1/22. Bilateral proximal radial and scaphoid fractures in a child.A 13-year-old boy fell and suffered concomitant bilateral fractures of the proximal radius and scaphoid. Ipsilateral fractures of the proximal radius and scaphoid have been reported only once previously in a child, and never bilaterally. This article reviews paediatric proximal radial fractures and scaphoid fractures and their associated injuries. This report underlines the importance of examining for other injuries when a child presents with an apparently isolated upper extremity fracture.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/22. brachial artery injury in closed posterior elbow dislocation case report.The authors describe a case with a closed posterior elbow dislocation associated with a distal radial fracture and complete transsection of the brachial artery. The patient had a pulseless distal upper extremity and immediate gross swelling of the elbow and forearm. As closed reduction was not possible, open reduction had to be performed through an anteromedial approach to the elbow. End-to-end suture of the brachial artery was successful. After fasciotomy and internal fixation of the distal radial fracture, the elbow was stabilized with an external fixator spanning the elbow joint. After two years, despite good function of the elbow, restoration of the hand function is not optimal owing to persistent motor deficit of the ulnar nerve.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
3/22. Interscalene and infraclavicular block for bilateral distal radius fracture.brachial plexus blockade is a suitable technique for surgery of the forearm, because it provides good intraoperative anesthesia as well as prolonged postoperative analgesia when long-acting local anesthetics are used. However, simultaneous blockade of both upper extremities has rarely been performed (1), because local anesthetic toxicity caused by the amount of drug needed to achieve an efficient block on both sides may be a problem. We report a case of successful bilateral brachial plexus block with ropivacaine in a patient with bilateral distal radius fracture, with each fracture requiring an open osteosynthesis. IMPLICATIONS: This case report presents the performance of a simultaneous blockade of both upper extremities in a patient who sustained a bilateral distal radius fracture. The patient was known to be difficult to intubate and to have a severe hypersensitivity to opioids.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
4/22. Tire explosion injuries to the upper extremity.Several articles have been published that bring attention to the destructive potential of tire explosions. Although the severity of tire explosion injuries to the head and neck region is well established, only one previous article has reported injuries to the upper extremity. Fourteen patients with upper extremity tire explosion injuries have been treated by us from 1980 to 1988. Each injury was caused by single-piece wheel assemblies, as opposed to multipiece wheel assemblies, which have traditionally been associated with the injury. Three representative patient reports are discussed. Prevention of this injury can be achieved by increased public awareness, formal industrial safety training, tire servicing with dedicated equipment including restraining devices or barriers, complete evaluation of wheel/tire serviceability before tire mounting, separation of servicing of single and multipiece wheels, and complete tire deflation before servicing.- - - - - - - - - - ranking = 6keywords = upper (Clic here for more details about this article) |
5/22. Biceps femoris perforator free flap for upper extremity reconstruction: anatomical study and clinical series.BACKGROUND: Perforator flaps are an important development in reconstructive surgery. The description of new perforator flaps is an open field in anatomical and surgical research. methods: The anatomy of the musculocutaneous perforating vessels of the short head of the biceps femoris muscle was investigated as a possible source for free tissue transfer in 10 fresh specimens. A series of 10 free biceps femoris perforator flaps for upper extremity reconstruction is described. RESULTS: There were three constant sizable perforators, located at 6 cm (range, 5 to 6.5 cm), 11.6 cm (range, 10 to 14 cm), and 15.3 cm (range, 14 to 17 cm), respectively, from the knee joint line. The distalmost perforator was a branch off the superior lateral genicular artery in all anatomical specimens. The middle perforator was a direct branch off the popliteal artery in 60 percent of the cases and off the profunda femoris in the remaining 40 percent. The uppermost perforator was usually a branch off the middle perforator. The flaps of the clinical series were based on the middle perforator (11.6 cm). All 10 free flaps were used for upper extremity trauma coverage, with a 100 percent success rate, although one flap required pedicle revision because of arterial thrombosis and developed partial necrosis. Donor-site delayed wound healing occurred in two patients. CONCLUSIONS: The vascular anatomy is relatively constant. Flap dissection is straightforward under tourniquet control, donor morbidity is low provided a primary closure is possible, and pedicle size is appropriate for repair. When a moderate-size free flap with moderate thickness and a medium-sized pedicle is needed, the biceps femoris perforator flap should be considered in the first-choice group of donor areas.- - - - - - - - - - ranking = 7keywords = upper (Clic here for more details about this article) |
