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PubMed1996

[Usefulness of brachial artery pressure with forearm compression as arterial pressure monitoring after cardiopulmonary bypass].

The pressures in the radial and brachial artery in the same extremity were measured before and after cardiopulmonary bypass (CBP) in 18 patients. Brachial pressures were measured in two different ways, with and without forearm compression. The forearm compression was achieved by a swelled blood pressure cuff. There were no significant differences in these pressures before CBP. But the brachial pressures with the forearm compression were the highest among three kinds of pressures after CBP and there were significant differences between them. The aortic pressures during weaning from CBP were measured and compared with these pressures in 4 patients. The brachial pressures with the forearm compression were closest to aortic pressures. Therefore brachial pressure with forearm compression was recommended as a good pressure monitor when CPB was about to be finished. The patients were them divided into two groups. The patient is in the first group had less than 10 mmHg pressure difference between brachial pressure and radial pressure just after CPB. The patients in the second group had higher pressure in brachial than those in radial for over 10 mmHg just after CPB. There were no significant differences in duration in CPB, lowest rectal temperature, hematocrit and doses of catecholamines between the two groups.

Aged↗

PubMed1997

Heterogeneous vascular response to vasopressin: radial artery versus forearm blood flow.

BACKGROUND: Arginine vasopressin (AVP) administered intra-arterially to normal volunteers exerts a biphasic effect on forearm blood flow when the effect is extrapolated from plethysmographic measurements. OBJECTIVE: To assess whether the high-dose AVP-induced increase in forearm blood flow could be confirmed when calculating blood flow from continuous radial artery diameter and flow velocity recordings obtained by using a high-resolution echotracking device combined with a Doppler system. METHODS: Increasing doses (0.04-0.8 ng/kg per min) of AVP were infused into a brachial artery of seven normal male volunteers (aged 21-33 years). Forearm blood flow derived from venous occlusion plethysmography was assessed simultaneously with proximal radial artery blood flow calculated from luminal area and flow velocity measurements. RESULTS: Confirming previous reports, plethysmography showed an increase in global forearm blood flow by > 100% with AVP concentrations > or = 0.2 ng/kg per min. In contrast, direct measurements of lumen diameter and blood flow velocity in the radial artery revealed a marked dose-dependent vasoconstriction with a > 30% decline in blood flow at the highest AVP concentration. CONCLUSIONS: The discrepancy between the two measurements suggests that AVP has a dual effect on forearm haemodynamics. At high AVP concentration, the muscle blood flow increase predominates over the vasoconstriction in the skin circulation. Furthermore, this study strongly suggests a heterogeneity of the vascular response to vasomediators by showing that opposing responses exist not only between resistive and conduit vessels but also between conduit arteries of a common vascular bed.

Adult↗

PubMed1997

A prospective comparison of two expanded polytetrafluoroethylene grafts for linear forearm hemodialysis access: does the manufacturer matter?

BACKGROUND: The function and patency of standard 6-mm Goretex (W.L. Gore and Associates, Flagstaff, AZ) and Impra (Impra, Inc., Tempe, AZ) expanded polytetrafluoroethylene (e-PTFE) grafts for hemodialysis as radial-antecubital linear arteriovenous fistulae for dialysis are compared. STUDY DESIGN: A randomized clinical trial was conducted in two community dialysis centers and in one hospital-based center serviced by one vascular surgical practice, that performed the access surgery. Selection of linear forearm access, as opposed to other hemodialysis graft configurations, was at the discretion of the surgeon. Candidates for linear grafts had palpable radial pulses with a normal Allen test and normal digital Doppler flow in the hand. Linear grafts were placed using end-to-side anastomoses to the artery and vein, and the graft type was determined by randomization. Primary patency was determined by first episode of thrombosis, first revision, or angioplasty of the graft. Secondary patency after thrombectomy, revision, or angioplasty was determined when the graft was no longer clinically usable, and a new graft needed to be placed as a parallel conduit in the forearm or in another site. Statistical analysis was by actuarial life-table methods. RESULTS: There were 131 linear forearm grafts in 117 patients. The Impra and Goretex groups were equally matched for gender and major risk factors, except for smoking, which was more common in the Goretex group. Minimum followup was 24 months. Life table primary patencies at 1 year (Impra 43%, Goretex 47%) and at 2 years (Impra 30%, Goretex 26%) were not statistically different (p = 0.78); secondary patency was also equal at 1 year (Impra 49%, Goretex 69%) and at 2 years (Impra 33%, Goretex 41%) (p = 0.15). Discontinuance of use of a patent graft, complications, episodes of thrombosis, and the need to replace the original graft occurred in the two groups without a statistically significant difference. CONCLUSIONS: In the linear forearm position from the radial artery to an antecubital vein, there is no difference in the performance of 6-mm standard e-PTFE grafts on the basis of manufacturer, whether Goretex or Impra. On the basis of performance, linear forearm dialysis grafts are an acceptable method for hemodialysis access.

