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[The measurement of wrist kinematics in children 4 to 16 years old and the comparison of the scapholunate distance with adult values].

OBJECTIVES: We sought to determine the position and values of the kinematic indices of the wrist (center of rotation, carpal height, carpal-ulnar distance), the third metacarpal length, and the scapholunate distance for children and compared the results with those reported for adults. METHODS: The study included 41 children (24 girls, 17 boys; age range 4 to 16 years) who presented with wrist and/or forearm injuries, and whose radiographs of the other wrist had been obtained for comparison. The children were divided into six age groups separated by 2-year intervals regardless of gender or the side of the wrists involved. Measurements were made on standard posteroanterior radiographs of healthy wrists and the mean values obtained were statistically analyzed. RESULTS: The carpal height, carpal-ulnar distance and the third metacarpal length were significantly different in all age groups. The ratios of the carpal height and the carpal-ulnar distance to the third metacarpal length were similar both in the age groups and to those reported for the adult values. However, the scapholunate distance exhibited significant differences between the age groups and from the standard adult value. CONCLUSION: The adult values given for the ratios of the carpal height and the carpal-ulnar distance to the third metacarpal length can be adopted as standard values for children. However, determination of the scapholunate dissociation in children should not be based on the normal range given for adults.

Adolescent↗

[Rehabilitation patients after fractures of upper limb].

Rehabilitation after fractures of upper limb is very complicated and should be coordinated with orthopedic procedures. A choice of method and schema is depended on general health status of patient and used orthopedic treatment. This process should start immediately after surgeon's intervention. An aim of rehabilitation is improvement of range movement, straight of muscles and acceleration of callus formation. It is very important to restore proprioception in a region of trauma. An intensity and velocity of rehabilitation is the greatest after extra bone consolidation and the slowest after conservative tutor management.

Arm Injuries↗

Automatic top loader washing machine related injury. A report of four cases with serious injury.

We are reporting four cases of serious washing machine related injury that presented within a period of 5 months. All patients were young children with the mean age of 9 year-old and three had their dominant hand injured. The washing machines involved were the automatic top loader type and all injuries occurred during the spinning phase. Serious automatic washing machine injury is not uncommon in Malaysia. We feel that there is a need to improve the safety features especially during the spinning phase. The operating instructions and safety precautions on the washing machine should be displayed in different languages that can be understood well. Parents should also aware of the potential risks of this seemingly benign household appliance.

Adolescent↗

The care of burned upper extremities.

Two sets of factors will ultimately influence the outcome of the burned upper extremity. The first set of factors is the depth and severity of the burn. The second set is the group of complications of the burn injury attributable to edema, inflammation, immobility, and malposition. An awareness of the potential pitfalls that follow burn injury has resulted in improved primary care and a lessening of deformity. Progressive acute care with topical chemotherapy, early motion, thoughtful splinting, and timely burn wound closure are essential to reduce the need for secondary operations. Reconstructive efforts should be tailored to the individual needs of the patient. These procedures should be carefully planned with a view toward balancing aesthetic and functional considerations and minimizing the time required for rehabilitation.

Arm Injuries↗

Salvage of replanted parts of the upper extremity.

Twelve patients with fifteen replanted parts had vascular exploration in order to salvage the replantation after impending failure developed. Arterial occlusion only was found in eleven parts, while arterial and venous occlusion was found in the other four. Vein grafts were used in ten parts, with success in eight. Thrombectomy was done in six, with success in only one. It was possible to salvage nine of the fifteen replanted parts. The best results were obtained when the revision was done within eleven hours after the replantation.

Adolescent↗