1/32. Ultrasound guided reduction of pediatric forearm fractures in the ED.Reducing badly displaced or angulated pediatric forearm fractures in the emergency department can be difficult. Multiple attempts at reduction may be required, with repeated trips to the radiology department, before an adequate reduction is achieved. We have recently found that bedside ultrasound by emergency physicians is very helpful in guiding the reduction of difficult forearm fractures, allowing the physician to assess the adequacy of the reduction at the patient's bedside. In this report, we describe the technique we have developed for ultrasound-guided fracture reduction and present three case histories showing the usefulness of this technique.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/32. forearm pseudarthrosis--neurofibromatosis: case report.A 3 1/2-year-old white girl with neurofibromatosis sustained left radius and ulna fractures. The radius was sclerotic with no medullary canal at the fracture site, and the ulna was hypoplastic distal to the fracture. The fractures failed to unite when immobilized in a long arm plaster cast for 5 months and pseudarthrosis developed. Three subsequent operative attempts to obtain union of the pseudarthrosis by means of internal fixation and bone grafting over the next 30 months were also unsuccessful, and the pseudarthrosis persisted. The forearm was supported in a custom molded leather brace until the child was 13 1/2 years old and had reached skeletal maturity. Osseous union was then operatively obtained using dual onlay tibial cortical and cancellous bone grafts. There has been no recurrence of the pseudarthrosis 3 years and 2 months after bone grafting. The author recommends postponing surgical attempts to achieve union of the forearm bone pseudarthrosis associated with neurofibromatosis until the patient reaches skeletal maturity.- - - - - - - - - - ranking = 0.57142857142857keywords = fracture (Clic here for more details about this article) |
3/32. 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 = 0.14285714285714keywords = fracture (Clic here for more details about this article) |
4/32. Avulsion fracture of the origin of the brachioradialis muscle.Avulsion fracture of the brachioradialis muscle from its origin on the lateral supracondylar ridge of the humerus has not previously been reported in the literature. In this article, we present the case of a patient who sustained a grade I open avulsion fracture of the lateral supracondylar ridge of the humerus. The mechanism by which this fracture occurred is proposed on the basis of the structure and function of the brachioradialis muscle.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
5/32. Coincidental rupture of the scapholunate and lunotriquetral ligaments with volar intercalated segment instability complicating a closed distal forearm fracture in an adolescent.A 15-year-old boy is described with concomitant scapholunate and lunotriquetral ligament injuries of the wrist, complicating a closed forearm fracture. The rotatory dislocation could be reduced and stabilized with a soft-tissue procedure.- - - - - - - - - - ranking = 0.71428571428571keywords = fracture (Clic here for more details about this article) |
6/32. Closed reduction of forearm refractures with flexible intramedullary nails in situ.BACKGROUND: Refractures of the forearm after flexible intramedullary nailing are rare. An alternative to nail replacement is closed reduction with the nails in situ. We successfully performed this maneuver on a thirteen-year-old boy. However, no data on the stability of previously bent nails are available. The purpose of the present study was to assess the mechanical stability of titanium and stainless steel flexible intramedullary nails after one cycle of reversed bending. methods: In an in vitro study, ten titanium and eighteen stainless steel 3.0-mm flexible intramedullary nails were subjected to an increasing lateral bending force until the point of first plastic deformation. As an analogy to the clinical case, they were then bent to an angle of 21 degrees and were manually reduced back to their original straight position and the experiment was repeated. The forces needed to achieve first plastic deformation and modified spring constants (force/deflection) were calculated and were compared between the native and previously bent nails. RESULTS: The average force required for permanent deformation of the previously bent nails was reduced by 37% for both titanium and stainless steel nails (from 21 to 13.2 N for titanium nails [p < 0.01] and from 25 to 15.7 N for stainless steel nails [p < 0.001]). The average modified spring constant decreased by 15.1% (from 0.814 to 0.691 N/ degrees ) for titanium nails (p < 0.001) and by 12.2% (from 0.991 to 0.870 N/ degrees ) for stainless steel nails (p < 0.001). overall, steel nails were stiffer and stronger than titanium nails were. There was no macroscopic evidence of metal fracture or fatigue after one cycle of reversed bending to 21 degrees. CONCLUSIONS: Closed reduction of a forearm refracture with flexible intramedullary nails in situ is a safe, noninvasive, and effective alternative to nail replacement. However, mechanical stability of the nails is significantly reduced after the procedure. Therefore, the patient should be instructed to avoid any excessive forces to the forearm until fracture union has been documented radiographically, and casting for a limited time may be appropriate.- - - - - - - - - - ranking = 1.1428571428571keywords = fracture (Clic here for more details about this article) |
7/32. Traumatic bowing of the forearm bones in roller machine injuries.Slow bending forces created by rollers of rotating machines and acting on forearm bones can result in traumatic bowing even in adults. Four patients having this peculiar injury pattern in industrial accidents have been reported in this paper. Three of these had concomitant fractures of ipsilateral humerus. There were problems in appropriate reduction of the deformity due to the presence of associated overlying soft tissue injury. The literature has also been reviewed for this injury and 13 reports defining the injury profile, problems in realigning forearm bones and their subsequent maintenance have been described. The eventual outcome of such machine injuries has not been good due to persistence of some degrees of bowing and associated restriction of forearm rotation.- - - - - - - - - - ranking = 0.14285714285714keywords = fracture (Clic here for more details about this article) |
8/32. Free adipofascial flap interposition for pediatric posttraumatic forearm synostosis with closed head injury.A case report is presented of a 12-year-old male after a motor vehicle accident: head injury and multiple fractures, including bilateral both bone forearm fractures. The patient developed bilateral extensive forearm synostosis that required release and interpositional free flap at 6 months postinjury. At 3-year follow-up, the patient has maintained full forearm rotation and reports unrestricted sports and other recreational activities.- - - - - - - - - - ranking = 0.28571428571429keywords = fracture (Clic here for more details about this article) |
9/32. Juxtaposition artefact in a forearm radiograph: a cautionary note in the interpretation of a multiply exposed radiographic plate.This case report outlines the risks associated with double plate exposure radiographs in follow up images of a child's forearm fracture. Protocols need to be established between radiology and orthopaedic departments for adequate imaging techniques of children's forearms.- - - - - - - - - - ranking = 0.14285714285714keywords = fracture (Clic here for more details about this article) |
10/32. Pediatric distal double bone forearm fracture remodeling.Children's bones differ from those of adults in their capacity for ongoing growth and their ability to adapt to a changing body habitus. Similarly, pediatric fractures generally heal more rapidly and have the ability to reshape deformities, a process known as remodeling. The following case exemplifies the remodeling process of a distal radius fracture over time.- - - - - - - - - - ranking = 0.85714285714286keywords = fracture (Clic here for more details about this article) |
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