Cases reported "Forearm Injuries"

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11/23. rupture of the distal biceps brachii tendon.

    A 53-year-old male, while lifting a heavy object, suffered a rupture of the distal biceps brachii tendon. Due to extremely well developed musculature, the patient had retained surprisingly good powers of supination and flexion, albeit decreased in comparison to the other side. During the following operation, the torn tendon was sutured to the tendon of the brachial muscle, with good results. In this type of patient, the mentioned operative procedure is preferable, rather than the more hazardous reinsertion of the tendon, which should only be used in cases with a significant loss of supination and flexion power.
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ranking = 1
keywords = operative
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12/23. transplantation of severed digits to forearm stump for restoration of partial hand function.

    Three cases of mutilating injury of the distal end of the forearm, wrist, and palm treated by transplantation of severed digits to the forearm stump are reported. Follow-up examinations made at 1 year and 4 months to 31/2 years postoperatively revealed fair sensory and motor functions. The functional result is better than that obtained after Krukenberg's operation or prosthesis fitting, and is comparable to that of "hand" reconstruction by autotransplantation of toes. Since this procedure can fulfill the basic requirements of hand function by reconstruction, namely, good sensibility; basic motor functions of pinching, grasping, and powerful gripping; and acceptable outward appearance, and can be accomplished in a one-stage operation without sacrificing toes, it should be considered as first choice whenever a suitable case is encountered.
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ranking = 1
keywords = operative
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13/23. Syndromes of compression of the median nerve in the proximal forearm (pronator teres syndrome; anterior interosseous nerve syndrome).

    Entrapment of the median nerve in the proximal forearm is seen in two forms: the pronator teres syndrome, and the anterior interosseous nerve (or Kiloh-Nevin) syndrome. Both syndromes are rare, and they comprised approximately 1% of the compression syndromes of the upper limb which were treated operatively by the authors. The symptoms, signs, etiologies, and intraoperative findings are discussed. It is pointed out that certain of the clinical features may resemble those of irritation of the median nerve by a supracondylar process or Struthers' ligament. Although both proximal median entrapment syndromes have a favorable prognosis when treated non-operatively, the authors recommend operative treatment in cases in which there is no perceptible improvement following 8 weeks of non-operative treatment, since this is likely to speed and enhance recovery. Nine cases of the pronator teres syndrome (8 treated successfully by operation, 1 failure) and 2 cases of the anterior interosseous nerve syndrome (both fully recovered) are added to the cases reported previously in the literature.
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ranking = 5
keywords = operative
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14/23. Forearm replantation--long-term functional results.

    The replantation of amputated extremities is justified only by the ultimate good function and appearance of the replanted part. This paper is a critical review of our clinical experience with forearm replantation and revascularization in 6 patients over the past ten years. All replanted parts survived. The long-term functional results of the forearm replants are analyzed. Return of function depends on nerve regeneration. The functional outcome in the first patient was unsatisfactory due to poor motor and sensory return. Specific attention directed to careful primary neurorrhaphy in subsequent cases yielded favorable results. We believe that two factors in particular are central in achieving good functional results in forearm replantation--careful repair of the severed major peripheral nerves, and postoperative hand rehabilitation programs.
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ranking = 1
keywords = operative
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15/23. Management of severe forearm injuries.

