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At least 433 records · Page 24Linked to original sources
PubMed1996

High frequency of the median artery of the forearm in South African newborns and infants.

In a sample of 60 neonates and infants from black communities in the Johannesburg area, the median artery of the forearm was found in 50% of individuals (11.7% in one forearm only, 38.3% in both forearms). The frequency per forearm was 44.2%, much higher than that found in any previous study, even among adults from the same community (27.1% per forearm). The artery occurs bilaterally significantly more often than it does in one antimere only. There are no differences in its frequency between sexes or between antimeres. The artery provides an additional route of blood supply to the forearm that should be kept in mind by hand surgeons. It can also be harvested for vascular grafts.

Arteries↗
PubMed1996

[Abnormal vasomotor response of the forearm due to propranolol-induced loss of cardiopulmonary baroreflex sensitivity: experience with seven cases of recent myocardial infarct].

In 7 patients suffering from acute myocardial infarction (AMI) occurring in the previous 30 days, we investigated forearm vascular reactivity to lower body negative pressure (LBNP), by the strain gauge plethysmography with simultaneous administration of negative pressure around the lower limbs. This manoeuvre has then been repeated after 10 days of oral beta-blocker therapy (propanolol 160 mg/die). A significant flow reduction derived from LBNP associated to plethysmography with respect to plethysmography alone, but this significant difference was suppressed by propranolol treatment, that prevented the reflex decrease in forearm blood flow, (forearm blood flow from 5.97 to 3.85 ml/min/100 ml in wash-out vs 5.64 to 5.75 ml/min/100 ml during propranolol treatment). We hypothesize that this phenomenon is due to the desensitizing effect of propranolol on cardiopulmonary mechanoreceptors (CPB), with the consequent loss or reduction of their functional inhibition for the efferent sympathetic outflow towards resistance vessels in skeletal muscle. Therefore, LBNP does not elicit forearm reflex sympathetic vasoconstriction, because pressure unloading of CPB areas is no longer able to modify sympathetic discharge, since the influence on it of baroreceptor activity has already been weakened by prolonged beta-blockade. Thus, the LBNP low levels, by ruling out and/or by removing the CPB activity are theorically able to elicit sympathetic "disinhibition", and to exercise, consequently, a reflex, vasoconstrictor influence upon the forearm vascular bed, whereas the same reflex behaviour by forearm resistance vessels does not appear feasible if the CPB activity has been preventively minimized by prolonged, chronic beta-blockade.

Adrenergic beta-Antagonists↗
PubMed2001

Sensate radial forearm free flaps in tongue reconstruction.

BACKGROUND: Successful rehabilitation after ablative surgery requires not only the reconstruction of 3-dimensional form but also the restoration of physiologic function. OBJECTIVE: To assess sensory recovery of reinnervated radial forearm flaps used for tongue reconstruction. PATIENTS AND METHODS: Seventeen patients, who underwent reconstruction of glossectomy defects with reinnervated radial forearm free flaps, formed the study group. Recovery of sensation was measured by both subjective and detailed objective tests 8 months after surgery. Sensory function of the flap was compared with that of the normal residual tongue or the adjacent oral mucosa and the contralateral forearm donor site. RESULTS: All patients involved in this study had tongue defects of hemiglossectomy or greater and adjacent floor of the mouth. Sensory recovery was observed in all of the 17 patients within 8 months. Detailed sensory testing showed that median static 2-point discrimination, moving 2-point discrimination, and pressure sensitivity (1.2 cm, 0.8 cm, and 3.7 psi, respectively) were subjectively greater in the innervated forearm flaps than in the contralateral forearm donor site (2.3 cm, 1.7 cm, and 4.6 psi, respectively) (P= .064) and similar to those of the normal tongue (0.9 cm, 0.5 cm, and 3.6 psi). CONCLUSIONS: In all modalities examined, sensate free flaps proved superior in sensory fidelity to the native forearm donor site and closely approached that of the normal tongue. Microsurgical reinnervation of flaps should be considered in tongue reconstruction.

Adult↗
PubMed2003

Incidence of childhood distal forearm fractures over 30 years: a population-based study.

