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At least 613 records · Page 34Linked to original sources
PubMed1990

The Hungerford disaster. A late perspective of the military experience.

Two years have passed since the worst firearms incident in recent British civil history. Most of the casualties were managed at a local district general hospital; this experience was reported soon afterwards. Two casualties were managed at Princess Alexandra's Hospital, RAF Wroughton; both are still under review. This paper describes their injuries, investigations and treatment. Current thoughts on optimal management are discussed; areas of particular controversy are highlighted.

Adult↗
PubMed2005

Shock attenuation of various protective devices for prevention of fall-related injuries of the forearm/hand complex.

BACKGROUND: Attenuation of the peak impact force is essential in any protective devices for prevention of fall-related injuries. HYPOTHESIS: Common wrist guards have limited effectiveness because of the multifaceted nature of wrist injury mechanisms, and other modalities may provide enhanced shock-absorbing functions. STUDY DESIGN: Controlled laboratory study. METHODS: A free-fall device was constructed using a mechanical surrogate to simulate falling impact. At 4 different falling heights, 5 different hand conditions were tested: bare hand, a generic-brand wrist guard, a Sorbothane glove, an air cell, and an air bladder condition. The impact force from the ground and the transmitted impact force to the forearm/hand complex were simultaneously measured. RESULTS: The falling height and hand condition significantly modulated the impact responses. The padded conditions always had significantly smaller peak impact forces compared with the bare-hand condition. The wrist guard became ineffective in impact force attenuation beyond the falling height of 51 cm. On the other hand, the air bladder condition maintained less than 45% of the peak impact force of the bare-hand condition and remained below the critical value, whereas other conditions were all ineffective. CONCLUSION: It was reconfirmed that common wrist guard design could provide limited impact force attenuation, whereas damped pneumatic springs would provide substantially enhanced shock-absorbing functions. CLINICAL RELEVANCE: A wrist guard incorporating volar padding with the pneumatic spring design principle might be more effective at preventing injuries than are currently available designs.

Accidental Falls↗
PubMed1997

Upper-extremity arterial injury.

Current experience in the management of upper-extremity arterial injury in a Level I trauma center between 1992 and 1994 is reported. Arterial trauma was seen in 21 of 643 (3.3%) patients admitted with upper-extremity injury. The mechanism of injury was penetrating in 15 of 21 and blunt in 6 cases. Patient characteristics were: 18 of 21 male, mean age 28, left upper extremity 12 of 21, and 4 patients in shock. Preoperative angiography was performed in 12 of 21 cases (5 of 6 blunt and 7 of 15 penetrating). Involved arteries included: brachial (10), axillary (5), radial (3), and subclavian (3). Associated injuries were common: nerve (9), bone (7), and vein (5). Twenty patients were explored; 18 of 20 underwent arterial repair (16 graft, 2 primary repair), and two proximal arteries were ligated. One intimal flap in the subclavian artery was observed, with a good result. Nerves were repaired in four cases, all with transection, and in four cases there was neurologic deficit without focal transection and no repair was performed. One patient died before his nerve injury could be repaired. Most venous injuries (four of five) were ligated, and three patients with blunt arterial injury underwent forearm fasciotomy. Immediate limb salvage was 100 per cent; there was one in-hospital mortality (4.7%) from exsanguination, and there was one persistent clinically significant late motor nerve deficit. Mean follow-up was 94 days (range, 0-305 days). Upper-extremity arterial injury often can be managed without angiography, particularly in cases of penetrating trauma. Good results can be anticipated with prompt arterial and nerve repair combined with selective use of venous reconstruction and fasciotomy.

Adult↗
PubMed1998

[Inline skating, an old sport, newly discovered: harmless or a potential danger with socioeconomic effects?].

