few case studies designated associated genetic
syndromes [5, 6]
. Ulnar dimelia results from the imbal-
Case Report
ance of the inductive signals across the radio-ulnar
plane during embryonic development [3, 7]
. Failure of
the morphogenesis signals on the radial side, while
the concentration of such signals on the ulnar side
produces ulnar dimelia. Diverse variants of the disease
depend upon the severity of the disproportion of the
signals across the radio ulnar plane [2, 8]
. In literature
case studies are reported, highlighting the various
aspects of deformity including anatomical variations,
clinical presentation, and management [1-4]
. We believe
that the case presented here deserves reporting not
only because of the rarity of the disease but also due
to its difficult and prolonged management requiring
multiple staged operations and henceforth consequent
neglect on the part of parents. An attempt is also made
to do a brief literature review.
CASE REPORT
A one-and-a-half-year-old male baby was brought to us
by his parents with complaints of restriction of move-
ments of the right elbow with polydactyly, giving an
unacceptable cosmetic appearance of the forearm and
hand. They further added that the child is also having
difficulty in holding the objects. The patient was their
third child with two female siblings without any such
complaints. There was no history of consanguinity.
The baby was full term, delivered through the vaginal
Yasir Salam Siddiqui et al 26
Clin Surg Res Commun 2020; 5(1): 26-29
DOI: 10.31491/CSRC.2021.03.071
Abstract
Ulnar dimelia is a rare congenital anomaly of the upper extremity. The condition presents with double ulnae
forearm and polydactyly with complete absence of radius bone and thumb. Clinically it presents not only as
functional deformity but also as cosmetic deformity. The case presented here is of a one-and-a-half-year-old
male baby, born with right side ulnar dimelia with no other musculoskeletal defect. We believe that the case
presented here deserves reporting not only because of the rarity of the disease but also due to its difficult man-
agement requiring multiple staged operations and henceforth consequent neglect on the part of parents. An
attempt is also made to do a brief literature review.
Keywords: Ulnar dimelia; polydactyly; ulna; radius; thumb
2. route. There was no history suggestive of any mater-
nal infection or any exposure to teratogenic agents
throughout the antenatal period. There was no family
history of the congenital elbow and hand anomalies in
first degree lineages. There was no developmental de-
lay. No history of any other joint involvement or other
systemic illness. Clinical examination revealed short-
ening of the right forearm with fixed flexion deformity
of 20 degrees at the elbow, with a further 50 degrees
of free flexion possible (range of motion = 20 to 70
degrees). Forearm rotations were grossly restricted.
The wrist was deviated radially with the hand having
six well-formed fingers in a single plane (Figure 1).
Contour and the movements of the right shoulder were
comparable to the left shoulder. The child was able
to hold the objects in between fingers (crude grasp).
However fine grasp requiring opposition function was
not conceivable. The left upper extremity was abso-
lutely normal. There were no other skeletal abnormali-
ties. Furthermore, no definite syndromic features were
noted. Systemic examination was unremarkable. Ul-
trasonography of the abdomen and echocardiography
were normal. The radiographic anatomical features of
our patient as seen in Figure 2 and 3 could be summa-
rized as follows:
(1) A normal humerus with an ossification center in
the post-axial part of the distal epiphysis;
(2) Thumb and radius was absent;
(3) Two ulnae facing each other: post-axial ulna had
a proper morphology and pre-axial ulna was shorter
with less defined proximal anatomical features;
(4) Wrist shows duplication of ossification centers cor-
responding to lunate;
(5) Normal morphology of metacarpals and phalanges
of three post-axial fingers;
(6) Hypoplasia of all pre-axial metacarpals;
(7) Shortening of all phalanges of the pre-axial index
finger;
(8) Normal pre-axial middle (M) and ring (R) fingers;
(9) Hypoplasia of pre-axial little (L) finger.
The wrist and hand showed two carpal bones and six
metacarpals all lying in the same plane compared to
the normal left hand (Figure 2 and 3). The two carpal
bones were centered over the medially placed ulna.
In the present circumstance, we planned for staged
surgeries, with an objective to provide a functional
range of motion at the elbow, forearm rotations, and
Yasir Salam Siddiqui et al 27
Figure 1. Clinical photograph of patient showing radial
deviation of the right wrist (arrow) with the hand having six
well-formed fingers in single plane. Also note the absence of
thumb.
