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PubMed1990

[A rare cause of compartment syndrome of the forearm and hand following snake bite injury].

With the intention to commit suicide a 25 year old patient was bitten by his own rattle snake. At the time of the admission the skin of the right forearm was dark, a hemorrhagic necrotizing colour, and the patient was in shock. He was immediately taken to the intensive care unit and the shock symptoms were treated there. Parasthesias in the area of the nervus medianus were also noticed. The treatment included an antiserum and the release of the tourniquet which caused a further increase of the swelling of the forearm. The lesion led to a hemorrhagic necrotizing inflammation. The surgical incision of the loge of Guyon, the carpal channel, the forearm and proximal of the lacertus fibrosus was persuaded. The circulation improved immediately and after three weeks the nerval function had recovered. The skin defect was covered 14 days after the first operation with meshgraft.

Adult↗
PubMed1996

Ulnar nerve laceration in a closed both bone forearm fracture.

Ulnar nerve injury is rarely associated with closed forearm fractures. This report describes a case of ulnar nerve laceration secondary to a closed fracture of the radius and ulna. Although a case report of an ulnar nerve laceration in an open fracture has been described, a review of the literature failed to reveal any cases in closed injuries. The standard surgical approach was modified to allow treatment of the fractures and microscopic repair of the nerve.

Accidental Falls↗
PubMedDate not supplied

Helicopter skiing wrist injuries. A case report of "bugaboo forearm".

Of the 42 skiers, 5 (11.9%) experienced symptoms of intersection syndrome early in their week of powder skiing. According to the mountain guides employed by the helicopter service, this overuse injury is quite common and does not represent an unusual incidence for this group of skiers. The mechanism of injury is likely repetitive dorsiflexion and radial deviation of the wrist against the resistance of deep snow on withdrawal of the planted ski pole. Interestingly, the more advanced competitive alpine skiers appeared to be most at risk, possibly because of their more aggressive pole plants. Preventive measures should include instruction in proper pole technique for powder skiing, avoidance of pole dragging and deep pole plants, and downsizing baskets from the standard 4-inch diameter to 2.5-inches and pole length 2 inches shorter than the recommended length for that skier. Once symptoms occur, switching to a different diameter grip, using the pole strap, nonsteroidal antiinflammatory medications, ice, taping of the thumb and wrist, and night splinting appear to offer some relief. Surgical treatment as described by others. is generally successful for those who fail conservative treatment.

Adult↗
PubMed1997

Neurosensory free flaps. Digits and hand.

Repairing complex soft-tissue defects of the hand and fingers remains a daunting task. Maintenance of functional mobility and sensibility are paramount in determining donor-site tissue. Critical sensibility is important for defects of the fingers and can be replaced only with tissue from the palmar surface of the hand itself or by free-tissue transfer from the toes. In this regard, glabrous skin and pulp from the great toe demonstrates the most critical level of sensibility, followed by tissue from the second toe. Complex soft-tissue defects of the palm, dorsum of the hand, or first web space can be replaced effectively by flaps that provide protective sensibility. The standard flaps employed are the lateral arm or radial forearm. The ultimate consideration in dealing with these difficult problems must be determined by the judgment and technical sophistication of the surgeon.

Finger Injuries↗
PubMed1996

Closure of wounds in the upper extremity using a skin stretching device.

A skin stretching device (SSD) harnessing the viscoelastic properties of skin using incremental traction has been used in 20 patients with skin deficits in the upper extremity. Complications were few considering the extensive damage to the skin and included slight partial dehiscence, necrosis of skin edges, local infection and hypertrophic scars. All wounds healed without the need for further surgical procedures. Application of the SSD is simple and it can even be used at the bedside under local anaesthesia. It reduces the need for more complicated surgical procedures like grafts or flaps.

Adult↗
PubMedDate not supplied

Fracture patterns in Nottingham children.

The incidence and pattern of fractures in children less than or equal to 12 years of age living in Nottingham, England, have been reviewed. The annual incidence rate is 16/1,000 children. Fractures are rare in those less than 18 months of age, and incidence increases with age. The most common cause of fracture was a fall in or around the home; the incidence rate of fractures after road traffic accidents was similar in all age groups. Fractures of the distal radius and ulna accounted for 35.8% of all fractures seen, with hand fractures the second largest group (14.7%). The most common fracture type was a green-stick fracture (51.6%), and 18.5% of fractures were epiphyseal injuries. Epiphyseal injuries in children less than 5 years of age, were uncommon whereas spiral/oblique fractures were more common. Rotational trauma is more likely to cause a spiral or oblique shaft fracture in a younger child and an epiphyseal fracture in an older child.

Accidents, Home↗
PubMed1998

Occurrence and trends in ski injuries in Norway.

OBJECTIVES: To provide an overview of ski injuries in Norway and to describe the changes between 1990 and 1996. METHODS: All ski injuries (7966) treated at four hospitals providing health care to a defined population of about 11% of the Norwegian population were registered prospectively from 1990 to 1996. For this study, 6462 injuries sustained in cross country skiing, downhill skiing, telemark skiing, and snowboarding were selected for further analysis. RESULTS: The relative distribution of ski injuries by type of skiing changed significantly from 1990 to 1996 (p<0.001). Injuries from snowboarding showed the highest relative increase, and those sustained during downhill skiing showed a decline. The proportion of fractures in all types of skiing increased during the study period (p=0.001). The proportion of injuries to knee/lower leg decreased and the proportion to the forearm/wrist/hand increased during the study period (p=0.03). The mean age of the injured skiers differed significantly among the different types of skiing activity (p<0.001): cross country skiers were the oldest followed by telemark skiers, downhill skiers, and snowboarders. CONCLUSIONS: Ski injury surveillance results in early detection of changes in temporal injury trends, allowing timely adjustment of injury prevention strategies. Injuries from snowboarding are on the increase in Norway, warranting more effective injury prevention measures.

