Fractures of the proximal forearm

Compartment syndrome affecting the upper extremities is a relatively underreported event compared with compartment syndrome affecting the lower extremities. Moreover, insidious onset forearm compartment syndrome has been rarely reported and is usually limited to single case reports. We report a compartment syndrome of the forearm in a teenager. She hit her right proximal forearm lightly on the cash register, but there was no pain. However, the next day, she had difficulty in moving her right hand. Although she underwent electrotherapy, her right forearm gradually became swollen, and she felt numbness in the ring and little fingers of her right hand. Six day after the onset, she came to our hospital and underwent fasciotomy. There was no aftereffect, and very good functional recovery was obtained. All clinicians need to keep the case of forearm compartment syndrome in a young individual with a diffuse course, such as in this case in mind.

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Use of Osteofasciocutaneous Fibular Free Flap and Radial Head Arthroplasty in Trauma for Limb Salvage and Continued Elbow Function

Case Reports in Orthopedics ◽

10.1155/2018/8295736 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Catherine Kilmartin ◽

Katharine D. Harper ◽

Chirag Mehta ◽

Joseph Thoder ◽

Andrew Newman

Keyword(s):

Limb Salvage ◽

Free Flap ◽

Radial Head ◽

Radial Head Prosthesis ◽

Review Of The Literature ◽

Joint Function ◽

Radial Head Arthroplasty ◽

Elbow Function ◽

Fibular Free Flap ◽

Proximal Forearm

Reconstructive flaps have revolutionized the ability of surgeons to restore function and cosmesis for patients. While reconstructive flaps have been used to bridge large defects due to oncologic or congenital maladies necessitating large debridements, few cases have observed salvage flaps in traumas which provide additional challenges secondary to an injury trajectory. This case report details use of an osteofasciocutaneous fibular free flap and radial head prosthesis to restore forearm function in a 64-year-old female with a comminuted fracture of the proximal radius. The patient has sustained a 5.5 cm epiphyseal radial defect with an associated 20 × 15 cm overlying tissue defect after serial debridement. In review of the literature, only one nontraumatic case using a combined free flap and radial head prosthesis for proximal forearm defect to restore joint function has been reported. We suggest that, for proximal forearm fractures, this technique can be used to restore elbow joint function in limb salvage.

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Reply: Dominant Radial Artery Perforator in the Proximal Forearm

Plastic & Reconstructive Surgery ◽

10.1097/prs.0b013e318200b09e ◽

2011 ◽

Vol 127 (2) ◽

pp. 1013-1014

Author(s):

Michel Saint-Cyr

Keyword(s):

Radial Artery ◽

Proximal Forearm ◽

Artery Perforator

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Intramuscular myxoid lipoma in the proximal forearm presenting as an olecranon mass with superficial radial nerve palsy: a case report

Journal of Medical Case Reports ◽

10.1186/1752-1947-5-321 ◽

2011 ◽

Vol 5 (1) ◽

Cited By ~ 3

Author(s):

Peter Lewkonia ◽

Shaun AC Medlicott ◽

Kevin A Hildebrand

Keyword(s):

Case Report ◽

Radial Nerve ◽

Nerve Palsy ◽

Radial Nerve Palsy ◽

Superficial Radial Nerve ◽

Proximal Forearm

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Vascular Access Perspectives in Patients After Kidney Transplantation

Frontiers in Surgery ◽

10.3389/fsurg.2021.640986 ◽

2021 ◽

Vol 8 ◽

Author(s):

Krzysztof Letachowicz ◽

Mirosław Banasik ◽

Anna Królicka ◽

Oktawia Mazanowska ◽

Tomasz Gołębiowski ◽

...

