11/18. Traumatic segmental bone defects in the upper extremity. Treatment with exposed grafts of corticocancellous bone.We treated twenty-two consecutive patients for an open fracture and segmental loss of bone in the upper extremity by delayed insertion of a graft of iliac corticocancellous bone. All of the wounds were left open and healed by secondary intention. Sixteen patients (nineteen grafts) had long-term follow-up. Ten injuries were secondary to a gunshot wound. The ten patients (twelve grafts) who had an injury to the hand were followed for an average of 24.1 months. No patient in this group had an infection, and all had primary union after an average of 13.3 weeks. Nine had a satisfactory result. The other six patients (seven grafts) had an injury to the arm or forearm and were followed for an average of 30.2 months. There were four non-unions, one refracture, and no persistent infections. The final result was satisfactory in five and unsatisfactory in one patient. Fourteen of the nineteen grafts were inserted within seventeen days after the initial injury. All nine of the grafts in the hand that were inserted early did well, but three of the other five (in the arm or forearm) became infected. The method that was used in the patients who had an open injury of the hand allowed early active motion and quick rehabilitation. The exposed cortical bone was not prone to infection. The technique has limited application in patients who have an open injury of the arm or forearm because of a high incidence of complications.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
12/18. Management of severe hand trauma with a mini external fixateur.maintenance of length, alignment, and mobility while affording ready access for wound care has traditionally been a problem in the management of severe hand trauma. However, miniaturization of existing components of external fixation has provided a significant step in the solution of this problem. Twenty-eight fractures in severely traumatized hands in 24 patients have been managed using a Hoffman mini external fixateur. The patients' mean age was 26.5 years. The dominant hand was involved 60% of the time, and 80% of the population was male. Most fractures (80%) were open injuries with marked comminution, often intra-articular, frequently the result of gunshot wounds (60%). Mini external fixation has afforded proper wound care and maintenance of desired alignment. Complications have been few, while improved results (alignment, range of motion, strength, fracture union), have been demonstrated. Our surgical technique, results, and some illustrative cases are presented.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
13/18. Elective free vascularized double transfer of toe joint from second toe to proximal interphalangeal joint of index finger: a case report.Alternatives to the treatment of major injuries to the proximal interphalangeal (PIP) joint include fusion, implant arthroplasty, perichondrial grafting, single autogenous free vascularized transfer, and double autogenous free vascularized transfer. A patient presented a gunshot wound to the index finger with loss of skin and extensor tendon and PIP joint disruption. The finger was reconstructed with a composite free flap of skin and extensor tendon and PIP and distal interphalangeal joints of the second toe. A follow-up of 10 months is presented, which demonstrates PIP joint motion and finger function.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
14/18. The role of arthroscopy in the management of low-velocity gunshot wounds of the knee joint.Eight patients with low-velocity civilian gunshot wounds of the knee were examined and evaluated by arthroscopy. Three of these patients were also treated by surgical arthroscopy and underwent limited arthrotomy for bullet removal. In two patients small arthrotomy incisions were made following arthroscopic exploration for removal of bullets. Two patients underwent diagnostic arthroscopy. One underwent internal fixation for a chondral fracture of the femoral condyle. The majority of patients sustained intra-articular damage and retained foreign materials (denim flecks and metallic shards) and osteochondral fragments. There were no postoperative infections after a minimum follow-up period of one year. arthroscopy is highly effective in the diagnosis and surgical management of low-velocity gunshot wounds of the knee both alone and in combination with limited arthrotomy depending on the severity of the condylar damage. The length of the hospital stay is reduced (length of stay exceeded 3-4 days only as a result of intravenous antibiotic coverage). Physical therapy requirements are minimal. Active mobility and a full range of motion are regained more rapidly with arthroscopy than with surgical exposure of multiple exploratory incisions or conventional standard arthrotomy.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
15/18. Reconstruction of traumatic complete loss of the medial collateral ligament: a case report.An unusual problem with traumatic complete loss of the medial collateral ligament in a 23-year-old man with a gunshot injury, was solved by transfer of the medial head of the gastrocnemius. At one-year follow-up the patient had returned to work with satisfactory functional results with respect to stability, strength, and range of motion. The medial head of the gastrocnemius provided a substantial buttress and effectively performed the function of the collateral ligament.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
16/18. adolescent PTSD and developmental consequences of crack dealing.The effect of crack dealing on emotionally disturbed adolescents in two African-American inner-city communities is examined and illustrated by case examples. Crack dealing was most often found to have dynamics and consequences separate from those of crack use. These include post-traumatic stress disorder and other significant emotional disturbances arising from the violence associated with crack dealing, and the shaping of adolescent identity by the associated culture of violence and guns. Implications for school drug abuse education are explored.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
17/18. Uncomplicated penetrating colonic injury.The case of a patient with an air gun pellet injury to the right colon is reported. This was treated conservatively, and the pellet was passed per rectum 12 hours after the injury. Gunshot wounds to the abdomen do not necessarily warrant immediate laparotomy. Sieving of bowel motions may identify if the foreign body has been passed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
18/18. Use of a hybrid external fixator for a severely comminuted juxta-articular fracture of the distal humerus.Severely comminuted, juxta-articular fractures present a difficult management dilemma for orthopaedic surgeons. Recently, hybrid external fixators have been used for treatment of such fractures in the lower extremity, particularly in the tibial plateau and the tibial plafond. The same technique may be applied to the upper extremity with gratifying results. This technique has the advantage of minimal dissection while restoring limb alignment and permitting immediate joint motion. The proximity of neurovascular structures to the humerus requires careful attention to anatomic detail when placing such a fixator.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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