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At least 577 records · Page 32Linked to original sources
PubMed1994

Free muscle transfer in Volkmann's ischaemic contracture.

The results of treatment of 28 cases of Volkmann's ischaemic contracture by free muscle transfer are presented. Attention is drawn to the existence of an infarct in the median nerve in addition to the infarct in the muscle and that loss of nerve function is as important as the motor loss in determining functional outcome. Comparison of those cases treated early (within 6 months of injury) by free vascularised muscle transfer with those operated late showed better sensory recovery in the early treated group while the amount of motion obtained was not significantly different. Our present indications, timing, and technique of free muscle transfer in Volkmann's ischaemic contracture are discussed.

Adolescent↗
PubMed1995

Serratus anterior intercostal nerve graft: a new vascularized nerve graft.

We present our investigative and clinical experience with a new vascularized nerve graft: the serratus anterior intercostal nerve graft. The serratus branch of the thoracodorsal arterial system was injected with silicone rubber injection compound in seven fresh cadavers (N = 11 injected specimens) after the composite serratus-intercostal structures were harvested. Microdissection of selected vascular territories was then performed. Our findings reconfirmed the previously described vascular connections between the thoracodorsal system and the intercostal vessels via periosteal vessels. We also newly discovered vascular anastomoses between the serratus anterior muscle and the intercostal artery running within a mesentery. This mesentery is lateral to and distinct from the serratus-periosteal-intercostal network. The nerve graft was applied clinically in the reconstruction of a complex soft-tissue, 13-cm ulnar nerve defect of the volar forearm after an electrical injury. The clinical application was successful with limb salvage and return of protective sensation at 4 months. Our clinical and investigative results support the feasibility of the serratus anterior intercostal nerve graft, a unique and versatile new vascularized nerve graft.

Adult↗
PubMed2001

Unusual development of acute compartment syndrome caused by a suction injury: a case report.

There have been recent reports of acute compartment syndrome secondary to suction injuries of the hands of children. We report the case of a 68-year-old patient who developed an acute compartment syndrome of the forearm after his arm had been sucked into an exhaust port. He was treated by emergency fasciotomies and the wound was closed five days later with a small skin graft. His recovery was uneventful.

Acute Disease↗
PubMed1995

[Swelling of the sternoclavicular joint].

From 1990 through 1993 nine patients presented with unexplained swelling of the sternoclavicular joint. In some cases a tumor was suspected. The clinical histories included trauma with injury of forearm and wrist or strain on the shoulder girdle without acute onset of any symptoms in the sternoclavicular joint. In trauma cases the time from injury to onset of symptoms was between 1 day and 1 year (median 5 weeks). CT studies demonstrated widening of the joint space in two cases, thickening of the pectoral muscle in six cases and thickening of capsule and ligaments in five cases. In one case arthroplasty of the sternoclavicular joint was performed and in a second we performed a biopsy. The remaining cases were not treated. Other differential diagnoses to be considered in the case of a swelling of the sternoclavicular joint are listed.

Adolescent↗
PubMed2006

Minimal change disease in association with fire coral (Millepora species) exposure.

Numerous agents have been associated with minimal change disease. We describe a previously unreported association in a 45-year-old white woman of scuba diving exposure to fire coral (Millepora species) that was followed by the development of nephrotic syndrome, acute renal failure, pulmonary edema, and intubation. The renal biopsy specimen was consistent with minimal change disease. Institution of corticosteroid therapy resulted in symptomatic improvement and resolution of proteinuria. Physicians, particularly those in scuba-diving areas, should consider minimal change disease in exposed patients with proteinuria because a prompt diagnostic and therapeutic approach may potentially limit complications.

Acute Kidney Injury↗
PubMed2005

Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair.

BACKGROUND: The aim of this study was to quantify variables that influence outcome after median and ulnar nerve transection injuries. The authors present a meta-analysis based on individual patient data on motor and sensory recovery after microsurgical nerve repair. METHODS: From 130 studies found after literature review, 23 articles were ultimately included, giving individual data for 623 median or ulnar nerve injuries. The variables age, sex, nerve, site of injury, type of repair, use of grafts, delay between injury and repair, follow-up period, and outcome were extracted. Satisfactory motor recovery was defined as British Medical Research Council motor scale grade 4 and 5, and satisfactory sensory recovery was defined as British Medical Research Council grade 3+ and 4. For motor and sensory recovery, complete data were available for 281 and 380 nerve injuries, respectively. RESULTS: Motor and sensory recovery were significantly associated (Spearman r = 0.62, p < 0.001). Multivariate logistic regression analysis showed that age (< 16 years versus > 40 years: odds ratio, 4.3; 95 percent confidence interval, 1.6 to 11.2), site (proximal versus distal: odds ratio, 0.46; 95 percent confidence interval, 0.20 to 1.10), and delay (per month: odds ratio, 0.94; 95 percent confidence interval, 0.90 to 0.98) were significant predictors of successful motor recovery. In ulnar nerve injuries, the chance of motor recovery was 71 percent lower than in median nerve injuries (odds ratio, 0.29; 95 percent confidence interval, 0.15 to 0.55). For sensory recovery, age (odds ratio, 27.0; 95 percent confidence interval, 9.4 to 77.6) and delay (per month: odds ratio, 0.92; 95 percent confidence interval, 0.87 to 0.98) were found to be significant predictors. CONCLUSIONS: In this individual patient data meta-analysis, age, site, injured nerve, and delay significantly influenced prognosis after microsurgical repair of median and ulnar nerve injuries.

