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Partial hand loss accounts for the overwhelming majority of upper limb deficiencies. Despite this, individuals with partial hand loss have a limited number of prosthetic options at their disposal. Existing externally powered devices typically house both motor and gear transmission in the proximal phalanx, which provides function at the expense of anthropomorphism. We present a novel design for an externally powered finger prosthesis with a custom gear transmission that is capable of higher intermittent torques compared to commercial gearheads of equivalent volume. We manufacture a fully functional transmission using a high-strength maraging steel alloy and direct laser metal sintering. The transmission consists of multiple planetary and spur gear stages arranged in a stackable (or laminar) configuration and accommodates joint movement at the proximal interphalangeal joint. The powered finger is equivalent in size to a 50th percentile female index finger and is capable of generating pinch forces comparable to those of commercial powered fingers at flexion speeds that exceed those of existing devices. While there are several practical and functional improvements for future iterations, our design represents a viable option for a powered finger capable of accommodating a wide range of individuals with partial hand loss.

Primary patellar neoplasms are uncommon and metastasis to the patella is rarer still. Very few reports have been published in the literature (Stoler & Staple, 1969; Keeley, 1973; Gall et al, 1974; Ashby & Dappen, 1976; Hussey, 1976; Kwa & Nade, 1989). We present a case of primary bronchogenic carcinoma presenting as a huge swelling around the knee owing to a metastatic lesion in the patella.

Objective: Vascular surgery is unique in that it combines intricate skill sets, involves almost every anatomic territory, and crosses over with other subspecialties. Recent editorial publications have insinuated that the interest in our specialty is declining. We sought to examine the relative interest in vascular surgery compared with interventional cardiology (IC), cardiothoracic surgery (CT), and interventional radiology (IR).Methods: Reviews of the National Residency Match Program and the American Board of Internal Medicine were performed for both fellowship and residency match data. Search terms were compared using Google trends. Job outlook was examined on the

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