[ON THE ADVISABILITY OF COMBINING AN AUTOPLASTIC GRAFT WITH KIRSCHNER WIRE IN THE TREATMENT OF FOREARM FRACTURES].
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Acute bowing of the bones of the forearm in children following trauma has only recently been recognized as a clinical and radiographic entity. This type of injury has been overlooked in the past because of lack of familiarity with the mechanical properties of curved tubular bones. Absence of a fracture line and the usual findings associated with a healing fracture on radiographs has contributed to the lack of recognition of this condition. The mechanism of injury, clinical and radiographic findings, clinical implications, and classification of these elusive childhood fractures are discussed on the basis of a study of 13 children.
The aggregated total of 385 cases of Dupuytren's disease arising after acute or specific injury, operation or infection of the forearm, wrist or hand between 1614 and 2003 are documented, including a personal series of 52 cases. The history of this relationship is recorded and the medico legal implications of the association are discussed.
Forty-six injuries caused by skateboards were seen in 3 months; these were predominantly fractures and sprains of the distal part of the limb caused by indirect violence. These injuries are likely to become common. They occur most frequently when the skateboard hits a stone or other irregularity on the surface used.
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A clinical survey of 92 upper extremity wringer injuries over the past four years at the Bexar County Hospital are presented. Our treatment regimen and results are outlined. Complex injuries occurred infrequently (7%). No vascular insufficiency developed and no fasciotomies were required. We are of the opinion that hospitalization is necessary in all but a small number of selected cases. Close observation is necessary to prevent edema progression and further tissue loss. Ninety-two upper extremity compression injuries secondary to washing machine wringers were reviewed. Seventy-six percent of the injuries occurred in persons under 10 years of age. Extremity distribution was equal. Injury occurred below the elbow in 72% of the extremities. Soft tissue injury was manifested by swelling and tenderness in 96%. Twenty-one percent had no violation of the skin. Major avulsion, such as third degree skin loss, crush injury, dislocation, and tendon avulsion, occurred in 8%. The treatment regimen consisted of surgical preparation with Betadine, compressing dressing, and elevation. Observation of the involved extremity is made every hour for development of vascular insufficiency. Fractures and other major injuries were treated as indicated. No fasciotomy was required. No vascular insufficiency developed. SKin slough was present in 16 of 92 extremities and skin graft was required in 5 of the 16. Results of treatment reveal 87% with no functional impairment of the involved extremity. Varying degrees of impairment are present in 6% of the injured extremities with all localized to the major avulsion group of injuries.
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