Should the term “neurovascularly intact” be abolished? A study evaluating neurological assessment in paediatric patients presenting with upper limb fractures

Introduction: Cast removal procedures can be a daunting experience for children giving rise to anxiety. The objective of this study is to measure the level of anxiety in children during cast removal at Hospital Tengku Ampuan Afzan. Materials and method: An experimental study was conducted with a sample of 40 paediatric patients with upper limb fractures and cast removal were randomly assigned into two groups: with multimedia distraction or without (control). Patient's heart rate was measured using a pulse oximeter before, during and after cast removal. Results: A total number of 20 children were randomized to multimedia distraction and another 20 to control with no distractions. The mean rise in heart rate between preprocedure and during procedure 5.3 beats/min in multimedia distraction group and 16.35 beats/min in control group (P = 0.001). The mean difference in heart rate between the pre-procedure and during the procedure was 5.64 beats/min in the multimedia distraction group and 13.13 beats/ min in the control group (P = 0.05). Conclusion: There was significant decrease in heart rate during cast removal with multimedia distraction. Therefore multimedia distraction is a useful tool in reducing anxiety among children during cast removal.

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FRI0617-HPR GRADED MOTOR IMAGERY IN POSTTRAUMATIC STIFFNESS OF THE ELBOW: A PILOT STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2660 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 913.2-914

Author(s):

T. Birinci ◽

E. Kaya Mutlu ◽

S. Altun

Keyword(s):

Pilot Study ◽

Motor Imagery ◽

Upper Limb ◽

Exercise Program ◽

Control Group ◽

Elbow Fracture ◽

Stiff Elbow ◽

Limb Fractures ◽

Upper Limb Fractures ◽

Graded Motor Imagery

Background:Elbow fracture is treated either conservatively or surgically followed by a period of immobilization with casting or splinting. A splint used to immobilize upper limbs for many weeks results in changes in both the peripheral musculature and the central nervous system. It is well known that common complaints after upper limb fractures include weakness, pain, and stiffness; therefore, pain management is important in the early stages of the rehabilitation of upper limb fractures.Objectives:This pilot study aimed to investigate the efficacy of graded motor imaginary (GMI) on pain, range of motion (ROM), and function in patients with posttraumatic stiff elbow.Methods:Fourteen patients with posttraumatic stiff elbow (6 women, mean age: 45.42 ± 11.26 years, mean body mass index: 24.29 ± 3.38 kg\m2and mean duration of immobilization: 4.75 ± 1.03 weeks) were randomly allocated to either GMI or control groups. The GMI group received GMI treatment in addition to a structured exercise program, and the control group received a structured exercise program (two days per week for six weeks) (Figure 1). The assessments included pain at rest and during activity using the visual analog scale (VAS), elbow active ROM with a digital goniometer (Baseline Evaluation Instrument, Fabrication Enterprises, Inc., White Plains, NY), and upper extremity functional status using the Disability of the Arm, Shoulder and Hand Questionnaire (DASH). The assessments were performed at baseline and after the 6-week intervention.Figure 1.Graded motor imagery performed with mirror boxResults:After the 6-week intervention, there was a significant increase in elbow flexion-extension ROM and supination-pronation ROM, and improvement in DASH score in both groups (p<0.05). However, improvement in VAS-rest and VAS-activity was significantly higher in the GMI group than the control group (p=0.03 and p=0.01, respectively).Conclusion:A conservative treatment program consisting of GMI treatment in addition to a structured exercise program applied twice a week for 6 weeks, has been found more effective in decreasing pain in the posttraumatic stiff elbow. It could be concluded that GMI is an effective treatment method for elbow fracture in patients with predominant elbow pain.References:[1] Harris JE, Hebert A. Utilization of motor imagery in upper limb rehabilitation: a systematic scoping review. Clin Rehab. 2015:29(11):1092-1107.[2] Opie GM, Evans A, Ridding MC, Semmler JG. Short-term immobilization influences use-dependent cortical plasticity and fine motor performance. Neuroscience. 2016:330:247-256.[3] Birinci T, Razak Ozdincler A, Altun S, Kural C. A structured exercise programme combined with proprioceptive neuromuscular facilitation stretching or static stretching in posttraumatic stiffness of the elbow: a randomized controlled trial. Clin Rehab. 2019:33(2):241-252.Acknowledgments:The present work was supported by the Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa (Project No: TDK-2019-33997).Disclosure of Interests:None declared

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A youngest reported case of type II Monteggia lesion associated with a posterior ulnohumeral dislocation

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2018.01.003 ◽

2019 ◽

Vol 26 (1) ◽

pp. 23-25

Author(s):

Avadhoot Kantak

Keyword(s):

Upper Limb ◽

Injury Pattern ◽

Type Ii ◽

Rare Injury ◽

Monteggia Lesion ◽

Injury Mechanisms ◽

High Incidence ◽

Limb Fractures ◽

Upper Limb Fractures

Monteggia fractures are uncommon injuries, despite a high incidence of upper limb fractures in teenage children. We describe a case of a type 2 Monteggia variant in an adolescent. This injury pattern consisted of ulnohumeral dislocation in combination with type 2 Monteggia lesion. We discuss the possible injury mechanisms of this rare injury and review available literature.

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