Adult↗

PubMed1997

Sympathoadrenal activation and muscarinic receptor stimulation induce acute release of tissue-type plasminogen activator but not von Willebrand factor across the human forearm.

We have previously shown that both mental stress and administration of the muscarinic receptor agonist methacholine induce an acute release of tissue-type plasminogen activator (t-PA) across the human forearm. There are data indicating that the regulated acute release of t-PA from the endothelium is closely interrelated with release of von Willebrand factor (vWF). The aim of the present study was to simultaneously determine basal and stimulated in vivo release rates of t-PA and vWF in an intact human muscle vascular bed. Eighteen healthy young males were studied at rest and during 10 min of mental stress (forced arithmetic). A subsample of ten subjects also received a step-wise i.a. infusion of methacholine (0.1-0.8-4.0 microg/min). Forearm blood flow was determined by venous occlusion plethysmography and interconverted to forearm plasma flow (FPF) using individual hematocrits. Net release/uptake rates of t-PA and vWF were calculated as the product of the arteriovenous concentration gradient and FPF. At rest there was a net release of both t-PA antigen and activity. In contrast, there was no significant local net release of vWF antigen across the forearm. Net release rates of t-PA roughly doubled in response to the stress test (0.4 to 0.8 and 0.2 to 0.5 ng x min(-1) x 100 ml(-1) for t-PA antigen and activity, respectively, p <0.05 for both). Local administration of methacholine induced a more than 10-fold increase in the net release rates of t-PA (0.6 to 9.6 and 0.3 to 6.6 ng x min(-1) x 100 ml(-1) at the highest dose step for antigen and activity respectively, p <0.01 for both). In contrast, neither mental stress nor local administration of methacholine induced a significant net release of vWF antigen across the forearm. The results demonstrate that the processes of acute release of t-PA and vWF are not necessarily linked in vivo in man.

Adrenal Glands↗

PubMed1998

Acute compartment syndrome of the forearm.

The forearm is the most common site for compartment syndrome in the upper extremity. The three compartments of the forearm include the volar (anterior or flexor), the dorsal (posterior or extensor), and the mobile wad. Both-bone forearm fractures and distal radius fractures are common initial injuries in adults that lead to acute forearm compartment syndrome. Supracondylar fractures, especially those with associated vascular injuries, are frequent causes of compartment syndrome in children. The flexor digitorum profundus and flexor pollicis longus are among the most severely affected muscles because of their deep location, adjacent to bone. Initial treatment consists of removal of occlusive dressings or splitting or removal of casts. If symptoms do not resolve rapidly, fasciotomy is indicated. Decompression fasciotomy of the forearm is performed through volar or dorsal approaches. The medial nerve is decompressed throughout its course, including high-risk areas deep to the lacertus fibrosus; between the humeral and ulnar heads of the pronator teres, the proximal arch, and deep fascial surface of the flexor digitorum superficialis; and the carpal tunnel.

Acute Disease↗

PubMed2001

Resurfacing of the nasopharynx after nasopharyngectomy using a free radial forearm flap.

