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PubMed1979

[The etiology of the refracture of the forearm in childhood (author's transl)].

The etiology of the refracture after forearm fractures in childhood has been studied in a follow-up examination of 199 patients with dislocated forearm fractures. The incidence of the refracture was 13%. In all cases the primary fracture was a greenstick fracture of at least one of the two forearm bones. The incompletely broken through greenstick fracture was found to be significantly responsible for the refracture. Duration of immobilisation or residual axis deviation at consolidation showed no relationship. The pathophysiology is briefly discussed. In every greenstick-fracture of the forearm the necessity of completing the fracture by total reposition is emphasized to prevent a refracture.

Child↗
PubMed1983

Complications of plate fixation of forearm fractures.

Sixty-four adult patients (87 diaphyseal forearm fractures) were treated by plating. Thirty-nine percent of the fractures were classified as single bone fractures (16% radius, 23% ulna); 43% were both radial and ulnar fractures, and 19% were Galeazzi or Monteggia fracture-dislocations. A major complication occurred in 18 (28%) patients. Nonunion occurred in six patients: three of 18 bones treated with four screws (17%), but only three of 69 bones fixed with five or more screws (4.3%), a nonunion rate four times higher for bones plated with four screws. Screws loosened in three fractures, all involving the ulna. Radioulnar synostosis occurred in seven forearms, and in five of these the forearm injuries were associated with multiple system trauma involving head injury. Two patients had osteomyelitis. Both were victims of massive crush injury and delayed internal fixation, and both required removal of the implant; but eventually the fractures healed. Plate fixation of forearm fractures can have a high complication rate. Meticulous attention to surgical technique and the use of plates long enough to provide secure fixation can not be overemphasized. An increased incidence of synostosis in polytrauma, head-injured patients was noteworthy.

Adolescent↗
PubMed1992

Angular deformities and forearm function.

Angular deformities were created in cadaver forearms at proximal, middle, and distal third levels of the radius and ulna separately, and at middle and distal third levels of both bones, to determine the corresponding limitations of pronation and supination. The ranges of pronation and supination were recorded using a rotational motion measurement apparatus instrumented with a 360 degrees goniometer. These experimental results were compared to data obtained from clinical and radiographic examination of 105 patients with similar residual deformities following treatment of fractures by nonsurgical means, to evaluate the accuracy of the experimental model and to determine if loss of rotational motion could be predicted based on radiographic findings. With cadaver forearms, on the average, angulation of 10 degrees of the radius or ulna in coronal or sagittal planes limited pronation and supination by less than 24 degrees, whereas angulation of 10 degrees of both the radius and the ulna limited pronation and supination by less than 18%. Comparison of experimental results with clinical findings showed that, despite the errors involved in measuring forearm deformities in patients using biplanar radiographs, the experimental results predicted the clinical loss of pronation and supination to within 17% for the fractures of the radius, and within 8% accuracy for the fractures of the ulna.

Cadaver↗
PubMed1990

[A rare cause of compartment syndrome of the forearm and hand following snake bite injury].

With the intention to commit suicide a 25 year old patient was bitten by his own rattle snake. At the time of the admission the skin of the right forearm was dark, a hemorrhagic necrotizing colour, and the patient was in shock. He was immediately taken to the intensive care unit and the shock symptoms were treated there. Parasthesias in the area of the nervus medianus were also noticed. The treatment included an antiserum and the release of the tourniquet which caused a further increase of the swelling of the forearm. The lesion led to a hemorrhagic necrotizing inflammation. The surgical incision of the loge of Guyon, the carpal channel, the forearm and proximal of the lacertus fibrosus was persuaded. The circulation improved immediately and after three weeks the nerval function had recovered. The skin defect was covered 14 days after the first operation with meshgraft.

Adult↗
PubMed1984

Lower limb salvage using an extended free radial forearm flap.

A case is reported of an unusual double injury, in which a lower limb salvage procedure employed a free radial forearm flap from an amputated upper limb. The use of amputated parts for salvage procedures is well documented but none has previously involved a free forearm flap. This clinical case shows that the entire forearm and hand skin can be adequately perfused on the radial artery along with the superficial palmar arch.

Adolescent↗
PubMed1996

Free arterialised venous forearm flaps for limb reconstruction.