CONTEXT: The incidence of distal forearm fractures in children peaks around the time of the pubertal growth spurt, possibly because physical activity increases at the time of a transient deficit in cortical bone mass due to the increased calcium demand during maximal skeletal growth. Changes in physical activity or diet may therefore influence risk of forearm fracture. OBJECTIVE: To determine whether there has been a change in the incidence of distal forearm fractures in children in recent years. DESIGN, SETTING, AND PATIENTS: Population-based study among Rochester, Minn, residents younger than 35 years with distal forearm fractures in 1969-1971, 1979-1981, 1989-1991, and 1999-2001. MAIN OUTCOME MEASURE: Estimated incidence of distal forearm fractures in 4 time periods. RESULTS: Comparably age- and sex-adjusted annual incidence rates per 100 000 increased from 263.3 (95% confidence interval [CI], 231.1-295.4) in 1969-1971 to 322.3 (95% CI, 285.3-359.4) in 1979-1981 and to 399.8 (95% CI, 361.0-438.6) in 1989-1991 before leveling off at 372.9 (95% CI, 339.1-406.7) in 1999-2001. Age-adjusted incidence rates per 100 000 were 32% greater among male residents in 1999-2001 compared with 1969-1971 (409.4 [95% CI, 359.9-459.0] vs 309.4 [95% CI, 259.3-359.5]; P =.01) and 56% greater among female residents in the same time periods (334.3 [95% CI, 288.6-380.1] vs 214.6 [95% CI, 174.9-254.4]; P<.001). The peak incidence and greatest increase occurred between ages 11 and 14 years in boys and 8 and 11 years in girls. CONCLUSIONS: There has been a statistically significant increase in the incidence of distal forearm fractures in children and adolescents, but whether this is due to changing patterns of physical activity, decreased bone acquisition due to poor calcium intake, or both is unclear at present. Given the large number of childhood fractures, however, studies are needed to define the cause(s) of this increase.

Adolescent↗
PubMed1994

Spine deformity index in osteoporotic women: relations to forearm and vertebral bone mineral measurements and to iliac crest ash density.

Bone densitometric measurements are widely used for monitoring therapeutic regimens for osteoporosis. However, it is a matter of debate which measurement site is most appropriate for prediction of individual fracture risk. The aim of this cross-sectional study was to investigate the relationship between bone mineral measurements at various sites and spine deformity index (SDI) in osteoporotic women. The SDI was determined in 37 osteoporotic women aged 56-87 years (mean 70.9 years). Peripheral (single-photon absorptiometry of the distal forearm, and iliac crest ash content) and axial (dual-photon absorptiometry of the lumbar spine) bone mass measurements were obtained. SDI increased with age (r = 0.34, p < 0.05), whereas forearm BMC (r = -0.52, p < 0.002) and forearm BMD (r = -0.62, p < 0.0001) decreased. No significant age-related changes were observed in lumbar BMC or iliac crest ash content in these osteoporotic women. A highly significant correlation was found between SDI and lumbar BMC (r = -0.60, p < 0.01). A significant, but less pronounced correlation was found between SDI and forearm BMC (r = -0.37, p < 0.05), whereas no relation was revealed between SDI and forearm BMD or iliac crest ash content. In a multiple regression model, the relationship between lumbar BMC and SDI remained significant after adjusting for the influence of age, whereas the relationship to forearm BMC disappeared. Furthermore, a multiple regression analysis was performed in order to evaluate the ability of all four bone mass measurements and age to predict variations in SDI.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1996

Different risk profiles for hip fractures and distal forearm fractures: a prospective study.