BACKGROUND: Nasopharyngectomy is emerging as an important treatment option for salvaging locally recurrent nasopharyngeal carcinoma (NPC). After nasopharyngectomy, resurfacing the nasopharynx and covering the internal carotid artery is important to minimize the risk of infection, osteoradionecrosis, and carotid rupture. Previous authors have advocated the use of free grafts of skin and mucosa for this purpose but have also described significant rates of partial and total graft failure. METHODS: We believe that the best and most reliable way to resurface the nasopharynx is with vascularized tissue, and our preference is for the use of a free radial forearm flap. To illustrate our approach, we present two patients who underwent nasopharyngectomy by means of a maxillary swing approach and who had resurfacing of the surgical defect with a free radial forearm flap. RESULTS: Both patients had complete en bloc resection of tumor followed by the insetting of a free radial forearm flap to reline the surgical defect. Both flaps remained completely viable, and both patients achieved successful resurfacing of the entire nasopharynx. The morbidity of surgery was minimal, and there were no perioperative complications. On assessment 1 year later, the free radial forearm flap continues to reline the entire neonasopharynx, and the long-term functional recovery after surgery is excellent. CONCLUSION: Resurfacing the nasopharynx after nasopharyngectomy with a free radial forearm flap aids healing and minimizes the risk of complications. The morbidity of surgery is minimal and the functional recovery is excellent.

Humans↗

PubMed1996

The increase of duration of isometric contraction may not relate to change of relative oxygenation of forearm muscle.

The aim of this study is to ascertain, how an increase in duration of isometric contraction influences tissue oxygenation of forearm muscles, undergoing physical training. Four subjects underwent 6 weeks of training of the left forearm muscles by performing isometric contractions. Subjects repeated 10 s contractions, 10-15 times in the first, and 20 s contractions in the second 3 week period. Relative oxygenation of forearm muscles was measured by using. Near Infrared Spectroscopy (CWS2000, NIM Incorporated, Philadelphia). The training increased the duration of isometric contraction at 20 kp of experimental forearm muscles by 41 +/- 25 s, which was more (P < 0.05) than in control forearm (8 +/- 4 s). This increase was not reflected in changes of maximum relative deoxygenation of experimental muscles, which decreased by only -6.9 +/- 14.4%. The results show that an increase in duration of isometric contraction may not depend on the oxygenation of muscle tissue at fixed force of 20 kp.

Exercise↗

PubMed1998

Long-term trends in the incidence of distal forearm fractures.

In this population-based descriptive study covering the 50-year period, 1945-94, there was a statistically significant increase in distal forearm fractures due to severe trauma in both women and men (p < 0.001) but no secular increase in fractures due to moderate trauma (approximately osteoporosis). Since fractures attributed to severe trauma comprised a greater proportion of the total in men (52%) than women (21%), an overall doubling of age-adjusted forearm fracture incidence in men between 1945 and 1994 was statistically significant (p < 0.001), but the 7% increase in age-adjusted rates among women was not (p = 0.90). While the epidemiological pattern of distal forearm fracture incidence in Rochester was similar to that seen elsewhere, the overall incidence rate of 287.4 per 100,000 person-years (95% CI 267.7-307.1) in 1985-94 was less than current rates in Sweden, presumably because the great increase in distal forearm fracture incidence seen, for example, in Malmö between 1953-57 and 1980-81 was not observed in Rochester. The trends in distal forearm fracture rates in Rochester men and women over the past 50 years are broadly consistent with trends in hip fracture incidence in this community over the same time span.

Adult↗

PubMed1999

Forearm bone mineral densitometry cannot be used to monitor response to alendronate therapy in postmenopausal women.

