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Acute nerve injury as a complication of closed fractures or dislocations of the elbow.

Twenty-one patients with acute injury of either the median, ulnar, radial, anterior interosseous or posterior interosseous nerves associated with 1540 closed fractures or dislocations of the elbow have been reviewed. The mean time of follow-up was three years and nine months. Nine patients, 6 of whom had ulnar nerve lesions, had persistent evidence of nerve damage. Five patients sustained median nerve lesions complicating supracondylar fractures of the humerus. One patient, in whom there was no evidence of nerve recovery at five months, made a full recovery following neurolysis. Of the 9 patients who sustained ulnar nerve lesions, 2 required neurolysis and anterior transposition of the nerve, at two months and five months respectively, to facilitate recovery. Except for one patient with persistent radial paraesthesiae, full spontaneous recovery occurred in 7 patients who had sustained either anterior interosseous, posterior interosseous or radial nerve lesions.

Adolescent↗

[Injuries of the medial epicondyle of the humerus in children. Conservative or surgical therapy?].

18 patients with avulsions of the medial epicondyle 1 10/12 to 16 2/12 years after trauma are presented. Non-union occurs very often after conservative treatment involving avulsion with or without displacement. Although non-union of the medial epicondyle gives no or only little disability, the fixation with one or two Kirschner wires is recommended to avoid non-union. Open reposition is necessary in cases with injury of the n. ulnaris and in cases with incarceration of the epicondyle in the elbow joint.

Bone Wires↗

Archery-related injuries of the hand, forearm, and elbow.

The five patients reported herein had various archery-related injuries of the upper extremities. Acute injuries included arrow laceration of a digital nerve and artery, contusion of forearm skin and subcutaneous tissue, and compression neuropathy of digital nerves from the bowstring. Chronic injuries included bilateral medial epicondylitis and median nerve compression at the wrist, de Quervain's tenosynovitis, and median nerve compression at the elbow. Essential measures for archery safety include use of archery protective gear, use of a light-weight bow, conditioning of the forearm flexor muscles, and modifications in drawing the bowstring.

Adult↗

Injuries in sport.

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Achilles Tendon↗

Treatment of complex below-the-elbow gunshot wounds.

Firearm injuries, many of which involve the hand, wrist, or forearm, pose a serious public health concern in the United States in both medical and economic terms. Despite the preponderance of low-velocity weapons, complex below-the-elbow gunshot injuries are commonly seen. A successful approach to these patients requires efficient treatment and early initiation of rehabilitation. Unfortunately, this goal is often not met because of multiple factors including wound infections, the need to coordinate multiple surgical specialties, long hospital stays, and delayed definitive reconstruction. At our institution, the plastic surgery hand service is able to treat all aspects of below-the-elbow trauma. A protocol of early aggressive debridement and skeletal stabilization, with definitive reconstruction within 1 week of injury, is used. We retrospectively reviewed all complex below-the-elbow gunshot injuries treated by the senior author between 1996 and 2003. Eighteen such patients were identified. All limbs were salvaged and all patients regained functional use of the extremity. There was no incidence of wound infection. The average length of inpatient stay was 8.9 days (median, 7 days). The use of this protocol by a single surgical specialty allows efficient reconstruction, short hospital stays, and early initiation of rehabilitation.

Adolescent↗

Arthroscopic treatment of posterior impingement of the elbow in athletes.

Arthroscopic treatment of posterior impingement of the elbow in athletes consistently can improve comfort and function. Arthroscopic treatment is particularly valuable because of increased intra-articular visualization of the anterior and posterior compartments and diminished soft tissue trauma. Arthroscopic visualization also can help the surgeon assess small pathologic changes in joint congruity seen in subtle forms of ligamentous instability, which are often symptomatic in high-demand athletes. Treatment of these subtle instabilities can be individualized to the athlete. Most athletes are able to return to the same level of their sport after arthroscopic surgery for posterior impingement of the elbow. In certain athletes, however, depending on the position played, reoperation rates are high, and return rates to the same level of competition can be less than in other athletes with posterior impingement of the elbow. Patient selection, technical expertise, and familiarity with open and arthroscopic elbow surgery are all criteria for success.

Arthroscopy↗