In a prospective cohort of elderly persons, aged 70 years and over, we examined risk indicators for which data could be easily obtained, to construct risk profiles for hip fractures and distal forearm fractures. Participants lived independently, in apartment houses for the elderly or in homes for the elderly. At baseline, information was obtained in 2578 subjects on age, gender, residence, mobility and the frequency of going outdoors. Mobility was measured using a walking score ranging from 1 (not able to walk independently) to 3 (able to walk independently for a fair distance). During the study period (median duration 3.5 years, maximum 4 years) 106 participants sustained a hip fracture and 60 participants suffered a distal forearm fracture. Women compared with men, adjusted for age, had a higher risk of hip fracture (adjusted relative risk (RR) = 2.4, 95% confidence interval (CI) 1.3-4.3) and distal forearm fracture (RR = 3.7, 95% CI 1.5-9.2). Age, adjusted for gender, was related to hip fractures only: the relative risk of fracture for those in the highest age category (> 85 years) was 9.5 (95% CI 4.3-21.2) compared with those in the lowest age category (70-75 years). Moderately impaired walking ability compared with normal walking ability, adjusted for age and gender, was associated with a higher risk of hip fracture (RR = 1.8, 95% CI 1.2-2.7) but with a lower risk of distal forearm fracture (RR = 0.4, 95% CI 0.2-0.8). The outdoor score, adjusted for age and gender, was associated with distal forearm fractures only: going outdoors less than once a week, compared with three times or more, was associated with a lower risk of fractures (RR = 0.3, 95% CI 0.1-0.9). In those living in homes for the elderly the risk of hip fracture was higher compared with those living independently (RR = 2.4, 95% CI 1.4-4.2), adjusted for age and gender. Risk profiles were constructed using stepwise Cox's proportional-hazards regression. The risk profile predicted probabilities of sustaining a hip fracture in a 4-year period ranging from 0.4% to 25.9%, and of distal forearm fractures ranging from 0.2% to 4.5%, depending on the subject's characteristics as defined by the risk indicators. We conclude that easily obtainable risk indicators can be used in the prediction of fractures and can discriminate among fracture types.

Accidental Falls↗
PubMed1995

[Functional limitation of the forearm after shaft fracture in childhood. Possible role of the antebrachial interosseous membrane: MRI and ultrasound studies].

Based on follow-up examinations of 16 patients aged 5 to 15 years, the integrity of the interosseous membrane following forearm shaft fracture was evaluated. The examinations which included magnetic resonance imaging (MRI) and ultrasound scanning of both the fractured and the nonfractured forearms were conducted 4 to 81 months after fracture. Using a 1.5 T MR tomograph, we obtained 20 cross-sectional images arranged over the entire length of the forearm which was in neutral position, while sonographicly at 7.5 MHz we obtained cross-sectional views of the proximal, middle and distal forearm thirds with the forearm in pronation, neutral position and supination at a time. The MR image of the interosseous membrane is a thin hypointense line, occasionally showing low contrast irregularities on the fractured side such as thickenings, tears or curvature inconstancies which would suggest membrane alterations. However, these alterations appear to be less than expected. They are not clearly seen in the ultrasound views, where the interosseous membrane is found as an echorich line. According to our preliminary results, there seems to be a correlation between MR-detected interosseous membrane alterations and initial fracture dislocation as well as functional fracture outcome, particularly forearm rotation.

Adolescent↗
PubMed2001

Bone loss from the hand in women following distal forearm fracture.

Bone loss occurs after distal forearm fracture, but it is unclear if this bone loss is fully recovered. We designed a cross-sectional study to evaluate the time course of the bone loss from the hand after distal forearm fracture. We identified 40 women who had a fracture of the distal forearm within the previous 4.5 years. Their ages ranged from 42 to 81 (mean 64 years) and time since fracture 6 to 54 (mean 28 months). These were compared with 95 women (mean age 67, range 57 to 80 years) from a population-based cohort. Lumbar spine (LS) and hand bone mineral density (BMD) were measured in all subjects using a Hologic QDR 1000/W densitometer. Ultrasound of the fingers of both hands was measured in the forearm fracture group using a DBM Sonic 1200 R model. Compared to controls, LS BMD was decreased by 6.4% (p<0.001), non-fractured hand by 3.2% (p<0.001) and the fractured hand by 6.1% (p<0.001) in the forearm fracture group. The mean difference in bone density between the fractured and non-fractured hand was 0.0207 g/cm2, the average value for the non-fractured hand being 0.304 g/cm2. The decement in hand BMD was equivalent to 6.2% (p<0.0001). The difference in hand BMD between the fractured and non-fractured side was greatest when the time since fracture was short; there was no further difference in hand BMD after 2 years. Ultrasound showed a mean difference of 18.7 m/s in amplitude-dependent speed of sound (AD-SoS) with the average value being 1893 m/s. A 1.0% decrease was observed in the fractured hand AD-SoS (p<0.05). A strong relationship was observed between AD-SoS and BMD in both hands (r = 0.70, p<0.001). We conclude that distal forearm fracture results in a significant decrease in hand BMD that is partially reversible. The decrease in hand BMD is reflected in the ultrasound properties of the finger phalanx.