Alendronate significantly increases bone mass and reduces hip and spine fractures in postmenopausal women. To determine whether forearm densitometry could be used to monitor the efficacy of alendronate, we examined changes in bone mineral density (BMD) at the forearm (one-third distal, mid-distal, ultradistal radius) versus changes at the hip (femoral neck, total hip) and spine (posteroanterior and lateral) in a double-masked, randomized, placebo-controlled clinical trial of 120 elderly women (mean age 70 +/- 4 years) treated with alendronate for 2.5 years. We found that among women in the treatment group, BMD increased by 4.0-12.2% at the hip and spine sites (all p<0.001), whereas BMD increased only nominally at the one-third distal radius (1.3%, p<0.001) and mid-radius (0.8%, p<0.05), and remained stable at the ultradistal radius. At baseline, forearm BMD correlated with that of the hip (r = 0.55-0.64, p<0.001), femoral neck (r = 0.54-0.61, p<0.001) and posteroanterior spine (r = 0.56-0.63, p<0.001). Changes in radial BMD after 1 year of therapy were not correlated with changes in hip and spine BMD after 2.5 years of therapy. In contrast, short-term changes in total hip and spine BMD were generally positively associated with long-term changes in total hip, femoral neck and spine BMD (r = 0.30-0.71, p<0.05). Furthermore, long-term BMD changes at the forearm did not correlate with long-term hip and spine BMD changes, in contrast to the moderate correlations seen between spine and hip BMD at 2.5 years (r = 0.38-0.45, p<0.01). We conclude that neither short- nor long-term changes in forearm BMD predict long-term changes in overall BMD for elderly women on alendronate therapy, suggesting that measurements of clinically relevant central sites (hip and spine) are necessary to assess therapeutic efficacy.

Absorptiometry, Photon↗

PubMed2001

Incidence of distal forearm fracture in British men and women.

Fracture of the distal forearm is one of the most frequent osteoporotic fractures. However, there are few data concerning its incidence in Britain. The aim of this study was to determine the incidence of distal forearm fracture in adult British men and women. Six centers took part in the study: Aberdeen, Hull, Nottingham, Portsmouth, Southampton and Truro. At each center, men and women aged 35 years and over with an incident distal forearm fracture and who resided in the catchment area of the main hospital at that center, were identified during a 12 month period. Incident fractures were identified from all possible point-of-contact sources in each locality, including accident and emergency records, fracture clinics, ward listings and plaster room registers. The population at risk was defined geographically according to postcode and the denominator obtained from 1991 census data mapped to these postcodes. During the 12 month study period, 3161 individuals with distal forearm fracture were identified. The age-adjusted incidence, age 35 years and over, was 36.8/10,000 person-years in women and 9.0/10,000 person-years in men. In women, the incidence of fracture increased progressively with age from the perimenopausal period, while in men the incidence remained low until later life. Fractures were more frequently left-sided (55.6%) and 19.4% of subjects required hospitalization. On the basis of these data we estimate that 71,000 adult men and women sustain a distal forearm fracture in Britain each year. Compared with previous British surveys the pattern of incidence with age appears to have changed in women, the reason for this is unclear.

Adult↗

PubMed2004

Fracture-related and implant-specific factors influencing treatment results of comminuted diaphyseal forearm fractures without bone grafting.

INTRODUCTION: Recommendations regarding the application of primary autologous bone grafting in the surgical treatment of comminuted diaphyseal forearm fractures are conflicting. Some recent studies suggested that there is no difference in the union rate between simple and comminuted forearm fractures and that the use of bone grafting in the treatment of these fractures is therefore not necessary. Our hypothesis was that among comminuted forearm fractures there is a small group of fractures with a very large extent of comminution that heal with a significantly lower union rate and a prolonged time to union compared with other fractures. We believe that in these fractures bone grafting could help to reduce the time to union and further decrease the rate of nonunion. MATERIALS AND METHODS: We reviewed the results of the treatment of 214 consecutive patients who sustained 319 diaphyseal fractures of forearm bones. To prove our hypothesis, union rate and time to union in fractures with different extents of comminution were compared. All fractures were treated by open reduction and internal fixation with plates without the use of bone grafting. In addition, the study evaluated other factors that could influence the union rate and time to union in observed fractures. RESULTS: Separate analysis of union rate and time to union in fracture groups with different extents of comminution confirmed our hypothesis only partially. Although we proved that fractures with bone loss greater than two-thirds of the diameter of the diaphysis had a significantly prolonged time to union, we could not demonstrate a significant difference in the union rate between groups. Based on these findings, we believe that primary autologous bone grafting of comminuted diaphyseal forearm fractures is not necessary in most cases. If used, its application should be reserved only for fractures where the bone loss exceeds two-thirds of the diameter of the diaphysis. Such fractures are rare; in our study, they accounted for only 5% of all fractures. CONCLUSION: The most important factors found to influence the union rate and time to union were stability of fixation and type of plate used for fixation.

