1/8. An open fracture of the ulna with bone loss, treated by bone transport.We report a Gustilo and Anderson IIIc fracture of the ulna with 8 cm of bone loss which was reconstructed primarily by the technique of external fixation and bone transport. Five operations were performed over a period of 14 months (treatment index = 52.5 days/cm). A satisfactory functional result was achieved, demonstrating the efficacy of this technique for difficult forearm reconstructions and comparing favourably with other methods of managing large bone and soft tissue defects.- - - - - - - - - - ranking = 1keywords = index (Clic here for more details about this article) |
2/8. Migrating foreign body in the tracheobronchial tree: an unusual case of firework penetrating neck injury.Firework injuries can manifest themselves in many different ways; usually as an explosive or burn injury. This case describes an unusual presentation of a firework penetrating injury resulting in a sharp coiled metal foreign body travelling through a small entry wound in the neck and subsequently lodging itself in the tracheobronchial tree. A foreign body such as this can potentially travel a considerable distance through the soft tissues and end up in an unsuspecting distant site. There must, therefore, be a high index of suspicion with the appropriate radiological investigations for appropriate management of such cases.- - - - - - - - - - ranking = 1keywords = index (Clic here for more details about this article) |
3/8. Krukenberg kineplasty: a case study.Functional independence has always been one of the most important goals in hand therapy. Following below-elbow amputation, this goal is often achieved by means of a prosthetic device. Unfortunately, there are rare instances in which an individual possesses an additional debilitating injury, such as blindness, that may preclude the use of a prosthetic device. Few hand therapists or surgeons actually have the opportunity to treat this type of patient. The purpose of this case study is to report the surgical methods, assessment techniques, and therapy guidelines for a 13-year-old male patient who suffered a below-elbow amputation of the left upper extremity and loss of vision after stepping on a land mine in his native country, nicaragua.- - - - - - - - - - ranking = 9.0409322951281keywords = assessment (Clic here for more details about this article) |
4/8. Complex cranial base trauma resulting from recreational fireworks injury: case reports and review of the literature.Two patients who sustained complex skull base trauma secondary to recreational fireworks injuries are reported. Initial assessment and management included axial and coronal computerized tomography, control of hemorrhage, debridement of wound and brain, isolation of brain from external environment, and reconstruction of the cranial base floor. Secondary orbital and facial reconstruction used available bone fragments and iliac bone graft in one patient and vascularized free tissue transfer in the other. In both patients, reconstruction of both the intracranial and extracranial compartments was successful with acceptable cosmetic result. Modification of multiple conventional approaches, along with a multispecialty surgical team, was used to deal effectively with these unique cases.- - - - - - - - - - ranking = 9.0409322951281keywords = assessment (Clic here for more details about this article) |
5/8. Pollicisation of the index metacarpal based on the first dorsal metacarpal artery.We present our experience of two cases in which we carried out pollicisation of the index metacarpal based on the first dorsal metacarpal artery and venae comitans. Both cases were complex severe hand injuries where the initial injury was the result of a firework exploding while held in the hand. In both cases the radial side of the superficial palmar arch was destroyed by the injury. In both cases there was virtually complete loss of the thumb ray and amputation of the index through the base of the proximal phalanx. A useful opposition post has been created from vascularised index metacarpal with free flap soft tissue reconstruction.- - - - - - - - - - ranking = 7keywords = index (Clic here for more details about this article) |
6/8. Optimum management of hand blast injuries.A series of 27 blast and gunshot injuries of the hand is presented. These wounds exhibit a spectrum of complexity and may include extensive soft tissue trauma complicated by burns, foreign bodies, fractures and amputations. A systematic management sequence is outlined to evaluate, treat, reconstruct and rehabilitate these hands, with the primary goal of obtaining early maximal function. Since these injuries vary in nature and complexity, this management sequence is specifically adapted to deal with the individual injury. A "reconstructive ladder" of techniques is utilized, ranging from "simple" (e.g., direct closure, skin grafts, local flaps) to "complex" (free flaps, toe-to-thumb transfer). The individual procedure selected is the most straightforward, consistent with expediency and early return of a functional hand. The return of these hands to function has been facilitated by recent advances in tissue assessment, free tissue transfer, and skilled hand therapy.- - - - - - - - - - ranking = 9.0409322951281keywords = assessment (Clic here for more details about this article) |
7/8. Tire explosion injuries to the upper extremity.We describe a protocol for treating tire explosion injuries to the hands on the basis of treatment of five cases over a 3-year period at Emory University Hospital. These high-energy wounds frequently require emergent initial debridement and stabilization, followed by complex soft tissue and skeletal reconstruction to maximize function. Data from all cases are summarized to show similarities among these injuries and differences in their response to treatment. We define the stages of treatment, emphasizing prevention, complete assessment, and early intervention, especially for limb-threatening conditions with fasciotomy, revascularization, thorough debridement, and rigid fixation. We also discuss the importance of aggressive therapy, close follow-up, and treatment of late complications. Functional reconstruction was achieved in each case, suggesting that our treatment protocol can be used successfully.- - - - - - - - - - ranking = 9.0409322951281keywords = assessment (Clic here for more details about this article) |
8/8. Unusual pattern of injury caused by a pyrotechnic hand held signal flare.The case is reported of a man shot with a distress flare from a range of about 3 m. The flare caused a large cavity deep in the pectoral muscles. There should be a high index of suspicion about the extent of the injury in all types of penetrating trauma.- - - - - - - - - - ranking = 1keywords = index (Clic here for more details about this article) |