6/22. Split flexor carpi ulnaris transfer: a new functioning free muscle transfer with independent dual function.BACKGROUND: A functioning free muscle transfer is a well-established modality of restoring upper limb function in patients with significant functional deficits. Splitting the neuromuscular compartments of the free muscle based on its intramuscular neural anatomy and using each compartment for a different function would allow for restoration of two functions instead of one at the new distant site. methods: The authors previously reported on the clinical use of a pedicled split flexor carpi ulnaris muscle transfer. They now report the use of this muscle as a functioning free split muscle transfer to restore independent thumb and finger extension in a patient with total extensor compartment muscle loss in the forearm and a concomitant high radial nerve avulsion injury. RESULTS: Nine months postoperatively, the patient was able to extend his thumb and fingers independent of each other. CONCLUSION: This is the first report of a functioning free split muscle transfer demonstrating two independent functions in the upper limb.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
7/22. A rare combination of fractures of the upper extremities: a diagnostic problem.The rare case is reported of fractures concurrently of the bilateral proximal radius and the right proximal carpal row. Initial radiographs of the patient showed only fractures in the bilateral proximal radius and the right triquetral bone. In addition, the bone scan showed focal increased uptake in the right scaphoid bone and lunate bone as well, suggesting fractures. Fractures of the entire right proximal row were confirmed by computer tomography. The patient received functional treatment for the elbows and had a scaphoid plaster-of-paris cast for the wrist. This resulted in a complete recovery after one year.- - - - - - - - - - ranking = 4keywords = upper (Clic here for more details about this article) |
8/22. A rare injury to the upper limb: elbow dislocation combined with Galeazzi fracture-dislocation.The authors describe a rare instance of elbow dislocation associated with Galeazzi fracture-dislocation in a 16 year-old patient injured in a motor vehicle accident. They analyze the modalities of the trauma, the type of treatment employed, and the result after 2 years.- - - - - - - - - - ranking = 4keywords = upper (Clic here for more details about this article) |
9/22. Simultaneous bilateral forearm revascularization.A successful simultaneous bilateral forearm revascularization was performed on a 17-year-old boy. Functional recovery of both forearms was evaluated 42 months after injury. The patient can use both hands for the activities of daily living. So far, he has been employed and has no significant psychological problems. Temporary intraluminal silicone shunts are extremely helpful for reducing ischemic damage to the injured limb. The sufficient skeletal shortening of the upper limb replantation is crucially important. The wounds must be managed by aggressive and repeated debridement. Accurate primary nerve repair is essential, and the early postoperative rehabilitation is also important to achieve a satisfactory functional return. The functional replanted or revascularized upper extremity is superior to an amputation or prosthesis, especially in the cases of bilateral upper extremity amputation or devascularization.- - - - - - - - - - ranking = 3keywords = upper (Clic here for more details about this article) |
10/22. External fixation of high-energy upper extremity injuries.Forty patients with high-energy upper extremity injuries involving the humerus and forearm bones were treated by primarye external fixation. Concomitant soft tissue or neurovascular injuries were rated by the Gustilo classification, and this rating correlated well with the final results: three fractures were Gustilo type I, two fractures were type II, and 35 were type III (IIIA, nine fractures; IIIB, eight; and IIIC, 18). Immediate external fixation, open wound treatment, delayed bone grafting, and late internal fixation led to good to excellent results in 73%. Complications were either minor (related to the external fixation and included pin loosening, 20%) or significant (osteomyelitis, 3%).- - - - - - - - - - ranking = 5keywords = upper (Clic here for more details about this article) |
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