Adult↗

PubMed2006

Interlocking nailing of forearm fractures.

INTRODUCTION: With the exception of forearm fractures, intramedullary techniques are preferred for osteosynthesis in the case of long-bone fractures. For the latter, however, the main problem remains insufficient stability against torsional forces resulting in high rates of non-union. This is why plate osteosynthesis by means of a DCP 3.5 or LC-DCP 3.5 is still being described as the standard procedure. MATERIALS AND METHODS: In a prospective study, 32 patients (33 forearms) with fractures of one or both forearm bones were treated by implantation of 40 intramedullary ForeSight nails (ulna: 23; radius: 17). Clinical and radiographic follow-up was performed at 6, 12, 26, and--if needed--52 weeks postoperatively. Time to follow-up was 31.4 months on average (range 24-44 months). RESULTS: The average time to fracture healing for 36 fractures of 29 patients was 4.4 months. A free range of motion was seen in 86%, and only four forearms had a loss of pronation and supination. DASH score averaged at 13.7. There were few complications: non-union 1, delayed union 2, radioulnar synostosis 2, and infections 0. No refracture was seen after 19 implant removals so far. Average time needed per operation was 67 min, average time for fluoroscopy was 4.4 min. CONCLUSION: This intramedullary nail can do justice to the specific anatomical needs in the case of the forearm. Static interlocking guarantees adequate stability in all fracture types. The surgical technique is demanding. Nonetheless, this system can yield results of comparable quality to those of plate osteosynthesis. So far, no refractures after removal of the implants and no complications connected with the actual implants have been observed.

Adolescent↗

PubMed2002

Simultaneous ipsilateral elbow and forearm fractures in children: a retrospective review.

The aim is to evaluate the incidence of simultaneous ipsilateral forearm fractures in pediatric patients who present with elbow fractures and to attempt to identify patients who might be at greater risk of this type of injury. All pediatric patients with elbow radiographs during a 3-month period were retrospectively reviewed. One hundred sixty patients were identified. Sixty-one of the 160 were diagnosed with elbow fractures. Of these, 7 had a simultaneous ipsilateral forearm fracture (12.3%). Of the 7 patients with simultaneous fractures, all had supracondylar fractures; 4 were displaced elbow fractures and 3 were nondisplaced. Although our initial experience is limited, there appears to be a fairly high incidence of ipsilateral forearm fractures in pediatric patients with elbow fractures. All of these cases involved a supracondylar fracture, and over 50% showed displaced fractures. We conclude that in preadolescent patients with elbow fractures, simultaneous forearm fracture should be considered, and clinical and or radiographic evaluation of the forearm may be warranted.

Journal Article↗

PubMed2001

Treatment of diaphyseal fractures of the forearm using the Point Contact Fixator (PC-Fix): results of 387 fractures of a prospective multicentric study (PC-Fix II).

Fractures of the forearm are considered to be a very good indication for plating. Conventional plating is still technically demanding. Extensive animal studies show that there is potential for improvement. The method consists of using an internal fixator that minimizes implant contact to the bone to reduce biological damage. Furthermore, foregoing the need for precise reduction and interfragmental compression makes it easier to use and, therefore, it should be safer. The goal of the study was to observe handling qualities, healing, and complications. For this purpose the study was designed to yield a very high follow-up in clinics with adequate experience and with a number of different surgeons performing the internal fixation. The study was designed as a prospective multicentre investigation in 16 trauma centres worldwide. To test the new approach to internal fixation, diaphyseal fractures of the forearm were stabilized surgically with the PC-Fix (Point-Contact Fixator) system, namely, 387 fractured bones involving 277 forearms in 272 patients. Internal fixation was performed using 387 PC-Fixators. 21% of the fractures were open and 25% occurred in polytraumatized patients. The rate of follow-up was 97%. 355 fractured bones healed uneventfully within four months. Overall, there were 32 complications before bone union occurred; 27 of these bones required re-operation (27 of 387, 7%). All of them subsequently healed without further complications. There were 15 delayed or non-unions and seven implant loosenings, two of which were associated with infection. Two superficial (0.6%) and two deep infections (0.6%) occurred in 306 closed fractures. Deep infection developed in one of 81 osteosyntheses of open fractures (1.2%). Other complications included one synostosis, fractures with the implant in situ with adequate trauma involving three bones, and two secondary correction procedures for postoperative malalignment. There were seven refractures occurring at a mean of three weeks after the removal of 150 PC-Fixators (4.7%). This study demonstrated that the technique of using an internal fixator is a simple one for the fixation of forearm fractures, resulting in shorter duration of surgery with a low rate of complications compared with the data reported in the literature on conventional techniques for forearm fracture stabilization.

