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Waterproof versus cotton cast liners: a randomized, prospective comparison.

Casting injured extremities can cause complications (eg, itching, odor, rashes, skin maceration), many of which are associated with the inability to wash the extremity because of water retention and slow drying of conventional cast liners. A waterproof cast liner allows casts to become wet and perhaps improves hygiene and comfort. Fifty-nine patients (age, > or = 10 years) with upper or lower extremity injuries were randomized to a waterproof-liner group (n = 29) or a cotton-liner group (n = 30). Both groups had casts made of fiberglass tape. At each clinic visit, patients and physicians completed questionnaires evaluating comfort and skin condition, respectively. The waterproof-liner group had better scores for itch (P = .008), discomfort (P < .001), irritation (P = .002), overall patient score (P = .012), and overall physician score (P = .049).

Adolescent↗

Lawnmower injuries in children.

Over an 8-year period 31 children in the Winnipeg area were admitted to hospital with lawnmower injuries. The accidents were always preventable and were caused by patient or parent carelessness. The wounds were severe, often resulting in amputation of a portion of an extremity. Infection was common; prophylaxis with a broad-spectrum antibiotic and human antitetanus globulin is recommended. Radiography, débridement of the wound with thorough exploration under general anesthesia, and defatting and reapplication of degloved skin should be done initially, then the wound should be reinspected and redressed at 2 to 3 days, and finally closed or skin grafted at 6 to 8 days. Children must be educated about the dangers of lawnmowers and prevented from riding on tractor mowers. The grass catcher should be used and the path cleared of missiles. Hand controls should be mounted on the mower's handle and the blade should be kept sharp so that the machine's speed can be reduced.

Accidents↗

[Surgical treatment of injuries of extremity vessels].

Results of treatment of 98 patients with injuries of extremity vessels were analyzed. The present-day character of osteo-vascular wounds requires a restoration of all anatomical structures. The best results were obtained by extrafocal methods of restoration. The author calls special attention to possible technical and strategy errors in treatment of such patients.

Adolescent↗

Commonly missed orthopedic problems.

Orthopedic problems that are often "missed" when the patient presents to the Emergency Department are discussed. Treatment suggestions for these conditions are made.

Arm Injuries↗

Tendon injuries of the lower extremity: magnetic resonance assessment.

MR is rapidly establishing itself as a premiere imaging modality for the assessment of musculoskeletal trauma. Its utility in the evaluation of the menisci and ligaments of the knee is well known, but there is far less known about the use of MR for evaluation of the tendons. MR, by virtue of its unmatched soft tissue resolution capability, can determine not only the contour of an affected tendon, but the tendon sheath and internal signal alterations that accompany tendonitis, partial and complete ruptures. Injuries to the Achilles tendon are well known to the athlete and the imager alike; however, abnormalities of the posterior tibial tendon, peroneal tendon, and flexor hallucis longus also result in significant clinical symptoms, as well as imaging abnormalities.

Athletic Injuries↗

Angiographic yield in penetrating extremity trauma.

Indications for angiography in the evaluation of penetrating extremity trauma remain controversial. Our experience was reviewed to determine the yield of angiography in penetrating extremity trauma and to correlate clinical findings with angiographic results. During an 81-month period from 1983 through 1989, 284 extremity arteriograms were carried out in 268 patients. The angiographic yield in patients with abnormal clinical findings was 51%. The angiographic yield in patients when proximity of the injury to major vessels was the only indication was 6% (7% with gunshot wounds and 0% with stab wounds). Neurologic deficit alone as an indication for angiography accounted for 55% of the angiograms interpreted as "negative" and none of those interpreted as "positive". We conclude that the use of angiography in patients with gunshot wounds to the extremity with "proximity injuries" to major vessels should continue, its use is not warranted in extremity stab wounds when proximity is the sole indication, and abnormal neurologic findings in the absence of other findings are a poor predictor of vascular injury.

Adolescent↗

Bite wound infections of the lower extremity.