Over a period of one year, all accidents associated with in-line skating (ILS) were surveyed. Sport-specific data was recorded with a standardized questionnaire. The study comprised 66 patients with 75 injuries (48 upper limb, 16 skull, eight lower limb, three trunk). We were looking after 42 male and 24 female patients with an average age of 20 years (5-53 years). Twenty-seven patients (40%) had to be treated as inpatients. Overall, the most frequent injury (one third of all injuries) was forearm fracture close to the wrist (21 radius fractures, four radioulnar fractures). It had to be reset in 20 cases. Additional internal fixation was required in 10 cases (Kirschner wire osteosynthesis, intramedullary nailing or plate osteosynthesis). Only five patients could be treated with plaster cast fixation alone. Most patients with injuries in the vicinity of the wrist were not wearing a wrist protector at the time of the accident. The most frequent reasons given for not wearing protectors was forgetfulness or the high price of protectors. However, there were also two distal radius fractures and a disc injury in the wrist in patients who had been wearing wrist protectors. In most cases, ILS accidents lead to appreciable damage requiring a healing period of several weeks to months (average period of loss of work 41 days). The bfu (advisory center for accident prevention) reckons with 60,000 ILS cases annually in Switzerland. These injuries are thus of great socioeconomic importance. In the future, better risk behavior must be achieved by informing the population (wearing protectors, especially for the wrist and head, attendance of training courses).

Absenteeism↗
PubMed1984

Traumatic dorsal dislocation of the triquetrum: a case report.

A case of traumatic dorsal dislocation of the triquetrum associated with direct trauma is reported. Diagnosis was delayed, and open reduction and internal fixation with Kirschner wire was performed 7 days after injury. Eight months afterwards, the patient had good alignment of the carpus assessed radiographically, with full range of motion of the wrist and normal grip strength.

Carpal Bones↗
PubMed2004

Deep cutting injury from the edges of a snowboard.

A laceration deep enough to reach the bone occurs very rarely in skiing or snowboarding. Two such cases are presented here. In one case, the popliteal fossa of a skier was cut during a collision with a snowboarder. All structures posterior to the knee were severed and the leg became ischaemic. The other case was of a snowboarder who sustained a deep cut to the distal forearm during landing after a jump, resulting in a "spaghetti wrist".

Adult↗
PubMed2001

Radial forearm fasciocutaneous free-tissue transfer in ankle and foot reconstruction: review of 17 cases.

Seventeen patients who underwent soft-tissue reconstruction of various anatomic regions of the foot and ankle, using the radial forearm fasciocutaneous free flap, are reported. The procedures were performed between January, 1992 and December, 1998. Indications for reconstruction included diabetes and/or vascular insufficiency (four patients), soft-tissue defects (six patients), and chronic osteomyelitis (seven patients). The weight-bearing surface of the foot was involved in 16 patients. Defects ranged in size from 35 to 206 cm2 (mean: 86.2 cm2). At a mean follow-up of 3.8 years, the radial forearm flap was successful in all cases (100 percent). Flap complications included superficial infection (three patients), and minor wound dehiscence at the flap-leg-skin interface (two patients). Recurrent ulceration occurred in two patients; both were diabetics with weight-bearing flaps. Donor-site complications included partial skin graft loss with tendon exposure in one patient, which healed with conservative management. Recurrent or persistent osteomyelitis was not demonstrated in any of the patients. Of the 16 patients with weight-bearing flaps, 12 were ambulatory, three had limited ambulation, and one was non-ambulatory. Three patients required modified shoes. No debulking of the transferred flaps was necessary. The radial forearm flap is one of the preferred flaps for reconstruction of moderate-sized ankle and foot defects, for weight-bearing surfaces, and in the treatment of osteomyelitic and diabetic wounds. It meets most of the anatomic prerequisites for an ideal foot coverage; it also facilitates the restoration of normal foot contour, allowing patients to wear ordinary shoes. The flap provides a durable and stable weight-bearing plantar surface during ambulation, and achieves excellent aesthetic results; when used as a neurosensory flap, it permits adequate reinnervation.

Ankle↗
PubMed1997

Case report of metallic mercury injury.

OBJECTIVE: Injury and poisoning from metallic mercury has become a rare event. Review of the literature and a case report of pediatric metallic mercury injury are presented. DESIGN: A case report. SETTING: The Emergency Department at St. Louis Children's Hospital. PATIENTS OR PARTICIPANTS: A 15-year-old boy. INTERVENTIONS: None. MAIN OUTCOME MEASURES: None. RESULTS: The 15-year-old boy fell on a broken mercury thermometer. A subcutaneous abscess formed on his left forearm during the next five days. He had no signs or symptoms of mercury toxicity. His wound was debrided in the operating room and healed completely after several months. CONCLUSIONS: This case shows elemental mercury from a thermometer as a potential, if unusual, source of mercury toxicity.

