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Immediate closure of traumatic upper arm and forearm injuries with the latissimus dorsi island myocutaneous pedicle flap.
This paper reports the authors' experience with latissimus dorsi island pedicle flaps in the acute treatment of massive arm injuries. Seven patients with upper arm injuries and four patients with forearm injuries were treated with latissimus dorsi pedicle flaps. All cases involved massive soft-tissue loss and open fractures. Primary healing of wounds occurred without complications in 10 of 11 patients; the eleventh developed a wound infection. There were no instances of flap loss or vascular complications. This report compares and discusses surgical management options and details the importance of robust, immediate soft-tissue coverage for optimal functional recovery. Contrary to traditional thought, delay in definitive wound closure may be unnecessary when aggressive debridement is followed by acute flap closure.
Nerve transfer to biceps muscle using a part of the ulnar nerve in brachial plexus injury (upper arm type): a report of 32 cases.
Thirty-two patients with absent elbow flexion secondary to brachial plexus injury underwent nerve transfer using 1 or 2 fascicles of the ulnar nerve to the motor branch of the biceps muscle. Twenty-six patients had root avulsion injury of C5 and C6; 4 had root avulsion injury of C5, C6, and C7; and 2 had lateral and posterior cord injury with distal injury of the musculocutaneous nerve. The follow-up period ranged from 11 to 40 months (average, 18 months). Thirty patients had biceps strength of M4 (flexion power ranged from 0.5 to 7 kg) and 1 had biceps strength of M3. All but 1 patient demonstrated signs of recovery of the biceps muscle. No notable impairment of hand function was observed.
Head and neck injuries during armed conflict.
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Paralysis of both arms from injury of the upper portion of the pyramidal decussation: "cruciate paralysis".
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INJURY TO THE THROWING ARM. A STUDY OF TRAUMATIC CHANGES IN THE ELBOW JOINTS OF BOY BASEBALL PLAYERS.
X-ray studies were made of both elbows of 162 boys in the 9 to 14 year age group, divided into three categories: Pitchers, non-pitchers, and a control group who had never played organized baseball. Changes involving the medial epicondylar epiphysis and opposing articular surfaces of the capitulum and head of radius in the throwing arm appeared to be in direct proportion to the amount and type of throwing. The most striking changes were in the arms of pitchers. Some degree of accelerated growth, separation and fragmentation of the medial epicondylar epiphyses was noted in the throwing arm of all 80 pitchers in the study. Five cases of traumatic osteochondritis of the capitulum and head of radius, and one case of juvenile osteochondritis of the head of the radius were also found among the pitchers. Better medical supervision and stress on prevention are needed, especially in the Southern California area where climatic conditions favor prolonged seasons and throwing practice the year around.
Head injury transfers: arm of greatest delay.
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[Surgical treatment of thoracic injuries in the armed forces. General characteristics of war injuries].
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[Acoustic injuries in armed forces personnel].
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[Increased number of knife assaults inspite of the legislation. Record of injuries among 399 patients].
From January 1985 to September 1993, 399 patients (368 men and 31 women), median age 28 years (mean 31.1, range 16-71 years), were admitted with stab wounds due to assault. The number of stab wounds per patient was one (N = 268 patients), two (N = 63), three (N = 31), four (N = 15), five (N = 7), or more than five (N = 15). The series as whole (N = 399) accounted for 543 sites of injury. Upper extremity wounds were the most frequent (35 per cent); of 188 arm injuries, 60 per cent were in the left arm. The next most frequent site was the head and neck region (N = 105; 12 per cent), followed by the chest (N = 75; 14 per cent), abdomen (N = 66;12 per cent), lower extremities (N = 59;11 per cent), back (N = 48;9 per cent), and the male genitalia (N = 2;0.4 per cent). Ninety-five major operations were performed in 74 patients. Seven patients died, and 40 had somatic or cosmetic life-time sequelae.
Analysis of pedestrian injuries in traffic accidents (2)--Especially on leg injury.
A deep case study on 118 pedestrians struck to fronts of vehicles or vehicle derivatives was carried out. In this paper we investigated a leg injury which occurs the most frequently in a vehicle-pedestrian collision. The data obtained from the case study were compared with those of autopsied cases. Influence of impact speed and point, and of an accident pattern were considered. The leg injury showed higher AIS (Abbreviated Injury Scale) than that of the arm injury caused by direct impact against the front exterior of vehicles. The impact speed and ISS (Injury Severity Score) showed strong correlation, but the former and AIS did not show significant correlation. The higher impact speed and the run-over are likely to cause a bilateral leg fracture.
[Intraoperative function diagnosis in the care of brachial plexus injuries].
Using somatosensory evoked potentials during the operation it is possible to get the following information concerning brachial plexus function: Function of the roots. Which parts of the brachial plexus are completely destroyed and which are in regeneration? From which level is it possible to repair an injured nerve with a nerve graft? In cases of severe upper arm injuries: Is there function in the brachial plexus and is it appropriate to do a replantation?
[Syndrome of severe compression of the extremities (compression syndrome or Bywater's syndrome)].
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Reconstruction of the upper extremity with a compound rib-latissimus dorsi osteomusculocutaneous flap.
The reliability and versatility of the pedicled latissimus dorsi muscle or osteomusculocutaneous flap make it our first choice in the management of upper arm injuries and we have treated three such patients in this way. They had severe skeletonising, crushing injuries of an upper extremity with humeral defects that were treated with latissimus dorsi musculocutaneous flaps and segments taken from the ribs. All the flaps survived completely with no injury of the pleura at the donor site. The reconstructed humerus was strong enough for the patients to participate in all activities of daily living. We think that this technique is suitable for the upper arm defects with humeral loss because of its simplicity and minimal morbidity.
[PERIPHERAL NERVE INJURIES IN LUXATION OF THE ARM].
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International Physicians for the Prevention of Nuclear War (IPPNW) International Medical Conference on Small Arms, Gun Violence and Injury: A call for action to reduce small arms deaths and injuries.
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[EMERGENCY TREATMENT FOR TRAUMA OF THE EXTREMITIES; ON THE MANAGEMENT OF INCISED WOUNDS AND THE CRUSH SYNDROME].
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Disability, direct cost, and payment issues in injuries involving woodworking and wood-related construction.
Treatment cost and payment patterns and disability for work, home, and recreation activities were examined for 495 consecutive persons seen as primary care patients over one year in Northern Vermont with injuries associated with woodworking, wood related construction, and home repair activities and materials. These primary care patients were from a larger sample of 601 persons with such injuries who received either primary or tertiary care. Mean total charges were $530 and $342 respectively for work and nonwork related injuries, with highest costs for back and arm injuries, and injuries involving powered equipment and elevations. At six months post injury, patients averaged 11.6 days of disability for work, 10.3 days for home activities, and 13.1 days for recreation. Overwhelmingly, this disability was experienced by nonhospitalized patients. Median charges and disability days were far lower, reflecting the fact that the majority of injuries were minor and only 6% resulted in hospitalization. Only 29% of hospital charges for injuries at work were paid by workmen's compensation, and a third either were unpaid or were paid by the injured party. Self-employed contractors and carpenters, in particular, lacked coverage by workmen's compensation.