Arterialised venous flaps are an alternative method to conventional flaps. Arterialised venous flaps include only the venous network and afferent blood comes from the arterial system. Arterialised venous flaps have been mostly used for closure of small defects. We have designed an arterialised venous flap utilising the venous network of the forearm and applied this flap in 5 patients with various defects in the extremities ranging in size from 6 x 8 cm to 10 x 12 cm. Four flaps totally survived. One flap had 30% partial necrosis. Overall clinical results were successful. The free arterialised venous forearm flap provides large, thin, good quality tissue with less morbidity at the donor site without sacrificing one major artery of the hand and can be an alternative for the conventional radial forearm flap.

Adolescent↗
PubMed1998

The significance of the three volar spaces in forearm compartment syndrome: a clinical and cadaveric correlation.

The goal of this study was to assess the importance of the 3 volar spaces in forearm compartment syndrome in a prospective manner. A cadaveric model was developed to correlate with our clinical experience. All but 1 of 21 volar compartments (superficial volar, deep volar, and pronator quadratus spaces) in 7 patients in our clinical series decompressed adequately after release of the superficial volar fascia. One patient needed further release of the pronator quadratus compartment; he had suffered a combined crush and vascular injury. All volar compartments in our cadaveric model decompressed with superficial fasciotomy. Prefasciotomy and postfasciotomy pressures should be obtained from all 3 compartments of the volar forearm. Superficial fasciotomy usually adequately decompresses the entire volar forearm; however, in the event that deep compartment pressures remain high after superficial fasciotomy, release of the affected space is indicated.

Adult↗
PubMed2002

The efficacy of magnetic resonance imaging and ultrasound in detecting disruptions of the forearm interosseous membrane: a cadaver study.

The purpose of this study was to examine the efficacy of magnetic resonance imaging (MRI) and ultrasound (US) in determining complete disruptions of the central portion of the forearm interosseous membrane. The midportion of the forearm interosseous ligament was longitudinally incised in 19 fresh-frozen cadaver arms. The specimens were imaged with MRI and US. The MRIs were examined by a hand surgeon, a musculoskeletal radiologist, and a general radiologist, all blinded to the state of the interosseous membrane. The musculoskeletal radiologist and general radiologists read the real-time US images in a consensus fashion. Magnetic resonance imaging showed a 96% accuracy rate, a 100% positive predictive value, a 93% negative predictive value, 93% sensitivity, and 100% specificity. Kappa analysis showed substantial interobserver agreement for MRI. Ultrasound showed a 94% accuracy rate, a 94% positive predictive value, a 100% negative predictive value, 100% sensitivity, and 89% specificity. There was no statistical significance between the accuracy of MRI and US. We conclude that MRI and US imaging should both be considered when forearm interosseous membrane integrity is in question.

Adult↗
PubMed1999

Fascial flaps based on perforators for reconstruction of defects in the distal forearm.

Twenty fascial flaps were used in the reconstruction of defects in the distal forearm, wrist and hand in 18 patients over a 2-year period. In 16 patients the fascial flaps were based on a single fascial feeding vessel or 'perforator' arising from the anterior interosseous artery and/or ulnar artery when the radial artery had been used as the donor vessel in free flap reconstruction elsewhere in the body. There was no loss of any fascial flap in the study. The use of fascial flaps based on fascial feeders of the anterior interosseous and ulnar arteries extends the range of fascial flaps that can be raised in the forearm for reconstruction of defects in the distal forearm, wrist and hand.

Adolescent↗
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↗
PubMed2005

Vascularized periosteal flaps of distal forearm and hand.

BACKGROUND: Vascularized periosteal flaps (VPFs) are flexible osteogenic flaps, suitable for the reconstruction of small skeletal defects. Pedicled VPFs, harvested near the recipient site, minimize donor-site morbidity and procedure duration. The donor sites and the potential recipient sites for pedicled VPFs of the distal forearm-hand were identified in this study. METHODS: In 16 fresh cadaver upper extremities, the dimensions and arcs of rotation of the VPF pedicle(s) were studied. RESULTS: Pedicled VPFs with mean dimensions ranging between 0.5 x 3 cm and 2.5 x 4 cm could cover, after adequate mobilization, the distal half of the forearm, wrist, and hand to the proximal interphalangeal joints. CONCLUSION: The VPFs identified in this study can be used for the reconstruction of small skeletal defects and for the treatment of osteonecrotic lesions and nonunions of the distal forearm, wrist, and hand. The choice of the most suitable VPF will be based on the anatomic location and the dimensions of the recipient site.

