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PubMed2005

[Difficulties in the diagnosis of isolated radial artery injuries: a case report].

Arterial injuries of the forearm account for an important fraction of peripheral vascular injuries. Early diagnosis and treatment are important for both function and viability of the extremity. Arterial injuries of the forearm mostly occur as a result of glass or knife cuts and gunshot wounds and the presence of accompanying injuries may facilitate the diagnosis. However, in this case (50-year-old male patient), a piece of nail behaved like a high-energy particle and injured the radial artery without any accompanying lesion. Detection of normal pulses in the radial and ulnar arteries delayed the diagnosis and treatment. This case report aimed to address difficulties in establishing the diagnosis of isolated radial artery injuries.

Diagnosis, Differential↗
PubMed1997

[Replantation in childhood and adolescence. Long-term outcome].

In 31 (out of 48) patients with 43 (out of 63) replanted or revascularized digits or parts of the extremities a study of long-term results was performed. Their ages were below 16 years at the time of injury. The results concerning function, sensitivity, cold intolerance, growth disturbance, patient acceptance and occupational changes were evaluated. Early complications consisted of venous stasis in 10.6% (n = 4), skin necrosis of the wound margin in 5.3% (n = 2) and in finger-tip necrosis in 5.3% (n = 2). One lower arm and one finger replanted (5.3%, n = 2) were lost after several revisions due to venous problems. In no case did arterial problems occur. Tendon adhesions were the most common complication in 28.9% (n = 11), followed by deviation of the axis in a frontal plane of more than 20 degrees in 13.3% (n = 5) and by joint instability in 5.3% (n = 2). Only twice (5.3%) did ankylosis or in another case osteomyelitis of the proximal phalanx result. At amputation level II (between the DIP joint and the nail root), 37.5% (n = 3) developed a reduction of range of active movement (RAM) with a mean of 31.7 degrees, and once an arthrodesis was necessary, whereas 50% (n = 4) of the patients have full range of active motion. At amputation level III (between the MP and DIP joint) 52.7% (n = 10) developed a reduction of RAM at the PIP joint with a mean of 29.5 degrees, and twice an arthrodesis was necessary, whereas 26.4% (n = 5) of the patients have full range of active motion. Of the patients 78.9% (n = 15) developed a reduction of RAM at the DIP joint with a mean of 35.7 degrees, and twice an arthrodesis was necessary. Only twice was ankylosis present, but 10.5% (n = 2) of the patients have full range of active motion. Excellent sensory recovery was observed with a mean dynamic two-point discrimination of 4.8 mm. In addition, only 29% (n = 9) of the patients report a surprisingly low incidence of cold intolerance, which is in contrast to adults with up to 100% cold intolerance in replanted digits. In 67.7% a radiologically measured difference of length with a mean of 3.8 mm and clinically measured a difference in the length of the digits with a mean of 4.9 mm was observed without complaints by the patients, instead, there was moderate discontent with the aesthetically disturbing fingertip atrophy, which was up to 30% in 48.4% of the patients. Of the patients who are now adult, 16.7% (n = 4) changed their choice of profession due to the trauma or because of the dissatisfactory result. These results and the success rate of 94.7% suggest the conclusion that one should not hesitate to perform a replantation or revascularization in children with even multiple amputations as the results are excellent.

Adolescent↗
PubMed1988

Why do children break their arms?

Over a 1-year period the mode of fracture of the long bones of children's upper limbs was analysed. There were 277 fractures and 4 dislocations recorded. The most common fractures were of the distal radius and ulna. Most injuries were due to falls from a low height but those from a high fall necessitated hospital admission most frequently. Preventative measures are discussed.

Accidental Falls↗
PubMed1991

Fishhook injuries: a prospective evaluation.

A prospective study was conducted involving 100 nonrandomized, consecutive patients who suffered fishhook injury during the summer of 1990 in Alaska. Time of injury prior to admission to the emergency department, location of fishhook, method of removal, wound care, systemic antibiotic prophylaxis, anesthetic, tetanus immunization status, fishhook size, and complication rate were evaluated. Results of this study suggest that most fishhook injuries involve the hands or head and that postremoval wound care including oral antibiotic therapy may not be critical. Local anesthetics and simple removal techniques are adequate for nearly all fishhook injuries. Routine systemic antibiotic prophylaxis is not necessary for uncomplicated soft tissue injury due to fishhooks not involving cartilage or tendons.

Alaska↗
PubMed2006

The role of imaging of work-related upper extremity disorders.

Work-related upper extremity disorders can pose a diagnostic and management challenge because the nontraumatic disorders that are often believed to be caused by repetitive work activities can and do occur without any apparent provoking activity and can be caused or associated with many systemic medical conditions. One mainstay in the assessment of hand and arm disorders remains imaging. Imaging capabilities have made incredible advances with the advent of MRI, CT, ultrasound, bone scan, and numerous technologies that enable clinicians to view fine details of anatomy and pathology. This article reviews the potential imaging choices and clinical indications for work-related injuries of the elbow, hand, and wrist.

Arm Injuries↗
PubMed1991

Left-side dominance of upper extremity fracture in children.

In 148 children who had sustained trauma to the upper extremities from falls, fractures were twice as common on the left as on the right side. This seemed to be due to the childrens' preferential use of the left hand to parry the fall even when both hands were free and because the left arm seemed to be more easily broken than the right arm during trauma.

Adolescent↗
PubMed1995

Major amputation of the upper extremity. Functional results after replantation/revascularization in 47 cases.