Keyword(s):

Blood Flow ◽

Kidney Transplantation ◽

Vascular Access ◽

Graft Function ◽

Protective Measure ◽

Study Group ◽

Renal Transplant Recipients ◽

Upper Arm ◽

Surgical Closure ◽

Proximal Forearm

Introduction: More attention has been paid to the influence of arteriovenous fistula (AVF) on the cardiovascular system. In renal transplant recipients, some beneficial effect of an elective vascular access (VA) ligation was observed in patients with a high AVF flow. However, this strategy is not widely accepted and is in contradiction to the rule of vasculature preservation for possible future access. The aim of our study is to elucidate the vascular access function and VA perspective in the kidney transplantation (KTx) population.Materials and Methods: KTx patients with a stable graft function were recruited to participate in this single center observational study (NCT04478968). The measurement of VA flow and vessel mapping for future vascular access was performed by a color Doppler ultrasound. The study group included 99 (63%) males and 58 (37%) females; the median age was 57 (IQR 48–64) years. The median time from the transplantation to the baseline visit was 94 (IQR 61–149) months. Median serum creatinine concentration was 1.36 (IQR 1.13–1.67) mg/dl.Results: Functioning VA was found in 83 out of 157 (52.9%) patients. The sites were as follows: snuffbox in six (7.2%), wrist in 41 (49.4%), distal forearm in 18 (21.7%), middle or proximal forearm in eight (9.6%), upper-arm AV graft in one (1.2%), and upper-arm AVFs in nine (10.8%) patients, respectively. Blood flow ranged from 248 to 7,830 ml/min; the median was 1,134 ml/min. From the transplantation to the study visit, 66 (44.6%) patients experienced access loss. Spontaneous thrombosis was the most common, and it occurred in 60 (90.9%) patients. The surgical closure of VA was performed only in six (4%) patients of the study group with a functioning VA at the time of transplantation. Access loss occurred within the 1st year after KTx in 33 (50%) patients. Majority (50 out of 83, 60.2%) of the patients with an active VA had options to create a snuffbox or wrist AVF on the contralateral extremity. In a group of 74 patients without a functioning VA, the creation of a snuffbox or wrist AVF on the non-dominant and dominant extremity was possible in seven (9.2%) and 40 (52.6%) patients, respectively. In 10 (13.1%) patients, the possibilities were limited only to the upper-arm or proximal forearm VA on both sides. Access ligation was considered by 15 out of 83 (18.1%) patients with a patent VA.Conclusions: In the majority of the patients, vascular access blood flow was below the threshold of the negative cardiovascular effect of vascular access. Creation of a distal AVF is a protective measure to avoid a high flow and preserve the vessels for future access. The approach to VA should be individualized and adjusted to the patient's profile.

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Differences in lymph drainage between swollen and non-swollen regions in arms with breast-cancer-related lymphoedema

Clinical Science ◽

10.1042/cs1010131 ◽

2001 ◽

Vol 101 (2) ◽

pp. 131-140 ◽

Cited By ~ 35

Author(s):

A. W. B. STANTON ◽

W. E. SVENSSON ◽

R. H. MELLOR ◽

A. M. PETERS ◽

J. R. LEVICK ◽

...

Keyword(s):

Breast Cancer ◽

Regional Differences ◽

Removal Rate ◽

Lymphatic Drainage ◽

Lymph Flow ◽

Lymph Drainage ◽

Lymphatic Function ◽

Γ Radiation ◽

Image Width ◽

Proximal Forearm

Recent research indicates that the pathophysiology of breast-cancer-related lymphoedema (BCRL) is more complex than simple axillary lymphatic obstruction as a result of the cancer treatment. Uneven distribution of swelling (involvement of the mid-arm region is common, but the hand is often spared) is puzzling. Our aim was to test the hypothesis that local differences in lymphatic drainage contribute to the regionality of the oedema. Using lymphoscintigraphy, we measured the removal rate constant, k (representing local lymph flow per unit distribution volume, VD), for 99mTc-labelled human immunoglobulin G in the oedematous proximal forearm, and in the hand (finger web) in women in whom the hand was unaffected. Tracer was injected subcutaneously, and the depot plus the rest of the arm was monitored with a γ-radiation camera for up to 6 h. VD was assessed from image width. Contralateral arms served as controls. k was 25% lower in oedematous forearm tissue than in the control arm (BCRL, -0.070±0.026%·min-1; control, -0.093±0.028%·min-1; mean±S.D.; P = 0.012) and VD was greater. In the non-oedematous hand of the BCRL arm, k was 18% higher than in the control hand (BCRL, -0.110±0.027%·min-1; control, -0.095±0.028%·min-1; P = 0.057) and 59% higher than forearm k on the BCRL side (P = 0.0014). VD did not differ between the hands. Images of the BCRL arm following hand injection showed diffuse activity in the superficial tissues, sometimes extending almost to the shoulder. A possible interpretation is that the hand is spared in some patients because local lymph flow is increased and diverted along collateral dermal routes. The results support the hypothesis that regional differences in surviving lymphatic function contribute to the distribution of swelling.