Abscess↗
PubMedDate not supplied

Forearm and wrist radiology: Part II.

The emergency physician must be well versed in diagnosing forearm and wrist injuries. Although many of these injuries are readily apparent, others require more sophistication to appreciate. Careful attention to radiographic findings given the assistance of a well-directed history and physical examination is imperative. Both the more common and the more subtle injuries will be discussed.

Carpal Bones↗
PubMed1990

Temporary ectopic implantation.

Temporary ectopic implantation is a technique designed for extremity salvage in cases of devascularization or amputation of an essentially intact part in conjunction with extensive segmental proximal injury. A case of a traumatic midforearm amputation that survived by ectopic implantation in the abdominal wall, with subsequent replantation eleven weeks later, is presented.

Abdominal Muscles↗
PubMed2000

[Effect of intravascular low level laser irradiation used in avulsion injury].

OBJECTIVE: To explore the effect of intravascular low level He-Ne laser irradiation on skin flap survival after orthotopic transplantation in avulsion injury. METHODS: Fifty eight cases suffered avulsion injury were treated by debridement and orthotopic transplantation of avulsed flap within 6 hours, 31 of them were received intravascular low level He-Ne laser irradiation and routine treatment, and 27 of them were received routine treatment as control group. RESULTS: The survival area and quality of avulsed flap in the experimental group were superior to that of control group after 15 days of operation, and the hemorheological items were markedly changed at 5 days after operation. CONCLUSION: The better flap survival after orthotopic transplantation in avulsion injury can be improved by intravascular low level He-Ne laser irradiation through changed superoxide dismutase activity and hemorheological items in optimal irradiation intensity.

Accidents, Traffic↗
PubMed1975

Axillary nerve blocks.

Axillary nerve block is a safe and reliable method of providing anesthesia for the upper extremity. It is particularly useful because it can be applied in cases of traumatic injury where general anesthesia might present particular hazards. The use of a large volume of anesthetic solution is important, particularly when it is essential to block the musculocutaneous or axillary nerve.

Adult↗
PubMed1991

Acute plastic deformation of the ulna in a skeletally mature individual.

Acute plastic deformation of a bone refers to traumatic bending or bowing without a detectable cortical defect. We present a case that is unusual in that bowing of the ulna occurred in a skeletally mature individual and was associated with injury to the distal radioulnar joint. In this patient, the symptoms were severe enough to warrant an ulnar osteotomy. The patient regained satisfactory function. Acute plastic deformity should be suspected whenever abnormal curvature of a long bone is noted, even in adults. If the distal radioulnar joint is dislocated, the deformation should be corrected as soon as possible to avoid permanent loss of forearm rotation.

Adolescent↗
PubMed2003

Antimicrobial management of mutilating hand injuries.

Antimicrobial drugs are commonly used in the treatment of mutilating hand injuries. Valid arguments for the use of systemic antibiotics can be made despite the lack of data clearly documenting their efficacy in this clinical scenario. There is no information to support the use of topical agents in open hand injuries. When choosing an appropriate systemic antibiotic, the physician should consider unique characteristics of these injuries, the various environments in which they occur, and the potential infecting organisms. The duration of antibiotic use is arbitrary but should be minimized to avoid complications and the development of bacterial resistance.

Accidents, Occupational↗
PubMed1994

Nutritional and metabolic variables correlate with amino acid forearm flux in patients with severe head injury.