Over a 7 year period, 47 patients underwent replantation of complete (19) and revascularization of incomplete nonviable (28) amputations of the upper extremity. Revascularization of incomplete nonviable amputations had a success rate of 100 percent, where as replantation of complete amputations had a success rate of 74 percent. 37 of the 42 patients with successful replantations had satisfactory functional use of the replanted extremity.

Activities of Daily Living↗
PubMed1993

The effect of upper extremity trauma on handedness.

The effect of severe trauma on handedness was studied through patient responses from 146 questionnaires that were correlated with individual chart review. Subjects were asked to designate their hand use preference, before and after injury, when performing 16 activities. The incidence of change in hand use was determined within four diagnostic types and five designated anatomical levels of injury. Results indicated a significant difference in the way subjects in different diagnostic types and anatomical levels of injury performed. Simple, short activities that did not require sustained fine motor coordination were reported as being performed more easily with a different hand after injury than complex, continuous activities that required sustained fine motor coordination. Significant differences in job duties and place of employment were found for the anatomical level of an injury but not for diagnostic type. Findings suggest that the diagnostic type, the anatomical level of an injury, and the complexity of a task should be considered before changes in hand use are recommended.

Activities of Daily Living↗
PubMedDate not supplied

[Extremity vascular traumas].

OBJECTIVE: The Authors report on a series of 61 vascular traumas treated over a 7 years, separated in two groups. The first one includes 35 cases, that are street accidents, on the work and gunshot wounds. The second group includes 26 iatrogenic causes due to arterial catheterism. METHODS: All patients underwent ecocolor Doppler directly in the operating theatre and, when this diagnostic procedure was not enough, pre-operating angiography was used (10 cases of complex traumas of the lower limb). RESULTS: One death was reported far each groups (3.27%). In 55 cases (90.1%), limb savage was achieved. In the others 4 (6.93%) of the first group, limb demolition was necessary for different causes. In the first group, severe neurological sequelaes were observed in 2 cases and motor deficits caused by tendon lesions in 1 case. CONCLUSION: The good results obtained are the result of the short ischemic interval between the acute event and treatment, thanks to a multidisciplinary approach of a specific equipe, that is rapid as possible.

Accidents, Occupational↗
PubMed1994

[Epiphyseal growth after replantation in childhood].

Long-term results in 17 patients with 19 replanted parts of the upper extremity after replantation during childhood are presented. Regarding longitudinal epiphyseal growth, three patients had normal growth. In 15 cases, average length of the replanted digits attained 88.6% of normal and one patient gained overgrowth of 118% of normal. In every case, consolidation of the fracture was seen. Four patients developed a deviation of the replanted finger in the frontal plane. The cause of deviation in every case was incorrect primary reposition and not a disturbance of growth of the replanted epiphysis.

Adolescent↗
PubMed1995

[Timing of management of severe injuries of the upper extremity by free flap-plasty].

From October 1986 until December 1993, fifty-five patients with severe injuries to the upper extremity were treated with 59 free flaps. The mean follow-up period was 34 months (8 TO 87 months). The average hospital stay was 19 days (8 to 40 days). Depending on the timing of reconstruction, the patients were divided into three groups: emergency reconstruction (within 24 hours after injury), delayed reconstruction (up to seven days) and late reconstruction (after seven days). In this paper we present our regime of treatment of severe upper extremity injuries using a free flap and discuss the principles of free flap choice.

Adolescent↗
PubMed2006

High-pressure injection injuries to the upper extremity: a review of the literature.

OBJECTIVES: The purpose of this review was to identify the relative impact of injected material, location of injury, time to debridement, injection pressure, infection, and the use of adjuvant steroid medication upon the need for amputation after high-pressure injection injuries to the upper extremity. DATA SOURCES AND STUDY SELECTION: A Medline literature search extending from 1966 to December 2003 was performed, referencing the key words "high-pressure injection injury," "grease gun injury," "paint gun injury," "pressure gun injury," and "high-pressure injection." The results were limited to the English language and to reports involving human subjects. Each abstract was reviewed to confirm that the described injury had occurred in the upper extremity and that it had truly been a high-pressure injection. The reference pages from each of the papers were reviewed to identify additional reports of high-pressure injection injury. Manuscripts describing injuries resulting from hand held syringes or other low-pressure mechanisms were excluded. DATA EXTRACTION: All of the manuscripts were analyzed to identify the clinical outcome, age, hand dominance, site of injection, substance injected, injection pressure, elapsed time to wide debridement, use of steroids, and incidence of infection. These variables were subjected to a Pearson chi test to determine their impact upon the need for amputation. RESULTS: Four hundred thirty-five cases of high-pressure injection injury to the upper extremity were identified. The amputation rate after these injuries was 30%. The location of the injury and the material injected contributed significantly to the need for amputation. For injections of paint, paint thinner, gasoline, oil, or jet fuel (organic solvents), the amputation risk was lower if wide surgical debridement occurred within 6 hours of injury. Steroids did not impact the amputation rate or incidence of infection. The presence of infection did not affect the incidence of amputation. CONCLUSIONS: The risk of amputation after high-pressure injection injury to the upper extremity is highest with organic solvent injection into the fingers. Injections into the thumb or palm result in a much lower frequency of tissue loss. Emergent surgical debridement reduces the amputation risk after injections of organic solvents. From the available data, no conclusions could be reached regarding functional outcomes, other than amputation, after high-pressure injection injury.

Forearm Injuries↗