Cadaver↗
PubMed2001

Magnetic resonance imaging of the interosseous membrane of the forearm.

BACKGROUND: Diagnosis of damage to the interosseous membrane of the forearm after trauma is difficult. Patients with a proximal radial fracture and associated damage to the interosseous membrane may have wrist pain in association with subluxation or dislocation of the distal radioulnar joint. Accurate identification of injury to the interosseous membrane may allow better planning of surgical treatment. METHODS: T1 and T2-weighted magnetic resonance images that were made in the axial, sagittal, and coronal planes were used to evaluate the interosseous membrane in the forearms of cadavera, volunteers, and patients. The images were evaluated subjectively by two orthopaedic surgeons and a musculoskeletal radiologist. RESULTS: The interosseous membrane was most consistently visualized on the axial images. Axial T2-weighted images showed the interosseous membrane clearly. The addition of fat-suppression techniques allowed abnormalities to be identified more accurately. Fast-spin-echo techniques were used to obtain data quickly and accurately. CONCLUSIONS: The intact and disrupted interosseous membrane can be evaluated with use of magnetic resonance imaging. Axial T2-weighted fast-spin-echo images with fat suppression in the middle one-third of the forearm provide the most accurate information.

Forearm↗
PubMed1985

Acute penetrating arterial injuries of the forearm. Ligation or repair?

The management of forearm arterial trauma is controversial and follow-up data on such injuries is scant. A survey was made of 249 patients with penetrating forearm trauma to determine the incidence and outcome of arterial injury. Sixty-six patients (26.5%) sustained 69 arterial injuries documented at operation or with angiography. The clinical manifestations of arterial injury were often subtle; 42.4 per cent of the patients had normal pulses and only 7.6 per cent presented with distal ischemia. In 9.1 per cent of the patients there was no clinical evidence of vascular injury. The most frequent types of arterial injury were transection (72.5%) and partial laceration (14.5%). Arterial repair was performed in 84.8 per cent of the cases, and resection with end-to-end anastomosis was usually possible. Volar compartment fasciotomies were necessary in 18.2 per cent of the cases. The early postoperative complications seen were wound-related, and these were six times more frequent in the group undergoing arterial ligation (36% vs 6%). In 49 patients evaluated an average of 6 months after repair, the patency rate determined by clinical examination was 85.7 per cent. Because of a high incidence of associated nerve (56.1%) and tendon (54.5%) injuries, the functional status of the injured extremity was less satisfactory, with only 49.2 per cent of the patients having normal hand function. Since the forearm vessels can be repaired with minimal morbidity and acceptable results, arterial ligation is recommended only when repair is not readily accomplished, or when treatment of a more pressing associated injury demands priority.

Acute Disease↗
PubMed1998

Disorders of the forearm axis.

Forearm pronosupination is a complex, integrated activity that demands specialized function of all structures between the elbow and wrist. This article describes the forearm axis as a comprehensive concept to unify these relationships. The anatomy and biomechanics of the forearm axis are reviewed. Pathologies that affect the entire axis are summarized.

Biomechanical Phenomena↗
PubMed1998

Pharyngoesophageal reconstruction with the ulnar forearm flap.