Absorptiometry, Photon↗
PubMed2000

Prediction of bone strength of distal forearm using radius bone mineral density and phalangeal speed of sound.

This investigation compares quantitative ultrasound (QUS) measurement of the phalanges with peripheral quantitative computed tomography (pQCT) and dual X-ray absorptiometry (DXA) measurement of the forearm, to estimate the strength of the distal radius in 13 cadaveric forearms. The cadavers were scanned at the distal radius by pQCT and DXA for bone mineral density (BMD) and at the approximate phalanges by QUS for speed of sound (SOS). The distal radii were subjected to a simulated Colles fracture produced with a materials testing machine. The load at which the distal radius was fractured was considered as a representation of bone strength. The bone strength correlated significantly with SOS at different phalanges (r = 0.63-0.72), BMD at different regions of interest by DXA (r = 0.67-0.75), and cortical BMD at different sites by pQCT (r = 0.61-0.67). Standard stepwise regression analysis showed that adding phalangeal SOS into forearm densitometric variables significantly enhanced the statistical power for prediction of the strength of the distal radius. Our results suggest that, for assessment of site-specific distal forearm strength, QUS measurement of the phalanges is comparable to forearm densitometry. Phalangeal QUS may add clinical value if distal forearm strength has a high priority.

Aged↗
PubMed2000

Biophysical measurements of human forearm skin in vivo: effects of site, gender, chirality and time.

BACKGROUND/AIMS: Measurements of transepidermal water loss (TEWL) and skin colour are biophysical techniques commonly used to measure the in vivo skin effects of cosmetics, topical medicaments and chemical irritants. The purpose of this study was to investigate the variability of TEWL and skin colour on human forearm skin as a function of regional variation, gender and preferred chirality over an 8 h period. METHODS: Biophysical measurements of TEWL and skin colour were made at five sites on both forearms of male (n=8) and female (n=9) human volunteers in vivo (38% relative humidity, 21 degrees C). RESULTS: Rates of TEWL at the forearm midpoint were 10% lower than at the forearm extremities (P<0.01). Skin redness (a*) near the wrist was 5-10% higher than at other sites (P<0.05). Rates of TEWL were 5% higher in male volunteers (P<0.05). Red and blue (b*) colour measurements of male forearm skin differed by 18% and 20% in comparison with female, respectively. Rates of TEWL, skin brightness (L*) and b* decreased by 9% (P<0.05), 1.8% (P<0.05) and 4% (P<0.05), respectively, with time whereas a* and skin temperature increased by 4.5% (P<0.01) and 7.2% (P<0.01), respectively. There was a significant correlation between the change in all measured parameters with time. CONCLUSIONS: Significant differences in TEWL and skin colour were identified that may have relevance in the design and interpretation of multivariate analyses of human forearm skin. Diurnal variation of TEWL, skin colour and temperature may have a single underlying mechanism.

Journal Article↗
PubMed2001

One-bone forearm fusion for pediatric supination contracture due to neurologic deficit.

The purpose of this study was to review the construction of a one-bone forearm performed to change the position of the forearm in children with fixed supination deformity due to upper extremity neurologic deficit. The one-bone forearm arthrodesis has been previously described in treating trauma, tumors, infection, and congenital deformities. It has not been described to improve forearm position in neurologically impaired upper extremities. We retrospectively evaluated 6 pediatric patients with upper extremity weakness and severe supination contracture who underwent forearm arthrodesis in neutral or slight pronation. Five patients achieved fusion, and 1 patient had an atrophic nonunion (17% nonunion rate). Average follow-up was 6 years 6 months (range 1 year 9 months to 11 years 2 months), and all patients were satisfied with their new forearm position.

Adolescent↗
PubMed2002

Dynamic splinting of forearm rotational contracture after distal radius fracture.