OBJECTIVE: To measure the arterial-venous amino acid flux across the forearm muscle in patients with severe head injury. DESIGN: Prospective, interventional study. SETTING: Level I trauma hospital in the neurosurgery intensive care unit (ICU) at a university medical center. PATIENTS: Eight nonsteroid-treated patients with severe head injury. INTERVENTIONS: Patients were prospectively randomized to receive either standard or supplemental intravenous zinc therapy. MEASUREMENTS AND MAIN RESULTS: Net forearm alanine, glutamine, tyrosine, phenylalanine, and branch-chain amino acid forearm flux were measured and compared with metabolic markers of energy expenditure and nitrogen excretion. There was a significant inverse relationship between the measured energy expenditure/predicted energy expenditure ratio and glutamine flux (r2 = .62; p < .05). The patients with the highest measured energy expenditure/predicted energy expenditure ratio had the greatest release of glutamine from forearm muscle. Nitrogen balance was significantly correlated with leucine flux (r2 = .53; p < .05) and with isoleucine flux (r2 = .67; p < .05). The patients with the most positive nitrogen balance had the least release of branch-chain amino acids from skeletal muscle. Tyrosine flux was highly correlated with net amino acid flux (r2 = .76; p < .01). Tyrosine flux was therefore indicative of overall muscle catabolism. Four patients had an overall negative flux of amino acids from skeletal muscle. Three patients had an overall negative flux of branch-chain amino acids. CONCLUSIONS: This preliminary descriptive report suggests that increased skeletal muscle efflux of amino acids correlates significantly with metabolic variables of hypermetabolism and hypercatabolism in nonsteroid-treated, head-injured patients.

Adult↗
PubMed1997

Tinel's sign or percussion test? Developing a better method of evoking a Tinel's sign.

Clinicians elicit a Tinel's sign by tapping over a nerve site with their fingertips. No standard force has been established, and overzealous tapping can produce a false-positive "Tinel's sign" that is actually a positive percussion test. The purpose of our study was to determine a threshold force that produces a positive percussion test in each of seven nerve locations in the upper extremities of subjects with no known nerve injuries and in subjects with nerve injuries. These data suggest limits for the amount of force necessary to elicit a Tinel's sign. If these limits are adhered to, the incidence of false-positive responses may be kept low.

Adolescent↗
PubMed1992

Radio-ulnar dissociation. A review of twenty cases.

The results of treatment were reviewed for twenty patients who had sustained concomitant injuries of the lateral compartment of the radiohumeral joint and the ipsilateral distal radio-ulnar joint. The ages of the patients ranged from eight to seventy-four years (average, thirty-five years) and the duration of follow-up ranged from four months to twenty-seven years (average, 113 months). In fifteen patients, the injury of the wrist was diagnosed after a mean delay of seven years and eleven months (range, one month to twenty-six years). In all fifteen, the radial head injury was treated by excision, either initially or after some delay. After excision of the radial head, all fifteen patients complained of severe pain at the distal radio-ulnar joint. The results, on the basis of elbow and wrist scores of fair or better without complications, were satisfactory in only three patients. In the remaining five patients, in whom the injuries of both the elbow and the wrist had been identified at the initial evaluation, the radial head was either preserved or replaced. The results, on the basis of elbow and wrist scores of fair or better, were graded as satisfactory in four of these patients. Our data show that any injury to the lateral side of the elbow should prompt a careful evaluation of the ipsilateral distal radio-ulnar joint for associated instability.

Adolescent↗
PubMed1999

Radial head subluxation: comparing two methods of reduction.

OBJECTIVES: To determine whether reduction of radial head subluxation (RHS) is more successful using pronation and flexion (PF) vs the more widely used supination and flexion (SF) method. METHODS: Prospective study in a tertiary care children's hospital ED from August 1996 through December 1997. Inclusion criteria included age <7 years with an upper-extremity injury. Exclusion criteria included neurologic impairment, congenital malformation, or obvious bony deformity or edema. Patients were randomized to receive either PF or SF. Reduction was considered successful if the child used the injured arm. Both the physician and the parent rated the child's pain during the procedure using a descriptive ordinal scale, from 0 (no pain) to 3 (severe pain). RESULTS: 148 patients were enrolled; 13 were excluded. Success was achieved on the first attempt in 53/67 (80%, 95% CI = 0.67 to 0.88) of patients receiving PF and in 47/68 (69%, 95% CI = 0.57 to 0.80) of those receiving SF (p = 0.186). For those injuring the left arm, 29/41 (71%, 95% CI = 0.54 to 0.84) were successfully reduced using SF, while 33/37 (89%, 95% CI = 0.75 to 0.97) were successfully reduced using PF (p = 0.044). Physicians perceived PF to be less painful than SF (p = 0.013). There was no significant pain score difference rated by parents. CONCLUSIONS: Both PF and SF can be used with success to reduce RHS. For left arm injuries, PF should be attempted first, since it may decrease the need for further treatment. PF may be less painful, particularly for first reduction attempts.

Arthralgia↗