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This article presents a simplified, direct way of measuring tissue pressure and shows that in a series of 45 patients with serious extremity injuries, it is possible to predict the need for fasciotomy, eliminating much of the risk to the patient.
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The prompt recognition and management (Tables 8-1 and 8-2) of chemical burns of the upper extremity may prevent injury to the deep structures of the hand and may make the difference between satisfactory rehabilitation and crippling deformities. Immediate irrigation with water is the single most important treatment that can be carried out, and should be continued for at least an hour and often for several hours, depending on the severity of the injury. Precious time should not be wasted hunting for a specific neutralizing agent. Hydrofluoric acid injuries and phosphorus injuries are the two exceptions to this principle. After copious irrigation and débridement, small superficial burns may be treated without dressings or topical therapy. Large partial-thickness burns are best treated with Sulfamylon burn cream and then with with biologic dressings until healing is achieved. Full-thickness injuries of limited extent should be excised and skin-grafted to regain maximum function, and more extensive burns treated in a nonexicisional regimen.
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This article explores the biomechanics of forearm loading and discusses various methods of treatment for injuries to the interosseous ligament of the forearm. Effective treatment of these injuries depends on a thorough understanding of the deformity and the pathomechanics of proximal translation of the radius.
OBJECTIVE: Details on airbag injuries to the upper extremity are relatively unknown to clinicians. The injuries presented here should provide a clear understanding of the mechanisms of forearm, hand, and wrist injuries that may be seen by emergency room physicians. MATERIALS AND METHODS: From our crash investigations of 325 airbag-equipped passenger cars, a subset of upper extremity injuries are presented that are related to airbag deployments. MAIN RESULTS: Minor hand, wrist, or forearm injuries--contusions, abrasions, and sprains--are not uncommonly reported. Infrequently, hand fractures have been sustained and, in isolated cases, fractures of the forearm bones or of the thumb, wrist, and fingers. The close proximity of the forearm to the airbag module door is related to most of the fractures identified. Steering wheel airbag deployments can fling the hand-forearm into the instrument panel, rearview mirror, or windshield, as indicated by contact scuffs, tissue debris, or the star burst (spider web) pattern of windshield breakage in fron of the steering wheel. CONCLUSION: Minor injuries of the upper extremity can occur when contacted by the deploying airbag either directly or by flinging the hand-forearm into interior car structures. Fractures of the forearm are rare and usually are due to direct impact by the forceful opening of the airbag module door.
We present a technique of providing complete skin cover for total degloving injuries of the hand and distal third of the forearm. This involves the use of a Y-shaped hypogastric groin flap. The proximal portion of the Y is tubed allowing the distal portion of each flap to be applied to the dorsal and volar surfaces respectively. This technique allows complete skin cover of both surfaces and yet retains the advantages of the groin flap in that it still has a long pedicle allowing the hand to be put through a full range of motion, speeding rehabilitation.
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