The results of dynamic forearm rotational splinting for the treatment of forearm rotational contractures in patients with acceptably aligned, healed distal radius fractures are documented. Fifteen patients with distal radius fractures that healed with < or =+5 mm ulnar variance and < or =20 degrees dorsal tilt had dynamic forearm rotational splinting for contractures that had failed conventional hand therapy. Average pronosupination arc before splinting was 83 degrees. Dynamic forearm rotational splinting increased forearm rotation by 52% to an average of 126 degrees. Only one patient with development of ectopic bone in the interosseous space during splinting failed to obtain at least 30 degrees pronation and supination after splinting. Dynamic forearm rotational splinting effectively treats rotational contractures in patients who have healed distal radius fractures that are in acceptable alignment.

Adult↗
PubMed2000

Tongue reconstruction with a combined brachioradialis-radial forearm flap.

Total glossectomy adversely affects speech and swallowing, and subsequent reconstruction results in limited functional return. The radial forearm flap has been reliably used to resurface glossectomy defects, but has limited bulk with which to aid in palatoglossal contact for speech. The authors have modified the forearm flap by incorporating a segment of brachioradialis muscle, to increase bulk posteriorly and to aid in speech. Sufficient muscle perforators arise from the proximal brachial artery and enter the brachioradialis to permit transfer of the muscle with the fasciocutaneous forearm flap as a single free-flap unit. The muscle is folded onto itself and enclosed within the forearm flap skin to create a neotongue. Coaptation of the antebrachial cutaneous nerves can provide a senate flap. Successful transfer of the combined brachioradialis/forearm flap in a patient who had undergone total glossectomy resulted in a neotongue good shape. Speech was rated good by a speech pathologist, and palatoglossal contact was observed on cineoradiograph. No functional loss at the donor site occurred. Inclusion of the brachioradialis muscle with the radial forearm flap as a combined unit results in a neotongue with good form and increased bulk posteriorly at the base, compared to a standard fasciocutaneous flap alone. This is a useful variation of the forearm flap. Sensory return is possible if the medial and/or lateral antebrachial cutaneous nerves of the flap are coapted to the lingual nerve.

Carcinoma, Squamous Cell↗
PubMed1997

The necessity of acute bone grafting in diaphyseal forearm fractures: a retrospective review.

OBJECTIVE: To determine the union rate of forearm fractures where acute bone grafting was recommended but not performed. DESIGN: Retrospective review. SETTING: Regional level one trauma center. PATIENTS: The criteria for inclusion in the study were patients with closed growth plates and a diaphyseal fracture of the radius, ulna, or both (including Monteggia and Galeazzi fracture-dislocations) that were treated with plate fixation. Patients were excluded from the study if they were lost to follow-up before radiographic documentation of bone union. The review identified 198 fractures that were eligible for inclusion. Fifteen fractures were excluded. INTERVENTION: The method of treatment of each fracture was open reduction and plate fixation with or without bone grafting. MAIN OUTCOME MEASUREMENT: Fracture union. RESULTS: The overall union rate in comminuted, nongrafted forearm fractures (open and closed) was 98% (99/101; 95% confidence interval: 93-100%). The union rate in closed, comminuted, nongrafted forearm fractures was 97% (74/76; 95% confidence interval; 91-100%). CONCLUSIONS: Open reduction and internal fixation of comminuted diaphyseal forearm fractures without bone grafting in this study produced union rates comparable to those reported for open reduction and internal fixation of comminuted forearm fractures with acute bone grafting. This study suggests that routine use of bone grafting in comminuted forearm fractures is not indicated.

Adolescent↗
PubMed2001

Nonmicrosurgical use of the radial forearm flap for penile reconstruction.

Although the era of microsurgical techniques has greatly expanded the number of possible solutions for penile reconstruction, additional options are still needed for some unusual situations when microsurgery is not available or not desired. This article describes the first nonmicrosurgical use of the radial forearm flap for penile reconstruction. With this technique, an osteocutaneous radial forearm flap 15 x 20 cm in size is elevated as a reverse-flow island flap and used to create a neopenis in the classic "tube within a tube" fashion. The neopenis is then transferred to the recipient site as a distant flap, without dividing its vascular connection with the forearm. Once a complete healing is ensured after the following 2 to 3 weeks, the pedicle is cut and the penile reconstruction is completed. Since 1995, this technique was used for total penile reconstruction in four patients: two with congenital penile agenesis, one with penile amputation as a result of a high-voltage electrical injury, and one with total loss of the external genitalia as a result of a shotgun injury. The patients have been followed up for 1 to 4 years. Good results were achieved in all patients. In conclusion, non-microsurgical use of the radial forearm flap seems to be a useful alternative to create an innervated functionally and aesthetically acceptable neopenis when microsurgery is not available or not desired. Although it is a multistage procedure, it is easy to perform. Moreover, this technique provides all well-known advantages of the radial forearm flap in penile reconstruction but does not require the sophisticated equipment and expertise of microsurgery. This is a great advantage that enables surgeons without microsurgical skill to use the radial forearm flap for phallic reconstruction. The author believes that the described technique will be extremely useful in developing countries that have limited resources and where microsurgery is difficult to obtain.

