Tamaliūnas, Vytautas

Introduction Bilateral partial hand amputations severely reduce function. Losing multiple fingers, especially thumbs, which provide about 40 % of hand function [1] limits grasp and independence. Crush injuries often cannot be fully reconstructed [2]. Partial hand prostheses fill a gap when reconstructive surgery is not possible [3]. Modern 3D scanning and printing allow rapid individualised prostheses. Case Presentation A 62 y music performer’s hands were crushed by a press, causing traumatic amputations of all fingers except the right thumb and index, part of the left thumb. Emergency surgery involved debridement, osteosynthesis of the remaining digits, attempted replantation. Nonviable fingers were amputated. Over the next year the right index developed chronic osteomyelitis with a comminuted fracture. After failed conservative care, sequestrectomy and Masquelet technique with a polymethylmethacrylate (PMMA) spacer reinforced the bone. Prostheses were considered only when no other treatments remained. Once the wounds healed, palms were laser scanned with a HandySCAN 700 to capture residual anatomy. Anonymised 3D scans were transferred into Fuse CAD to create digital models of a mechanical left hand prosthesis with custom sockets, finger segments. Discussion Digital fabrication provided precise, patient specific prosthesis. Reports show that custom 3D printed devices improve grasp and fit [4]. A mechanical design was chosen because body powered prostheses are lighter and more durable than myoelectric prostheses [5]. The HandySCAN 700 captures up to 480000 measurements s⁻¹ using laser triangulation enabling accurate custom prosthetic design [6]. Although many body powered partial hand devices can be coupled to preserved joints, digits this case used a self contained mechanical prosthesis without residual finger actuation. Masquelet technique reinforced the index finger. Its PMMA spacer fills bone cavities and provides structural support [7]. Conclusions Digital 3D scanning and CAD based fabrication produced a custom mechanical partial hand prosthesis that should restore functional grasp and improve the patient’s independence. Precisely matched to the residual palm this printed lightweight body powered device provided a stable, comfortable interface and may offer a feasible option when multiple digits are amputated and not reconstructable.

Įvadas. Sustorėjęs A1 skaidulinis žiedas, esantis ties delnakaulio galva, neleidžia sausgyslei laisvai judėti kanale. Pasireiškus šiam sutrikimui, pacientai, lenkdami ar tiesdami pirštą, Jaučia vietinį skausmą ir strigimą. Tikslas. Įvertinti pacientų, sergančių stenozuojančiu tenosinovitu, ankstyvuosius ir vėlyvuosius rezultatus, pritaikius atvirąjį chirurginį gydymą, atliekant anulotomiją. Metodika. Tiriamiesiems atlikta standartinė operacija - atviras chirurginis plaštakos piršto skaidulinio A1 žiedo atvėrimas (anulotomija). Skausmas (verbalinė skausmo skalė), plaštakos ir rankos funkcijos (QuickDASH) bei komplikacijos vertinta po operacijos praėjus 1 sav., 3 mėn. ir 6 mėn. Rezultatai. Tyrime dalyvavo 45 pacientai, iš jų - 29 (64 %) moterys, 16 (36 %) vyrų. Didžiausią skausmą pacientai jautė prieš operaciją (mediana - 5; TKN 5), mažiausią - praėjus 6 mėn. po operacijos (mediana - 2; TKN 2). Skausmo rezultatų skirtumas prieš operaciją ir praėjus 1 sav., 3 mėn. bei 6 mėn. po operacijos - statistiškai reikšmingas (p < 0,001). Rankos ir plaštakos funkcijos blogiausiai vertintos prieš operaciją ir praėjus 1 sav. po operacijos (mediana atitinkamai: 52 (TKN 33) ir 52 (TKN 35). Plaštakos funkcija pacientams atkurta praėjus 6 mėn. po operacijos (mediana - 0; TKN 11). Skirtumas statistiškai reikšmingas (p < 0,001). Išvados. Atviroji anulotomija - viena iš efektyviausių stenozuojančio tenosinovito gydymo metodikų. Atlikus šią operaciją, gerėja plaštakos funkcija, mažėja skausmas. Vis dėlto pooperaciniu laikotarpiu nemažai daliai pacientų kyla tam tikrų nepatogumų ar komplikacijų, iš kurių dažniausiai minėtinas nepatogus randas. Neretai pacientus vargina rando jautrumas.

Background and Objectives: Cardiac amyloidosis is an infiltrative, progressive, and restrictive cardiomyopathy that leads to heart failure, reduces life quality, and causes death. This is a multisystem disorder caused by mutations of the transthyretin protein and is associated not only with cardiac diseases or carpal tunnel syndrome but also with nerve, liver, lung, gastrointestinal tract, kidney, or eye pathologies. Carpal tunnel syndrome is an early red-flag symptom of transthyretin (TTR) cardiac amyloidosis; therefore, screening for unsuspected cardiac amyloidosis can be performed through histological testing of flexor retinaculum specimens gathered during carpal tunnel release surgery. Our case highlights that early detection and accurate diagnosis of a disease are important factors for improving clinical outcomes in patients with TTR amyloidosis. Case Summary: We report the case of a 71-year-old man who presented with bilateral carpal tunnel syndrome. Amyloid deposits were detected after carpal tunnel release surgery through histological testing of the synovial tissue. The patient was sent for a cardiological evaluation. Physical examination, laboratory tests, and the ECG revealed no significant changes. The diagnosis of amyloidosis was confirmed with multimodality imaging in the early stage, which helped to start specific medicamental treatment with the transthyretin stabilizer tafamidis. Conclusions: Our objective is to highlight the early recognition and specific medicamental treatment of cardiac amyloidosis for better patient prognosis and outcomes.