Adolescent↗

PubMed1981

Role of sensory nerves in the cardiovascular and respiratory changes with isometric forearm exercise in man.

1. To investigate the stimulus to the cardiovascular and respiratory systems during isometric exercise, two patients with sensory neuropathies affecting forearm afferent nerves were studied and their circulatory and respiratory responses compared with those of normal subjects. The contribution of pain to the cardiorespiratory changes was also investigated in normal subjects by using hypnosis to relieve pain during and after isometric exercise. 2. The patients and normal subjects performed fatiguing isometric forearm exercises on a handgrip dynamometer on at least two occasions, once with normal forearm circulation and once with the forearm circulation occluded by an arterial cuff during and after exercise. Blood pressure, heart rate, minute ventilation, oxygen consumption and ventilatory equivalent were measured before, during and after exercise. 3. During exercises with and without occlusion increases in blood pressure and heart rate in patients and in subjects under hypnosis were similar to those in control subjects. Changes in oxygen consumption were also similar to those of controls, but the patients showed a smaller rise in ventilation and no increase in ventilatory equivalent. 4. After exercise in normal subjects occlusion of the forearm circulation produced continued elevation of blood pressure and respiration. Blood pressure also remained elevated after exercise with occlusion in subjects under hypnosis, but not in patients with sensory loss. Respiration did not remain elevated in either subjects under hypnosis or patients. 5. The results suggest that cardiovascular and respiratory changes during isometric exercise can occur without involvement of muscle sensory nerves and that pain contributes substantially to the increase in respiration. Normal sensory innervation is apparently necessary only for maintenance of raised blood pressure after exercise with occlusion.

Adolescent↗

PubMed2002

Short-term cortisol infusion in the brachial artery, with and without inhibiting 11 beta-hydroxysteroid dehydrogenase, does not alter forearm vascular resistance in normotensive and hypertensive subjects.

BACKGROUND: Vascular tone is increased in primary hypertension, and glucocorticoids affect vascular tone. Local cortisol availability is modulated by activity of 11 beta-hydroxysteroid dehydrogenase (11 beta-HSD). As this activity may be decreased in patients with primary hypertension, vascular sensitivity to cortisol may be increased in these patients. We studied the acute effect of cortisol on forearm vascular resistance (FVR) by infusing cortisol directly into the brachial artery, both with and without inhibition of 11 beta-HSD, in normotensive and hypertensive subjects. DESIGN: Twenty normotensive volunteers and 20 patients with primary hypertension participated in the study. After a 10-min infusion of vehicle (glucose 5%), cortisol was infused into the brachial artery in three stepwise increasing doses (3.5, 10.5 and 35 microg per 100 mL of forearm volume), each for 10 min. Next, the participants received placebo or 500 mg glycyrrhetinic acid (GA) orally, and 150 min later the same infusion schedule was repeated. Forearm vascular resistance was measured during the last 5 min of the infused vehicle and of each dose. Arterial and forearm venous plasma samples for measurement of cortisol and cortisone were taken at the end of the infusions of glucose 5% and the highest cortisol dose. RESULTS: In both normotensive and hypertensive subjects, neither the infusion of cortisol nor the administration of GA changed FVR. Also 2 h after the cortisol infusion there remained no change in FVR in both the normotensive and hypertensive groups who received placebo. Following the infusion of the highest cortisol dose, total plasma cortisone levels in the venous plasma were decreased compared with levels in the arterial plasma (36 +/- 3 and 49 +/- 4 nmol L-1, respectively, P < 0.05). The protein-bound venous cortisone was 37.1 +/- 4.8 nmol L-1 during the vehicle compared with 23.9 +/- 3.7 nmol L-1 during the cortisol infusion (P < 0.01), whereas the free cortisone level was not altered by the cortisol infusion. CONCLUSIONS: In both normotensive and hypertensive subjects, high-dose cortisol infusion both with and without 11 beta-HSD inhibition did not change FVR either immediately or after 2 h. We could not demonstrate in vivo 11 beta-HSD activity in the forearm vascular tissues. When binding of cortisone to CBG is changed, e.g. during cortisol infusion, arterio-venous changes in cortisone cannot reliably be used to assess (alterations in) local 11 beta-HSD activity.