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Simultaneous Compression of the Median and Ulnar Nerve at the Elbow: A Retrospective Study

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835518500200 ◽

2018 ◽

Vol 23 (02) ◽

pp. 198-204 ◽

Cited By ~ 1

Author(s):

Dimitrios Skouteris ◽

Sofia Thoma ◽

Georgios Andritsos ◽

Nikolaos Tasios ◽

Praxitelis Praxitelous ◽

...

Keyword(s):

Retrospective Study ◽

Ulnar Nerve ◽

Correct Diagnosis ◽

Sudden Onset ◽

Cubital Tunnel Syndrome ◽

Surgical Decompression ◽

Cubital Tunnel ◽

Tunnel Syndrome ◽

Proximal Forearm

Background: Simultaneous compression of the median and ulnar nerve at the elbow region has not been sufficiently highlighted in the literature. The purposes of the present study are to report our experience regarding this entity, to elucidate the clinical features, and to describe the operative technique and findings as well as the results of simultaneous decompression performed through the same medial incision. Methods: We performed a retrospective study of thirteen elbows in thirteen patients -nine men and four women- with simultaneous compression of the median and ulnar nerve at the elbow region between 2000 and 2011. All were manual workers. Diagnosis was largely based on symptoms, patterns of paresthesia, and specific tests. Surgical decompression of both nerves at the same time was performed through a single anteromedial incision creating large flaps. Results: Patients were followed for a mean of thirty-eight months (range seven to ninety six). Resting pain in the proximal forearm as well as sudden onset of numbness in the ring and little fingers were reported by all patients. Nerve conduction studies were positive only for cubital tunnel syndrome. In all patients symptoms subsided following surgical decompression. At the time of final follow up there is no evidence of recurrence. Conclusions: Proximal median nerve compression can be seen in association with cubital tunnel syndrome. Careful evaluation of the reported symptoms as well as thorough clinical examination are the keystone of the correct diagnosis. Also, on the basis of this study, we believe that concurrent decompression can be performed through a single medial incision, though extensive dissection may be required.

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Early experience and observations in endovascular dialysis fistula re-intervention

The Journal of Vascular Access ◽

10.1177/1129729819888374 ◽

2019 ◽

Vol 21 (6) ◽

pp. 818-825

Author(s):

Robert G Jones ◽

Aurangzaib Khawaja ◽

Karen Tullett ◽

Nicholas G Inston

Keyword(s):

Open Surgery ◽

Early Experience ◽

Emerging Technology ◽

Trial Data ◽

Technical Success ◽

Drainage Pattern ◽

Patterns Of Failure ◽

Early Trial ◽

Dialysis Fistula ◽

Proximal Forearm

In recent years, new emerging technology has allowed the endovascular creation of dialysis fistulas in the proximal forearm without the need for open surgery. Two such systems currently exist, and evidence to date has demonstrated high rates of technical success in fistula creation, high rates of dialysis functionality, and low rates of re-intervention using both systems. Whilst early trial data has demonstrated lower rates of re-intervention to maintain patency compared to surgical fistulas, endovascular re-interventions are still required to maintain functionality. The endovascular fistula (endoAVF) typically exhibits a shared drainage pattern and is morphologically distinct from the surgical fistula and patterns of failure observed often differ to what has been traditionally encountered. A fresh approach and understanding is therefore required and here we share our observations and experience of endovascular re-intervention in endoAVF created with the Wavelinq system.

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