Animal bite wounds of the lower extremity are considered high-risk wounds for infection, especially in the medically compromised individual. Management should be aggressive. Copious irrigation and debridement of the wound clearly proves to be of greater value in the prevention of infection than the indiscriminate use of so-called "prophylactic" antibiotic agents. Frankly infected wounds must also be managed aggressively, incorporating the use of antibiotics to eradicate the infection. Empiric use of an agent containing clavulanic acid or sulbactam is suggested until results are obtained from the bacterial culture and sensitivity. Tetanus prophylaxis should be considered for every bite wound, whereas rabies prophylaxis is warranted in selected cases.

Adult↗

[Isolated rupture of the anterior distal syndesmosis. A diagnostic problem].

Referring to one case of isolated rupture of the distal tibiofibular syndesmosis the mechanism of accident, findings, differential diagnosis and therapy of this rare and isolated injury are discussed. The clinical symptoms are not clear. In diagnostics the arthrography of the upper ankle joint proves very good. For the protection of suture of the ligament the hook according to Engelbrecht seems to be superior to the positioning screw.

Adult↗

The latissimus dorsi musculocutaneous flap for extremity reconstruction in orthopedic surgery.

The latissimus dorsi was transferred as a pedicle flap in ten patients and as a free vascular flap in ten others for extremity reconstruction. Group I comprised ten patients in whom the transfer was used solely to cover a skin or soft-tissue defect. Although there was partial necrosis of the transferred skin in one patient, the remaining nine patients obtained complete coverage without further reconstructive surgery. Group II comprised five patients in whom transfer of the latissimus dorsi was performed for active flexion or extension of the elbow or for abduction of the shoulder. Postoperatively, muscle strength obtained was classified from Grades 0 to 5 according to the muscle testing method. Three patients obtained muscle strength of Grade 3, while two obtained Grade 2. Group III comprised five patients who had brachial plexus palsy after high-dose irradiation. Coverage of the skin and soft tissue was performed after neurolysis of the brachial plexus palsy to free the tissue bed of scarred tissue. Postoperatively, sensory and motor disturbances were alleviated in four of five patients.

Adolescent↗

[Conduction anesthesia in orthopedic operations in injuries of the extremities].

An analysis of results of using conduction anesthesia for various operations on extremities of 274 patients of different age groups has been made. Complete effects were achieved in 91% of the patients, 5% of the patients were potentiated with neuroleptanalgesia drugs because of insufficient anesthesia, in 2% of the patients general anesthesia was used. The method of conduction anesthesia makes it possible to use a conveyer method of bringing patients to the operating room. It is more economical as compared with narcosis, easy in use. It may be recommended for wider use.

Adjuvants, Anesthesia↗

[The role of echotomography in sports traumatology of the lower extremity].

Sonography, which is commonly used in the evaluation of muscular traumas following exercise, quite often provides the radiologist with normal findings. One hundred and fifty-nine athletes were considered (170 US examinations), and the clinical diagnoses the patients had been referred for were compared with US findings: the pathologic condition was confirmed in 59% of the cases, while the extant 41% had normal findings. The highest percentage of positive findings was observed in the Achilles tendon region (75%), while the figure dropped to 38% in the thigh. In the latter location, muscular ruptures were confirmed in 69% of the cases, versus 17% in case of muscular distraction. As for the Achilles tendon, pathologic conditions both along the axis and in the insertion of the tendon were confirmed in 20% of the cases, but clinical accuracy was improved by US in 47% and 20% of the patients, respectively, and the diagnosis was changed in 10% and 20% of the cases, respectively. Therefore, clinical accuracy was demonstrated to depend on the pathologic condition as well as on the anatomical region involved.

Athletic Injuries↗

Compartment syndrome as a presentation of non-Hodgkin's lymphoma.

An 80-year-old woman sustained an injury to her left leg and presented having a compartment syndrome. Biopsy at the time of fasciotomy revealed lymphoma infiltrating the muscles of the left leg. We conclude that tumors may present as compartment syndrome and should be included with the differential diagnosis.

Aged↗