11-beta-Hydroxysteroid Dehydrogenases↗

PubMed2000

[Late sequelae of fractures of the distal third of the forearm during the growth period].

Fractures to the distal third of the forearm are the most common fractures of the upper extremity, with the majority occurring between the age of ten and 14 years. With the exception of the rare epiphyseal fractures, they have a favourable prognosis. The present study investigates the frequency and extent of potential clinical and radiological late sequelae of fractures in the distal third of the forearm during growth. Of the patients treated at the Innsbruck University Department of Traumatology from 1980 to 1992, 220 patients of a growing age with 232 closed fractures in the distal third of the forearm were followed up. The radius alone was affected in 60% of these cases; the radius and the ulna in 40%. Fractures of the ulna alone were not present. The mean age of the patients at the time of injury was nine years (range one to 16 years) and the mean time of follow-up ten years (range five to 16 years). In addition to the patient's subjective assessment, the right and left sides were compared with regard to mobility of the wrist and rotational movement of the forearm. Based on standard X-rays, the frontal (radio-ulnar) and lateral (dorso-palmar) radial joint angle as well as the difference in the radio-ulnar plane were compared with the contralateral side. Clinical and radiological findings were summarised into an overall result. 19% of the patients reported pain in the injured wrist. Mobility of the wrist in the sagittal and/or frontal plane was limited in 5% of patients and rotation of the forearm was limited in 16% of patients. A statistically significant accumulation of limited rotation was seen after physeal fractures of the ulna ("one-way" ANOVA-test, p = 0.0033). A difference between the left and right side in regard to the frontal radial joint angle was seen in 6% of patients and a difference in the lateral radial joint angle was registered in 2% of patients. A difference in the radio-ulnar plane was observed in 37% of patients. In the presence of relative ulna-plus variance, 75% of patients complained of pain in the ulnocarpal compartment of the wrist. In these patients, dynamic magnetic resonance tomography revealed a compression of the ulnocarpal disk between the proximal carpal bones and the head of the ulna, as well as degeneration in the central portion of the disk. The overall outcome was very good in 72%, good in 19%, moderate in 6% and poor in 3% of patients. The younger the children had been at the time of injury, the more favourable were the results (chi-square test, p = 0.009). Children older than ten years of age with an angulatory deformity of more than 20 degrees and/or fragment dislocation over half of the breadth of the shaft at fracture consolidation showed the poorest results. Further factors having a negative influence on the outcome were repeated reduction manoeuvres and an additional fracture of the ulna.

Adolescent↗

PubMed2002

A new flap design for monitoring the circulation of a buried free radial forearm flap in pharyngoesophageal reconstruction.

The viability of a free radial forearm flap which is used in pharyngoesophageal reconstruction is difficult to monitor because it is hidden by skin. As the most reliable method for monitoring, exteriorization of a small island flap has been reported. The authors used a skin paddle which is placed ulnar to the radial forearm reconstruction flap at the ulnar side of the distal part of the forearm as a monitor flap in one patient. Flap viability was assessed by observing tissue color, turgor, capillary refill, and bleeding of the monitor flap. This monitor flap is easy to elevate. The perfusion of the flap is good because it has a wide pedicle. It permits a long vascular pedicle for the radial forearm reconstruction flap and does not reduce available forearm skin for pharyngoesophageal reconstruction.

Esophageal Neoplasms↗