OBJECTIVE: To evaluate the use of a generous fasciocutaneous ulnar forearm free flap in pharyngoesophageal reconstruction. DESIGN: Tertiary referral center. SETTING: Private practice. PATIENTS: From September 1, 1991, to October 30, 1996, 20 ulnar forearm free flaps were used to reconstruct the pharyngoesophagus in 19 patients after surgery for squamous cell carcinoma. There were 13 circumferential defects and 7 near-circumferential defects (<2 cm of mucosa remaining). The reconstructions were performed primarily (at the time of tumor resection) in 16 cases and secondarily in 4 cases. INTERVENTION: A generous fasciocutaneous ulnar forearm flap with a minimum dimension of 9 x 22 cm was harvested to reconstruct the pharyngoesophagus. A 2-layer closure was performed in flap tailoring and proximal (pharynx to flap) and distal (flap to esophagus) anastomoses to minimize the risk of leakage. Also, portions of the flap were used to monitor flap viability, to cover cervical vessels, to obliterate dead space, and as skin coverage when the skin flaps were deficient. RESULTS: Nineteen of the 20 flaps transferred were successful. Swallow function was restored in 18 cases, and voice was rehabilitated in all the patients using either tracheoesophageal puncture and a voice device or an electrolarynx device. There was 1 perioperative mortality. Three fistulas occurred, all of which healed with nonsurgical treatment. One stricture developed that required intermittent dilatation. The donor site morbidity was minor. CONCLUSIONS: This versatile technique achieves excellent results with a decreased complication rate compared with other methods currently available in pharyngoesophageal reconstruction.

Adult↗
PubMed1987

Oral and pharyngeal reconstruction using the free forearm flap.

Recent progress in myocutaneous and free flaps has facilitated the primary closure of various complex defects resulting from ablative surgery of head and neck cancers. The musculocutaneous flap (such as the pectoralis major flap or the latissimus dorsi flap) has in particular proved its greater versatility. The forearm free flap for intraoral defects can provide thin and pliable skin and has great potential in the reconstruction of oropharyngeal defects. Between November 1982 and August 1985, we achieved 74 free forearm flap transfers for patients with head and neck cancers. Herein we present several clinical applications of the free forearm flap and discuss its advantages and disadvantages, especially hand morbidity after flap elevation.

Adult↗
PubMed1995

Free forearm flap in oral reconstruction. Functional outcome.

OBJECTIVE: To examine functional outcome associated with free radical forearm flap reconstruction of oral cavity and oropharyngeal defects. DESIGN AND SETTING: Case series obtained from a head and neck clinic conducted at a regional cancer center. Patients underwent surgery at the associated tertiary care center. PATIENTS: Thirty consecutive patients treated for oral and oropharyngeal malignant neoplasms staged from T1 to T4 were studied. Subjects were assigned to five groups based on the site and extent of their surgical resections, as specified on a resection template. INTERVENTION: All patients had undergone free radial forearm flap reconstruction of their surgical defects. OUTCOME MEASURES: Ten factors reflecting functional properties and processes of the upper aerodigestive tract were evaluated clinically or with videofluoroscopy or both. RESULTS: Near-normal and fair oral and oropharyngeal function wholly characterized the sample. Patients who underwent reconstruction of unilateral tongue, floor of mouth-ventral tongue, and retromolar trigone-buccal defects functioned well on most measures; the function of patients with anterior tongue-jaw and tongue base-tonsil defects varied. CONCLUSIONS: Functional outcome with free radial forearm flap reconstruction was favorable for three of five subgroups of oral and oropharyngeal cancer patients. Qualitatively different functional profiles emerged for subgroups based on resection site. Methodologic issues for research on surgical reconstruction and functional outcome include the need for a meaningful, reliable system of classifying oral and oropharyngeal resections, and the development of standardized procedures for evaluating functional outcome.

Adult↗
PubMed2000

Postcontraction depression of reciprocal inhibition in human forearm muscles.

We tested whether a preceding muscle contraction changes reciprocal inhibition (RI) between forearm antagonists. RI was studied in 14 healthy subjects by assessing changes in the H reflex (evoked by median-nerve stimulation) in forearm flexor muscles after conditioning radial-nerve stimulation at 0- and 20-ms intervals. The maximum sizes of the M wave (M(max)) and H reflex (H(max)) were also measured. After a long-lasting maximum voluntary handgrip contraction (mean +/- SEM: 3.9 +/- 0.6 min) of ipsilateral forearm muscles, M(max) and H(max) were unchanged but RI was diminished. After contraction of the contralateral homologous muscles and after contraction elicited by ipsilateral muscle stimulation, RI remained unchanged. These results show that a preceding maximum voluntary contraction (lasting 30 s or more) reduces the activity of the spinal inhibitory interneurons mediating RI. This finding may imply the need to reinterpret results from RI studies in normal subjects and in patients with movement disorders.

Adult↗