1/12. Severe, traumatic soft-tissue loss in the antecubital fossa and proximal forearm associated with radial and/or median nerve palsy: nerve recovery after coverage with a pedicled latissimus dorsi muscle flap.A total of 6 patients with complex, traumatic wounds of the antecubital fossa and proximal forearm were included in this study. All patients presented with radial and/or median nerve palsies in addition to their soft-tissue defect. Except for 1 patient with a 15-cm defect of the radial nerve, all other traumatized nerves appeared in-continuity at the time of surgery. However, the nerve injury was severe enough to induce wallerian degeneration (i.e., axonotmesis in traumatized nerves in-continuity). Three patients required brachial artery reconstruction with a reverse saphenous vein graft. Wound coverage was accomplished using a pedicled latissimus dorsi muscle flap, which was covered with a split-thickness skin graft. Successful reconstruction was obtained in all patients. Follow-up ranged from 2 to 6 years. The range of motion at the elbow and forearm was considered excellent in 5 patients and good in the remaining patient who had an intra-articular fracture. Motor recovery of traumatized nerves in-continuity was observed in all but 1 patient who had persistent partial anterior interosseous nerve palsy. The grip strength of the injured hand measured 70% to 85% of the contralateral uninjured hand. median nerve sensory recovery was excellent in all patients. The versatility of the pedicled latissimus dorsi muscle flap for coverage of these complex wounds with traumatized neurovascular bundles around the elbow is discussed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/12. Salvage of impending replant failure by temporary ectopic replantation: a case report.Temporary ectopic replantation of amputated parts has been reported previously as an alternative to orthotopic replantation in difficult cases. We report a case in which the left arm initially was replanted orthotopically with subsequent development of extensive infection. The impending vascular failure of the replanted arm was salvaged by reamputation and temporary ectopic transfer of the arm to the groin region. Nine days later the arm was transferred back to the clean humeral stump. The functional result was similar to that of a standard transhumeral replantation, with 30 degrees to 120 degrees of active range of elbow motion, basic grip pattern, and S3 sensibility.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/12. Burn scars treated by pinhole method using a carbon dioxide laser.Many patients with burn injuries have various complications and emotional problems due to scars. Although various modalities to improve burn scars have been attempted, such as excision of scars, skin grafts, laser abrasion and silicone product usage, the cosmetic outcomes have not been satisfactory for a large portion of patients. Herein, we describe two cases which showed satisfactory cosmetic results after treatment of burns scars with the pinhole method using a carbon dioxide (CO(2)) laser that allowed us to make deep, closely set holes reaching down to the upper dermis. A 20-year-old female patient with a scar on her neck and a 25-year-old female patient with a scar on her right forearm after burn injuries are presented. As early as only a few weeks after the treatment, the scars showed relaxation of contracture, reduction of wrinkles and improvement of texture and color compared to before the treatment. Treatment of burn scars with the pinhole method can be easily performed and results in dramatic improvement in scar quality with only a few side-effects.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/12. fatigue fracture of the ulna occurring in pitchers of fast-pitch softball.We have reported three cases of fatigue fracture of the ulna in male pitchers of fast-pitch softball. To elucidate the etiology of injury, we first selected three healthy male and three healthy female pitchers from a well-trained college team and analyzed their forearm movement by high-speed cinematography. This showed slight flexion of the elbow joints during wind-up motion, dorsal flexion of the hand joints upon releasing the ball, and extreme pronation of the forearms during the follow-through. We then took 8 mm CT scanning sections of the forearms. Using these images, we investigated shapes and areas of cross-sections of the ulna and its cortical and cancellous bones from the elbow to the hand joints. Our results reveal that the shapes of the sections are significantly different from circles at around the center of the ulna, and the cross-sectional areas are smaller in the middle one-third of the ulna than in other parts. These observations imply that fatigue fractures of the ulna in pitchers of fast-pitch softball must be torsionally induced, tending to occur at the middle one-third of the bone.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/12. The proximally pedicled arteria radialis forearm flap in the treatment of soft tissue defects of the dorsal elbow.Soft tissue defects of the dorsal side of the elbow require a stable soft tissue reconstruction. Therefore, for the treatment of limited, uninfected defects, local or distant skin flaps should be used. For large and infected defects, the use of the proximally pedicled arteria radialis forearm flap is indicated. We used the flap in 14 patients as an alternative to conventional methods. This neurovascular, septocutaneous flap proved safe and versatile, guaranteeing stable soft tissue reconstruction of the dorsal aspect of the elbow. The flap has an orthograde flow and is nourished by the radial artery. With its long, neurovascular pedicle, it can be transposed in a proximal ulnar or radial direction. Four years after operation, all elbow joints showed a complete range of motion. No further soft tissue instabilities were seen.