Figure 2. Radiograph of the right upper extremity including
elbow revealed double ulnae facing each other with complete
absence of radius and thumb. The laterally placed ulna is
hypoplastic with a broad distal end (thin arrow). The wrist and
hand showed two carpal bones and six metacarpals all lying in
the same plane. The two carpal bones were centered over the
medially placed ulna (thick arrow).
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3. as the genetic mechanisms of ulnar-dimelia [19, 20]
.
A classical ulnar dimelia has symmetrical distribution
around the midline axis. However, the non-classical
one lacks symmetrical distribution in morphogenesis
of the forearm bones and the fingers [8]
. In the non-
classical one, the forearm may contain an ulna and a
radius, or even three bones in different combinations
[9-11]
. Even though seven [9, 10]
or eight [2, 10-14]
digits are
typical, patients with six [15, 16]
or even five digits [17]
have been described in the literature. Taking into ac-
count the bony morphology of the forearm, Al-Qattan
et al published a descriptive classification for the ul-
nar dimelia [2]
. The goal of the management of such a
condition is to achieve a functional and cosmetically
acceptable upper extremity by executing single-stage
or more often multiple-stage operations. The literature
designates, depending upon the severity of the func-
tional and cosmetic deformity, the management of this
condition varies from physiotherapy alone to multiple-
stage operations [1, 2, 7, 8, 11, 18]
. The best age for the recon-
struction of hand is before the second year [11]
. Surgery
is preceded by passive range of motion exercises and
choosing the appropriate radial digit for pollicising.
Hand deformities can be corrected to give a satisfac-
tory outcome when they are not so severe. Either in-
dex or middle finger can be pollicised depending upon
the type of ulnar dimelia. When deformity correction
is not feasible the goal is to achieve the hold function
of the hand. Good functional and cosmetic results have
been reported in a few studies [3]
. The thenar recon-
struction by interosseous muscle transfers and further
improvements can be achieved by tendon transfer at a
later date has also been described in the literature [21]
.
The function of the wrist, forearm, and elbow may im-
prove with arthroplasty of the affected joints [22]
.
In the present case study, we discussed with the par-
ents about the future prospects and limitations of
activities due to deformity and planned for staged
surgeries with an objective to provide functional and
cosmetically acceptable upper extremity. However,
the parents never turned up again with the patient for
taking treatment, highlighting the neglect of the defor-
mity. The neglect was probably due to the low socio-
economic status and ignorance of parents. We believe
that in the patient described above, excision of the
proximal end of the laterally placed ulna with soft tis-
sue reconstruction along the medially placed ulna and
pollicization would have given a reasonable functional
and cosmetic enhancement of the upper extremity.
Yasir Salam Siddiqui et al 28
reconstruction of the thumb for oppositional grasp.
Meanwhile, the patient was put on stretching exercises
of elbow, wrist and fingers, especially to correct the ra-
dial deviation of the wrist along with night splinting of
the wrist in a neutral position. Parents were communi-
cated about the need for regular follow-up for proper
treatment and rehabilitation of the child, least as the
child would grow there will be limitations of activities
which require coordinated movement of the elbow,
forearm, and hand-like writing, buttoning, unbutton-
ing, tying shoelaces and others. However, the parents
never turned up again after their first visit, highlight-
ing the neglect of the deformity.
DISCUSSION
Our patient had double ulnae in the right forearm
with six digits with six corresponding metacarpals in
a single plane with two carpal bones supported by a
medially placed ulna. Laterally placed hypoplastic ulna
was not supporting any of the carpal bones. This might
be due to a delay in the development of the ossifica-
tion centers on the lateral side. Both thumb and radius
were absent. Although the laterally placed ulna was
hypoplastic in comparison to the medial one, both ul-
nae were well molded. Our case was classified as type
I ulnar dimelia, according to Al‑Qattan et al classifica-
tion [2]
.
Ulnar dimelia is probably due to the failure of differen-
tiation of a part of the ray rather than its pure duplica-
tion [18]
. During the embryogenesis, a disturbance of dif-
ferentiation of Zone of Polarizing Activity (ZPA) along
the axis of the limb may lead to post-axial duplication
and ulnar dimelia [3]
. Few authors have reported HOX
genes mutations or translocation breakpoint at 14q13
Figure 3. Radiograph of hand showing ulnar dimelia in right
hand compared with normal left hand.