Adult↗
PubMedDate not supplied

Neurological complications resulting from supracondylar fractures of the humerus in children.

One hundred thirty-eight children with supracondylar fractures of the humerus were reviewed. Seventeen (12%) exhibited neurological deficits. Nine median, four ulnar, and four radial neuropathies were encountered. The neurological deficit was treated expectantly. The osseous injury was treated by a variety of methods. All patients except two recovered spontaneously in an average of 9 weeks. One patient was still improving at 9 months' follow-up. Another patient with radial neuropathy underwent exploration 6 months after injury and was found to have a transected radial nerve. This study demonstrates that neurological deficits from supracondylar humeral fractures remain common, involve all three major nerves of forearm, and, with rare exception, recover with conservative therapy.

Child↗
PubMed2005

Treatment of acute flexor tendon injury: zones III-V.

Many of the principles of flexor tendon repair and rehabilitation can be applied to zones III-V. Injuries in zones III-V are rarely isolated and neurovascular involvement is common. Because of the often extensive and unknown degree of injury, there should be a low threshold for surgical wound exploration. Primary repair of injured tendons and neurovascular structures is recommended by way of a systematic approach. Good to excellent outcomes in range of motion and tendon function can be expected; however, functional outcomes of associated nerve injuries are varied, with younger patients generally demonstrating the best results (Fig. 2E).

Forearm↗
PubMed1995

Free arterialized venous forearm flap.

Arterialized venous flaps are the result of the search for new flap techniques because conventional flaps are sometimes insufficient and have donor-site morbidity problems. In the patient presented here, a free arterialized venous flap measuring 12 x 8 cm was transferred from the forearm to a burn-scarred area on the face. This flap contained two parallel main veins, one was arterialized for perfusion and one was for the venous drainage. The flap we have designed is advantageous in that it is not bulky, it has less donor-site morbidity, it does not sacrifice one major artery, and it uses the rich venous network of the forearm. The operative and postoperative results are satisfactory.

Adult↗
PubMed2003

Gunshots to the hand and upper extremity.

Gunshot injuries to the hand and upper extremity have been studied during military conflicts and in urban settings. Treatment concepts include identification of injured structures, aggressive surgical wound care, and reconstruction of important functional structures. There are various types of missile injuries. For simplicity, low-energy injuries imply limited damage, and require only conservative approaches. High-energy injuries are complicated by significant tissue destruction, rehabilitation dilemmas, and uncertain outcomes. The surgeon must recognize the anatomic complexity of the hand and proceed with caution. Most gunshot injuries to the hand involve a combination of tissue types. Bone injury is dramatic and is seen radiographically. However, injury to the soft tissue including skin, tendon, blood vessel, and nerve also must be appreciated. Individually, the tissues have varied function and properties of healing. Therefore, the challenge is to prioritize the injury, select an aggressive surgical approach, and integrate a suitable rehabilitation plan.

Bone and Bones↗
PubMed1995

Contralateral median nerve autograft.

Interfascicular nerve autografting is a useful method to repair nerves with gaps, mainly if the removal of a nerve does not imply a defect to the donor area. Final results of peripheral nerve repair definitely depend on the size of the nerve gap, the level of the injury and the time elapsed from the time of injury until the nerve is repaired.

Electromyography↗
PubMed1998

Internal fixation of multiple fractures in patients with polytrauma.

Within the last decade understanding of the pathogenetic consequences of trauma has been improved significantly. An additional reduction of lethality has been achieved that in part is related to increasing discrimination of complex injury patterns. Accordingly, additional staging in fracture management of these injuries has been developed. An overview of the current status of fracture management in polytrauma is given and certain regimens that are still controversially are discussed. The principles determined are based on the treatment experience of 4003 multiply injured patients within the past 23 years. The most important principles within the first hours after trauma represent adequate hemorrhage control. In fracture treatment the primary goal remains to perform primary stable osteosynthesis. In severe polytrauma with severe injuries to the extremities, the first decision is whether limb salvage can be achieved without risk of deterioration of the patient's condition. If this is the case, open fractures Grades III b and c usually can be stabilized primarily by unreamed intramedullary nailing or percutaneous plating. The priority pattern in multiple closed fractures is as follows: (1) tibia; (2) femur; (3) pelvis; (4) spine; and (5) upper extremity. Exceptions may ensue if severe head or thoracic trauma is present. Delayed treatment is performed for complex joint reconstruction, definitive treatment of maxillofacial injuries, and soft tissue reconstruction.

Algorithms↗
PubMed1992

Iatrogenic injection injuries of the hand and upper limb.

30 cases of iatrogenic injection injuries to the hand and upper limb are reported. 16 followed therapeutic injections (steroids--11 cases, infusions--five cases) and 14 occurred during anaesthetics procedures (local blocks--ten cases, general anaesthetics--four cases). Guidelines for minimizing the risk of injection injury are outlined.

Adolescent↗