Adult↗
PubMed1992

Double injuries of the forearm: a common occurrence.

To evaluate the frequency of different types of forearm fractures and, in particular, determine the frequency of double injury to the forearm, the authors prospectively examined 119 consecutive forearm fractures and found double injuries to the forearm in all but five cases. In 79 of the 119 patients (66%), ligamentous injury was seen in addition to the obvious fracture. Nine patients with apparent isolated fractures on initial radiographs underwent examination by means of radionuclide bone scanning, which revealed a second injury in eight of them. Four patients with apparent single fractures did not undergo bone scanning because of their critical conditions. In four patients, a single fracture was initially diagnosed, but after reduction and casting, dislocation of the radioulnar joint was seen. These findings indicate that injury to the forearm almost invariably occurs at two or more sites and involves either both bones or bone and ligament. Because the distal radioulnar joint was affected in 71 patients (60%), scrutiny of the wrist is imperative whenever injuries to the bones of the forearm are discovered.

Arthrography↗
PubMed1983

Forearm blood flow and metabolism during stylized and unstylized states of decreased activation.

We have measured forearm oxygen consumption and blood flow changes during two wakeful rest behaviors. We have observed acute reduction of forearm respiration (28%) during an acute stylized rest state (TM) and a nonsignificant small decline (11%) during unstylized ordinary eyes-closed rest. These changes were not associated with significant change of forearm blood flow or glycolytic metabolism. Hence, forearm oxygen consumption decline was due almost solely to decreased rate of oxygen extraction. Small variation of forearm blood flow implies that little of the previous findings of increased nonrenal, nonhepatic circulation during TM or increased nonrenal circulation during ordinary rest can be accounted for by altered muscle blood flow, which therefore is consistent with possible increased cerebral blood flow. However, reduced muscle metabolism was a likely contributor to the forearm metabolic decline. The lack of coupling between metabolic and blood flow changes during TM indicates limitation of obligatory coupling between cardiovascular and metabolic function in the rest state of TM.

Adult↗
PubMed1990

Impaired vasodilation of forearm resistance vessels in hypercholesterolemic humans.

The effect of hypercholesterolemia on vascular function was studied in humans. To eliminate the potential confounding effects of atherosclerosis, vascular reactivity was measured in the forearm resistance vessels of 11 normal subjects (serum LDL cholesterol = 111 +/- 7 mg/dl) and 13 patients with hypercholesterolemia (serum LDL cholesterol = 211 +/- 19 mg/dl, P less than 0.05). Each subject received intrabrachial artery infusions of methacholine, which releases endothelium-derived relaxant factor, and nitroprusside which directly stimulates guanylate cyclase in vascular smooth muscle. Maximal vasodilatory potential was determined during reactive hyperemia. Vasoconstrictive responsiveness was examined during intra-arterial phenylephrine infusion. Forearm blood flow was determined by venous occlusion plethysmography. Basal forearm blood flow in normal and hypercholesterolemic subjects was comparable. Similarly, reactive hyperemic blood flow did not differ between the two groups. In contrast, the maximal forearm blood flow response to methacholine in hypercholesterolemic subjects was less than that observed in normal subjects. In addition, the forearm blood flow response to nitroprusside was less in hypercholesterolemic subjects. There was no difference in the forearm vasoconstrictive response to phenylephrine in the two groups. Thus, the vasodilator responses to methacholine and nitroprusside were blunted in patients with hypercholesterolemia. We conclude that in humans with hypercholesterolemia, there is a decreased effect of nitrovasodilators, including endothelium-derived relaxing factor, on the vascular smooth muscle of resistance vessels.

Adult↗