Kaplan’s Lesion of the Little Finger Treated with Open Reduction by a Volar Approach: A Case Report

Kaplan’s lesions are defined as open wounds with the metacarpal head exposed in the palms, accompanied by complex dorsal dislocation of the metacarpophalangeal joint (MCPJ). Kaplan’s lesions are clinically rare because the volar side of the MCPJ is anatomically supported and reinforced by a stronger adjacent structure. Moreover, lesions in the little finger are very rarely reported because most Kaplan’s lesions occur in the index finger. The reduction of lesions and restoration of joint stability is difficult when Kaplan’s lesions occur. Various methods have been currently introduced in the treatment of Kaplan’s lesions; however, no standardized treatment has been established because of the rarity of this disease. This paper reports a case of Kaplan’s lesion of the left little finger without fracture after a fall; the case was successfully treated with open reduction using a volar approach.

Artificial Intelligence for Ultrasound Informative Image Selection of Metacarpal Head Cartilage. A Pilot Study

Objectives: This study aims to develop an automatic deep-learning algorithm, which is based on Convolutional Neural Networks (CNNs), for ultrasound informative-image selection of hyaline cartilage at metacarpal head level. The algorithm performance and that of three beginner sonographers were compared with an expert assessment, which was considered the gold standard.Methods: The study was divided into two steps. In the first one, an automatic deep-learning algorithm for image selection was developed using 1,600 ultrasound (US) images of the metacarpal head cartilage (MHC) acquired in 40 healthy subjects using a very high-frequency probe (up to 22 MHz). The algorithm task was to identify US images defined informative as they show enough information to fulfill the Outcome Measure in Rheumatology US definition of healthy hyaline cartilage. The algorithm relied on VGG16 CNN, which was fine-tuned to classify US images in informative and non-informative ones. A repeated leave-four-subject out cross-validation was performed using the expert sonographer assessment as gold-standard. In the second step, the expert assessed the algorithm and the beginner sonographers' ability to obtain US informative images of the MHC.Results: The VGG16 CNN showed excellent performance in the first step, with a mean area (AUC) under the receiver operating characteristic curve, computed among the 10 models obtained from cross-validation, of 0.99 ± 0.01. The model that reached the best AUC on the testing set, which we named “MHC identifier 1,” was then evaluated by the expert sonographer. The agreement between the algorithm, and the expert sonographer was almost perfect [Cohen's kappa: 0.84 (95% confidence interval: 0.71–0.98)], whereas the agreement between the expert and the beginner sonographers using conventional assessment was moderate [Cohen's kappa: 0.63 (95% confidence interval: 0.49–0.76)]. The conventional obtainment of US images by beginner sonographers required 6.0 ± 1.0 min, whereas US videoclip acquisition by a beginner sonographer lasted only 2.0 ± 0.8 min.Conclusion: This study paves the way for the automatic identification of informative US images for assessing MHC. This may redefine the US reliability in the evaluation of MHC integrity, especially in terms of intrareader reliability and may support beginner sonographers during US training.

Application of CT Medical Imaging Technology in the Diagnosis of the Impact of Exercise on the Development of Adolescent Metacarpal Bone

Objective: Based on the principles of sports biomechanics, this paper uses CT medical imaging technology to observe the effect of volleyball on the morphology and structure of the metacarpal bone. Methods: Nine young professional volleyball players (volleyball group) and 8 non-volleyball players (control group) were selected from our province. They were male and right-handed. Scan the subject's hand with multi-layer spiral CT, and perform 2D and 3D reconstruction on it. The 2D reconstructed image is filtered, grayed, enlarged, intercepted, enhanced, and segmented to measure the gray value of each metacarpal bone. After manual segmentation of the 3D reconstructed image in the workstation, the CT value, length, volume, and width of each side of the metacarpal head were measured, and the size and index of each metacarpal head were calculated. Statistical analysis of differences in metacarpal parameter values. Results: Compared with the control group, (1) the volleyball group reduced the gray value of the right hand I, V metacarpal and left hand I to V metacarpal bones (P < 0.05), and the right hand II metacarpal bone decreased. (P < 0.001), the gray value of the third and fourth metacarpal bones of the right hand decreased (P < 0.01); Conclusion : The stress caused by volleyball can adaptively change the morphology and structure of the metacarpal bones of young athletes, as follows: Values, CT values decreased; metacarpal length, volume, and metacarpal head size (volume) increased; metacarpal head index decreased; in addition, non-snooker palm bone morphology and structure changed similarly to the spiker.