    A review of principles and an operative guideline for repair of severely mutilating injuries to the forearm have been set forth. These concepts and their application have been illustrated in a series of clinical cases. The following key concepts have developed from these clinical experiences: 1. The surgeon must evaluate each case based upon the potential for return of sensation and function. One cannot justify the statement that a replanted arm is always superior to a prosthesis, even if its only purpose is cosmetic. 2. Care must be taken in the emergency room to evaluate the entire patient, and not to ignore other injuries while concentrating on a mangled extremity. 3. The crush-avulsion nature of injuries seen in a large referral center necessitates aggressive debridement of damaged soft tissue and bone. Wounds that have avulsion of skin, muscle, and nerve throughout the length of the arm do not lend themselves to repair. Destruction of an elbow joint generally precludes repair. 4. A well stabilized skeleton is essential before definitive soft tissue repairs can be performed. 5. Vascular repairs are meticulously performed using magnification. All vessels are reconstructed in an effort to recreate the original anatomy. 6. Wide destruction of muscle and tendon is frequent necessitating ingenuity in connecting proximal motor units to distal tendon. After repair, early active motion of the extremity is emphasized. 7. Perhaps the strongest contraindication to reconstruction of a severely damaged upper limb is avulsion of the nerves throughout the length of the forearm. Sharply divided nerves can be repaired by group fascicular suture. Crushed, divided nerves do well with accurate epineural approximation. Crushed nerves with epineural continuity ar best treated by observation and secondary grafting as required. 8. Primary coverage of areas denuded of skin is by split graft of local transposition flaps. More sophisticated techniques may be used at a later time (myocutaneous flaps or free flaps) if further reconstruction is contemplated. 9. Dressing must be carefully applied without constricting the extremity. A protective plaster is applied beginning from above the elbow and ending in a bonnet over the hand; this allows the recovery room nurse to monitor the vascular status of the repair. 10. The physiotherapist and occupational therapist are integrated into the perioperative care. Active range of motion exercises are begun as soon as the third day after the operation. Lightweight static and dynamic splints help to restore mobility.
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ranking = 2
keywords = operative
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16/23. decompression of forearm compartment syndromes.

    The diagnosis of forearm compartment syndrome by clinical findings alone has been difficult and inconsistent. This study was designed to assist in the diagnosis and treatment of forearm compartment syndromes. We evaluated several forearm incisions and determined their effectiveness by measuring compartment pressures using the wick catheter. The wick catheter is a simple, safe, and effective means of determining forearm compartment pressures. Preoperative and intraoperative measurements of the dorsal as well as the volar compartment pressures should be performed. Volar fasciotomy is effective in decompressing the volar compartment and may be effective in lowering the dorsal compartment pressure as well. Dorsal fasciotomy should be performed when that pressure remains elevated following volar decompression. The curvilinear volar and volar-ulnar incisions were equally effective in lowering compartment pressures experimentally, but the curved incision allowed beteer exposure to nerves and vessels and is preferred.
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ranking = 2
keywords = operative
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17/23. Temporary arterial shunt in the severely injured limb.

    Silicone rubber tubing and matching vessel tips are available in any hospital with a renal dialysis unit. These materials may be used as a temporary measure to restore distal circulation in the severely injured limb. The operative technique and postoperative management of a case in which this manoeuvre was used are presented.
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ranking = 2
keywords = operative
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18/23. The management of impalement injury.

    Four cases of impalement injury are described. The principles of management are discussed, these being minimal manipulation of the object before and during transport, preoperative planning, a multidisciplinary approach, and wound care.
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ranking = 1
keywords = operative
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19/23. Ilizarov lengthening of a posttraumatic below elbow amputation stump. A case report.

    Lengthening of a nonfunctional posttraumatic below elbow stump via ilizarov technique is described. Preoperatively, the 5 cm ulna in the residual forearm provided an insufficient lever arm for practical use of a standard below elbow prosthesis. An additional 5 cm of ulnar length was achieved (100% increase) by distraction histogenesis, ultimately limited by impending necrosis of adherent skin covering the tip of the residual limb. Utilizing the ilizarov technique, ulnar lengthening converted the functional level of the patient's amputation from elbow disarticulation to below elbow status.
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ranking = 1
keywords = operative
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20/23. Case report: upper extremity soft-tissue reconstruction by alloplastic implant: long-term result and follow-up.

    Prosthetic implants for reconstruction have found a variety of applications. Soft-tissue defects of the extremities are but one example in which alloplastic reconstruction is useful. As shown in the following case, gratifying cosmetic results can be obtained in posttraumatic upper extremity defects by reconstruction with a silastic implant. Although it is not a novel use for the device, it is one that has not been widely reported. The patient has been followed for 7 years postoperatively and he remains pleased with the cosmetic result. Furthermore, his function has not been compromised by placement of the prosthesis.
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ranking = 1
keywords = operative
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