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PubMed1996

[Essex-Lopresti injury combined with forearm fracture].

The Essex-Lopresti injury is uncommon and often overlooked. A case is presented in which a 22-year old male sustained an injury that was a combination of an Essex-Lopresti injury and a fracture of the forearm. The primary treatment was osteosynthesis of the forearm. Ten weeks after injury the fractured radial head was removed because of pain and poor function of the elbow. The full extent of the injury was not recognized until sixteen weeks after injury. Final treatment consisted of excision of the ulnar head. The final results when seen at eight years follow-up were good.

Adult↗
PubMed1985

The importance of the deep volar compartment in crush injuries of the forearm.

Two cases are described of blunt injury to the forearm in the absence of bone injury, resulting in an acute deep volar compartment syndrome. The importance of the deep flexor compartment of the forearm is noted. The diagnostic pitfalls and the use of intra-compartmental monitoring are discussed. We emphasize that all such cases must be admitted and carefully studied as a matter of routine. If operation is undertaken, both the superficial and deep volar compartments must be adequately decompressed.

Acute Disease↗
PubMed2001

Epidemiology of amputations and severe injuries of the hand.

In a prospective population-based study, all open hand, wrist, and forearm injuries that were treated during a 10-year period, at hospitals and emergency wards in three Norwegian cities with 225,000 inhabitants, were registered. Injury severity was graded using the abbreviated injury scale (AIS). For moderate injuries (AIS 2) overall incidence (95% CI) was 59 (56-62), incidence among males 92 (86-98), and among females 28 (25-31) per 100,000 person-years. For severe injuries (AIS > or = 3), overall incidence (95% CI) was 7.5 (6.3-8.6), incidence among males 11.1 (9.1-13.1), and among females 4.0 (2.8-5.2) per 100,000 person-years. In a second study, all upper extremity amputation and devascularization injuries were referred during a 9-year period to the only replantation center in a southern Swedish region where 1.6 million inhabitants were analyzed. The incidence rate (95% CI) for upper extremity amputation or devascularization injuries potentially requiring replantation or revascularization was 1.9 (1.7-2.1), incidence among males 3.3 (2.9-3.7), and among females 0.5 (0.4-0.7) per 100,000 person-years.

Abbreviated Injury Scale↗
PubMed1986

Soft-tissue injuries of the forearm and hand.

In general, musculotendinous injuries of the forearm are not uncommon and are generally self-limited. The fact that there are so many different modalities of treatment speaks well for the human body to repair itself under some very adverse circumstances. Rest and splinting of the part, elevation, and judicious use of analgesics is still the treatment of choice. The injudicious use of heat and cold and electrical appliances of various types usually indicate a therapist in search of a treatment.

Athletic Injuries↗
PubMed2005

Monteggia fractures: beware!

Monteggia fractures consist of an ulna fracture accompanied by radial dislocation. These fractures are easily overlooked because of the prominence of the ulnar fracture. Furthermore, the leading cause of malpractice cases brought against emergency departments involve missing high-risk orthopedic injuries, such as Monteggia fractures. The purpose of this article is to provide sufficient information to reduce the possibility of underestimating forearm injuries and, consequently, diagnose a Monteggia fracture correctly. This article outlines the classification of Monteggia fractures, the mechanism of injury, a specific case report, and a discussion of consequences when the extent of the injury is underestimated. Finally, specific ways are presented to easily avoid the misjudgment of a Monteggia fracture.

Child↗
PubMed2004

[Combined injuries of arteries, nerves and tendons of the forearm].

Combined injuries of the forearm occupy an important place in modern structure of functionally severe traumas. Discussions concerning the best time for nerve reconstructions and unsolved questions of a necessity to restore one of the arteries if the other is safe confirms the importance of the problem. An analysis of the domestic and foreign literature data on diagnosing and treatment of the traumas in question is given. Main specific features of treatment depending on the time, character of injuries and functional role of the injured structures are described.

Arteries↗
PubMed1999

Patient and injury characteristics in the development of cold sensitivity of the hand: a prospective cohort study.

In this prospective cohort study, we questioned whether cold sensitivity occurring after all types of injuries decreases, increases, or remains constant. We also questioned which patient and injury characteristics are most associated with the development of cold sensitivity. The degree of cold sensitivity of 123 patients with acute hand and forearm injuries was repeatedly scored from a prevalidated questionnaire over 11 months after injury. Twenty-five patients with more severe symptoms at 11 months were reassessed at 3 years. The patients' age, gender, smoking habit, workers' compensation status, mechanism of injury, level and orientation of injury, and injured structures were analyzed with respect to cold sensitivity. The results of our study indicate that the severity of cold sensitivity increased from the time of injury until 3 months following injury and then remained constant until 11 months following injury. At 3 years from injury, symptoms in patients with severe cold sensitivity had significantly reduced to 67% of the 11-month level. Cold sensitivity was common in all types of hand injuries, not just in amputations and in arterial or nerve injuries. A multiple linear regression analysis suggested that the severity of cold sensitivity was most related to the presence of bone injury. Cold severity was not specifically related to smoking or amputations.

Adolescent↗
PubMed1997

[Repairing bone and soft tissue defects of the forearm with a composite segmented-fibula osteoseptocutaneous flap].