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/12. An adjustable splint for forearm supination.The adjustable supination splint is used in select cases in which traditional mobilization therapy is not productive in supination gains. The success of the splint varies depending on many factors, including the type and severity of the injury; the timing of the intervention; the patient's age; and the patient's tolerance of and compliance with the treatment program. The therapist must consult with the physician and have his or her approval before initiating the treatment regimen. Splint use is contraindicated in patients with unstable fractures or with injuries that require surgical intervention before splinting. Therapists should watch for edema, pain, and neurological changes. Depending on the severity of these symptoms, the splint may need to be discontinued or the wearing time and tension adjusted. In our experience at Union Memorial Hospital and in our weighing of the above considerations, we have found favorable results in the use of the adjustable supination splint, with gains in range of motion and function in select patients.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/12. sural nerve grafts for delayed repair of divided posterior interosseos nerves.sural nerve grafts were used in three patients to bridge gaps measuring 2 1/2 to 4 1/2 cm in previously transected but not repaired posterior interosseous nerves. The grafts were done at 4, 5, and 7 months after injury. Extension was weaker in all three than on the uninjured side, but the range of motion was complete, with the exception of a slight lag of index finger extension and partial return of extension of the extensor carpi ulnaris in the same patient. All three patients recovered full function of the involved hand 1 year after grafting. The properties of the posterior interosseous nerve (pure motor and short distance to the muscle) contribute to good results with nerve grafts in delayed nerve repairs. We believe that these results are better than tendon transfers, at least in young patients.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/12. Tendon transfers in muscle and tendon loss.Tendon transfers in muscle and tendon loss offer some of the most gratifying results to both patient and surgeon. Poor results do occur at times in tendon transfer. When patients whose results were found to be less than expected were studied, the following problems were identified: 1. Acceptance of less than full passive range of motion before transfer. In some instances, this will be unavoidable. The use of pretransfer hand therapy techniques may improve the situation; or, if possible, pretransfer capsulotomies may better prepare the patient for the tendon transfer. 2. Adhesions along the course of the transfer. At times the transfer route can be better prepared by the use of skin grafts adding subcutaneous tissue to the transfer bed. The use of a staged technique in which a silicone rubber tendon implant is installed along the transfer route, to prepare for a later transfer, is occasionally indicated. 3. Technical failures: a. juncture breakdown, b. transfer put in under too little tension. 4. Patient noncompliance. A recent experience in which a patient removed his postoperative cast and came in 2 weeks later with his transfer disrupted is an extreme example. Many other patients are not prepared to undertake what may be a rigorous and time-consuming postoperative transfer program. Adequate preoperative evaluation, including patient selection as well as careful attention to the details of the procedure during surgery, along with attentive postoperative care, should eliminate most of these problems.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/12. The Y-shaped hypogastric--groin flap.We present a technique of providing complete skin cover for total degloving injuries of the hand and distal third of the forearm. This involves the use of a Y-shaped hypogastric groin flap. The proximal portion of the Y is tubed allowing the distal portion of each flap to be applied to the dorsal and volar surfaces respectively. This technique allows complete skin cover of both surfaces and yet retains the advantages of the groin flap in that it still has a long pedicle allowing the hand to be put through a full range of motion, speeding rehabilitation.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/12. Traumatic dorsal dislocation of the triquetrum: a case report.A case of traumatic dorsal dislocation of the triquetrum associated with direct trauma is reported. diagnosis was delayed, and open reduction and internal fixation with Kirschner wire was performed 7 days after injury. Eight months afterwards, the patient had good alignment of the carpus assessed radiographically, with full range of motion of the wrist and normal grip strength.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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