Abbreviated Injury Scale↗
PubMed2003

The surgical management of pediatric fractures of the upper extremity.

The vast majority of pediatric fractures of the upper extremity can and should be treated with closed reduction, immobilization, and close follow-up. However, there is an ongoing debate in the orthopaedic community regarding the exact role of surgical management in the treatment of pediatric fractures. In the past 2 decades, surgical management of certain fractures (e.g., percutaneous pinning of displaced supracondylar fractures) has provided better results than closed management. Surgical management is clearly indicated for certain injuries, such as those requiring anatomic realignment of the physis or articular surface. Increasingly, however, surgical management is being used to maintain optimal alignment or to allow early motion. In many such cases, both nonsurgical and surgical methods have yielded good results and have vocal advocates. Certain technical advances, such as flexible intramedullary fixation and bioreabsorbable implants, have further increased enthusiasm for surgical management of pediatric fractures.

Adolescent↗
PubMed2003

[An appropriate alternative for the reconstruction of soft tissue defects in the hand and the wrist: the distally-based island posterior interosseous flap].

OBJECTIVES: We evaluated the use of a distally-based island posterior interosseous flap in patients with soft tissue defects of the hand and the wrist. METHODS: The distally-based island posterior interosseous flap was used to cover soft tissue defects in eight patients (1 female, 7 males; mean age 30 years; range 9 to 51 years). Of these, six patients had crush injuries, and two patients had wrist flexion contracture due to high-voltage burns. The defects were in the volar aspect of the wrist in two patients, in the dorsum of the thumb metacarpal in two patients, and in the dorsum of the metacarpals in four patients. The mean follow-up period was 3 months (range 2 to 7 months). RESULTS: The results were satisfactory in all but one patient. Flap necrosis developed in one patient with crush injury of the hand and blunt injury of the forearm. Venous congestion of the flap was encountered in four patients, but none resulted in flap necrosis during the follow-up period. CONCLUSION: The distally-based island posterior interosseous flap may be easily and safely employed in the coverage of soft tissue defects of the hand and the wrist due to such advantages as minimal donor area morbidity, an acceptable cosmetic appearance, and a more simple dissection than required for other surgical flaps.

Adolescent↗
PubMed1987

[Use of the free forearm flaps in cervicofacial surgery. Apropos of 5 cases and review of the literature].

The free fasciocutaneous forearm flap has been described only recently. Five cases of pharyngeal or oral repair with a forearm flap (FAF) are reported and used as a basis to discuss anatomical features and the technique used for removal of the flap. The relevant literature is reviewed. The FAF appears to be the flap of choice for reparative surgery of pharynx or mouth regions in oncology, the principal advantages of this flap being: fineness, flexibility and plasticity of the skin, reliability and lack of morbidity, and function effectiveness with respect to phonation and feeding. Indications for forearm and myocutaneous flaps in oncology of upper respiratory and digestive tracts are assessed critically, other indications for the forearm flap being cutaneous repair of cervicofacial lesions due to tumor or injury. The forearm flap is of pronounced value for cervicofacial repair surgery and constitutes a new step in the plastic conception of these repair procedures.

Adult↗
PubMed2006

Protective effect of female gender against bone loss in the forearm following clean-cut tendon injuries, repair, and passive mobilization.

The aim of this study was to investigate whether there is any significant difference in bone loss between female and male patients as a result of early passive mobilization after surgery for acute tendon-artery-nerve clean-cut injuries at the wrist level. A total of 51 patients who underwent such operations were enrolled in this study. Group I consisted of 40 male patients (mean age 30.2 +/- 9.1 years, age range 15-44 years) and group II consisted of 11 female patients (mean age 24.1 +/- 9.9 years, age range 14-43 years); postmenopausal women were not included in this group. Twenty-one patients in group I and six patients in group II were operated on for clean-cut tendon injury combined with nerve injury, artery injuries, or both. Bone mineral density (BMD) measurements of injuired forearms were obtained at 1 week, 6 weeks, 3 months, and 12 months after operation. The BMD of the radius and ulna did not change significantly throughout the follow-up period in group II (P > 0.05). In group I, BMD values were reduced significantly in the distal regions of the ulna and in the ultradistal region of the radius at the follow-up measurements when compared to the values at week 1 and the reduction was higher in month 3 than at other times. On the other hand, after 12 months, the BMD values of the ultra-distal region of the ulna and radius were higher than those after 3 months. In conclusion, our results showed that there is considerable bone loss of the radius and ulna in patients operated on for acute clean-cut tendon injuries on the volar side of the wrist at postoperative month 3 in male patients. These bone losses were recovered after 12 months. Additionally, female patients are less likely to experience immobilization-induced bone loss than male patients.

Adolescent↗
PubMed2001

[Timing of soft tissue reconstruction in severe crush injury of the upper extremity].

Complex injuries of the distal forearm and the hand by industrial machines often require extensive reconstructive procedures. Crush injuries with soft tissue damage extending over the limits of visible injury require a special approach. Large soft tissue defects often have to be covered by extensive flap procedures. The optimum point of time for plastic reconstruction is an essential question and represents a controversial issue in the literature. To be able to compare different patient cohorts in the future, we classify crush injuries into five clinically relevant categories. In the course of this review article, three different cases of severe crush injuries of the upper extremity are representatively discussed. Two patients were reconstructed in a secondary procedure, one patient in the acute phase. Definite coverage of soft tissue defects in severe crush injuries should be performed secondarily after 5-7 days since the extent of damage in this special form of trauma can often only be judged after a few days and the reconstruction of bones, vessels and tendons is completed.

Accidents, Occupational↗