The segmented-fibula osteoseptocutaneous flap has been used to repair the bone and soft tissue defects of the forearm. During the operation, the fibula is divided subperiosteally at proper site according to the bony defects. The two segments of the fibula were then inserted to the radial and ulnar defects before vascular anastomosis is performed. Experience shows that anastomosis of only one group of vessels can ensure survival of both the segmented fibula and the cutaneous flap. Care should be taken to protect the muscle cuff and periosteum of the fibula, which is the source of blood supply to one segment. Four patients with bone and soft tissue defects of the forearm have been treated using this method. All the flaps survived with good function. The success of this technique contributes to the application of the free fibular flap in repair of forearm injury or osteomyelitis.

Adult↗
PubMed1974

One-bone forearm.

Six patients with complicated forearm injuries with ununited fractures of the ulna and soft-tissue deficits, and one patient with the same deficit from infection, were treated by production of a one-bone forearm positioned in neutral of supination-pronation. A stable, functional extremity resulted in each patient and only mild complications were encountered.

Adult↗
PubMed2000

Reverse radial forearm fascial flap for soft tissue coverage of hand and forearm wounds.

Six patients with severe hand and forearm injuries involving open wounds and exposed structures were treated with reverse radial forearm fascial flaps and split-thickness skin grafts for soft tissue cover. There were five men and one woman aged between 16 and 36 years. Injuries included soft tissue avulsion on the dorsum of the hand and fingers, extensive flexor and extensor tendon damage, multiple phalangeal fractures, a grade IIIB open dislocation of the index to little carpometacarpal joints, a grade III open metacarpal fracture and a finger amputation. The average wound size was 9 cm in length and 7 cm in width. The mean duration of follow-up was 12 months (range, 5-20 months). All flaps healed well, and all patients were satisfied.

Adult↗
PubMed2003

Combined fracture of the distal radius and scaphoid in children. Report of 2 cases.

The authors report 2 cases of concomitant scaphoid and distal radial fractures, a rare combination of lesions in children. The first case was in a 13-year-old boy who presented a transverse midscaphoid fracture associated with a Salter type II distal radial fracture. The second concerned a 10-year-old boy who presented a bilateral wrist injury. On the left side, a distal forearm fracture with anterior displacement was associated with a transverse midscaphoid fracture. On the right side, there was only a distal forearm fracture. Scaphoid fracture associated with distal radial fracture seems to have been more frequently reported in the literature during the last decade, probably because it is more frequently recognised. In fact, children with distal forearm injury should be well examined both clinically and radiologically in order to search for an associated scaphoid fracture. Reduction of the radius fracture should be done carefully to avoid possible displacement of the scaphoid fracture.

Adolescent↗
PubMed1992

Double injuries of the forearm: a common occurrence.

To evaluate the frequency of different types of forearm fractures and, in particular, determine the frequency of double injury to the forearm, the authors prospectively examined 119 consecutive forearm fractures and found double injuries to the forearm in all but five cases. In 79 of the 119 patients (66%), ligamentous injury was seen in addition to the obvious fracture. Nine patients with apparent isolated fractures on initial radiographs underwent examination by means of radionuclide bone scanning, which revealed a second injury in eight of them. Four patients with apparent single fractures did not undergo bone scanning because of their critical conditions. In four patients, a single fracture was initially diagnosed, but after reduction and casting, dislocation of the radioulnar joint was seen. These findings indicate that injury to the forearm almost invariably occurs at two or more sites and involves either both bones or bone and ligament. Because the distal radioulnar joint was affected in 71 patients (60%), scrutiny of the wrist is imperative whenever injuries to the bones of the forearm are discovered.

Arthrography↗
PubMed1993

Transfer of innervated latissimus dorsi free musculocutaneous flap for the restoration of finger flexion.

Transfer of functioning free muscle for the restoration of finger flexion is an uncommon procedure. We present our experience with five patients with severe forearm injuries in whom a latissimus dorsi musculocutaneous free tissue transfer was performed in an attempt to provide soft tissue coverage and active digital flexion. Four patients had active finger flexion with volitional control of the transferred muscle between the tenth and the fifteenth weeks. On average, active flexion lags were 2.0 cm in the index finger, 2.1 cm in the long finger, 2.3 cm in the ring finger, and 1.4 cm in the small finger. Although preoperative grip strength was doubled, postoperative strength was still only about 31% of that on the opposite side. All patients required at least one tenomyolysis or revision tenorrhaphy before the best clinical outcome was achieved.

Adolescent↗
PubMed1985

Compartment syndrome in the upper extremity.

It has been the purpose of this article to assist us in our approach to compartment problems, for, although a full-blown compartment syndrome following forearm injury is statistically uncommon, the results of this ischemic process can be devastating. A compartment pressure of greater than 30 mmHg for eight hours or more can cause cell death by interference with the microcirculation. Clinical diagnosis is made on the basis of a number of modalities, especially pain and paresthesias. Peripheral pulses or capillary flow are not specific indicators of compartment well-being. Direct compartment pressure measurements can be an invaluable tool but must be used in conjunction with the trend of the clinical findings. Limb elevation is not assistive in reducing compartment pressure, although removal of circumferential dressings and maintenance of mean arterial pressure can be. Prompt surgical decompression of the compromised compartment is the treatment of choice.

Arm↗
PubMed1991

Combined vascularized fibula and peroneal composite-flap transfer for severe heat-press injury of the forearm.

A free combined vascularized fibula and peroneal composite flap was transferred to the forearm in a patient with a severely damaged forearm following a heat-press injury. The operative technique, postoperative management, and subsequent clinical course are described, and the advantages of this method are outlined. Not only can the fibula now be used as a free vascularized bone graft in simple bone defects, but further applications, such as a combined fibula and peroneal composite flap, can be employed in the treatment of severely damaged forearms.

Burns↗