Clin Surg Res Commun 2020; 5(1): 26-29
DOI: 10.31491/CSRC.2021.03.071
4. hands and feet with a distinct nasal defect, an autosomal
dominant condition. American journal of medical genet-
ics, 46(2), 129-131.
7. Gaba, S., John, N., Bhogesha, S., Singh, O., & Vemula, G.
K. (2017). Mirror Hand: An Uncommon Neglected Case
Managed with Pollicisation. World journal of plastic sur-
gery, 6(2), 263.
8. Afshar, A. (2010). Ulnar dimelia without duplicated arte-
rial anatomy. The Journal of Bone and Joint Surgery. Brit-
ish volume, 92(2), 293-296.
9. Barton, N. J., Buck-Gramcko, D., & Evans, D. M. (1986).
Soft-tissue anatomy of mirror hand. Journal of Hand Sur-
gery, 11(3), 307-319.
10. Bhaskaranand, K., Bhaskaranand, N., & Bhat, A. K. (2003).
A variant of mirror hand: a case report. The Journal of
hand surgery, 28(4), 678-680.
11. Jafari, D., & Sharifi, B. (2005). A variant of mirror hand: a
case report. The Journal of Bone and Joint Surgery. Brit-
ish volume, 87(1), 108-110.
12. King, R. J., & Hoyes, A. D. (1982). The mirror hand abnor-
mality. The Hand, 14(2), 188-193.
13. Pintilie, D., Hatmanu, D., Olaru, I., & Panoza, G. (1964).
Double ulna with symmetrical polydactyly. The Journal of
bone and joint surgery. British volume, 46(1), 89-93.
14. Yang, S. S., Jackson, L., Green, D. W., & Weiland, A. J. (1996).
A rare variant of mirror hand: a case report. The Journal
of hand surgery, 21(6), 1048-1051.
15. De Smet, L. (1999). Ulnar dimelia. Acta orthopaedica bel-
gica, 65(3), 382.
16. Gorriz, G. (1982). Ulnar dimelia—a limb without antero-
posterior differentiation. The Journal of Hand Surgery,
7(5), 466-469.
17. Chinegwundoh, J. O. M., Gupta, M., & Scott, W. A. (1997).
Ulnar Dimelia: Is it a true duplication of the ulna?. Journal
of Hand Surgery, 22(1), 77-79.
18. Muradian, A. A. (2007). Ulnar dimelia, a case report. Bas-
rah Journal of Surgery, 13(2), 73-74.
19. Apiou, F., Flagiello, D., Cillo, C., Malfoy, B., Poupon, M. F., &
Dutrillaux, B. (1996). Fine mapping of human HOX gene
clusters. Cytogenetic and Genome Research, 73(1-2),
114-115.
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T., Sasaki, T., ... & Niikawa, N. (1997). Molecular mapping
of a translocation breakpoint at 14q13 in a patient with
mirror-image polydactyly of hands and feet. Human ge-
netics, 99(4), 450-453.
21. Hussl, C. H. H. (1999). A case of mirror hand deformity
with a 17-year postoperative follow up: case report.
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CONCLUSION
Ulnar dimelia is a rare congenital anomaly presenting
as functional as well as cosmetic deformity. If untreat-
ed, renders the patient with poor function and cos-
metic appearance of the extremity. The condition not
only has the difficult management requiring multiple
staged operations is a therapeutic challenge for treat-
ing orthopaedic surgeon but also neglect on the part
of caregivers. Hence, awareness among the masses is
to be developed regarding the condition and educating
them that an acceptable outcome can be achieved with
proper treatment.
DECLARATIONS
Authors’ contributions
Siddiqui YS and Abbas M: substantial contribution to
conception and designing and supervision of the study.
Nusra Rahman and Julfiqar: provided material & tech-
nical support for the study.
Conflict of interest
All authors declared that there are no conflicts of inter-
est.
Ethics approval and consent to participate
Informed consent was obtained from the parents of
the patient to participate in the study.
Consent for publication
Written informed consent for publication was obtained.
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