scholarly journals High-Energy Blast Injury Requiring Transradial Amputation with Associated Essex Lopresti and Terrible Triad Injuries of the Elbow: A Rare Presentation

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Paul Knapp ◽  
Dexter Powell ◽  
Ivan Bandovic ◽  
Matthew Coon ◽  
Benjamin Best
Keyword(s):  
Upper Extremity ◽  
Hand Surgery ◽  
Elbow Flexion ◽  
Blast Injury ◽  
High Energy ◽  
Terrible Triad ◽  
Rare Presentation ◽  
Salvage Operation ◽  
Essex Lopresti ◽  
Severe Soft Tissue

Case. Blast injuries to the upper extremity can be devastating and emotionally stressful injuries. We describe a case of a high-energy blast injury to an upper extremity from an explosive. The transfer of energy caused severe soft tissue/bony damage to the hand, but also led to associated Essex Lopresti and terrible triad injuries. The patient required emergent transradial amputation by hand surgery as well as definitive fixation by our orthopaedic team. Conclusion. We describe a unique salvage operation that established forearm pronosupination, elbow flexion, and proper prosthetic fitting. We feel that describing our technique could help others in treating this injury if encountered.

scholarly journals An Unusual Terrible Triad Variant Associated with an Essex-Lopresti Injury

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Luis M. Salazar ◽  
Abdullah Ghali ◽  
Jose M. Gutierrez-Naranjo ◽  
Thomas L. Hand ◽  
Anil K. Dutta
Keyword(s):  
Distal Radius ◽  
Radial Head ◽  
Motor Vehicle ◽  
Elbow Dislocation ◽  
Distal Radioulnar Joint ◽  
High Energy ◽  
Terrible Triad ◽  
Internal Joint ◽  
Unusual Variant ◽  
Essex Lopresti

Essex-Lopresti injuries and terrible triad injuries of the elbow are rare injuries that typically result from high-energy trauma such as falling from a height or a motor vehicle collision. However, the combination of an Essex-Lopresti injury and terrible triad injury is unique and poses a significant challenge for treatment as these injuries are independently associated with poor functional outcomes if they are not acutely diagnosed. We describe a case of a 19-year-old who presented with an unusual variant of a terrible triad injury associated with an Essex-Lopresti injury. The patient had a distal radioulnar joint (DRUJ) and elbow dislocation, a radial head and coronoid process fracture, and a distal radius fracture. Almost a reverse Essex-Lopresti, this injury was successfully managed with open reduction and repair of the distal radius, radial head, and damaged ligaments in the elbow, along with an internal joint stabilizer (IJS).

18.4 Correlation between elbow flexion angle and joint loading of the upper extremity during a forward fall

2005 ◽  
Vol 21 ◽  
pp. S113-S114
Author(s):  
P.H. Chou ◽  
Y.L. Chou ◽  
C.K. Chen ◽  
Y.C. Shi
Keyword(s):  
Upper Extremity ◽  
Elbow Flexion ◽  
Flexion Angle ◽  
Joint Loading

Perceptions of Emergency Medicine Residency and Hand Surgery Fellowship Program Directors in the Appropriate Disposition of Upper Extremity Emergencies

2015 ◽  
Vol 40 (12) ◽  
pp. 2435-2439 ◽  
Author(s):  
Brian C. Drolet ◽  
Scott D. Lifchez ◽  
Sidney M. Jacoby ◽  
Andrew Varone ◽  
Linda A. Regan ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Upper Extremity ◽  
Hand Surgery ◽  
Program Directors ◽  
Fellowship Program

scholarly journals The Serially-Operated Essex-Lopresti Injury: Long-Term Outcomes in a Retrospective Cohort

2020 ◽  
Vol 12 (01) ◽  
pp. 47-55
Author(s):  
Svenna H. W. L. Verhiel ◽  
Sezai Özkan ◽  
Christopher G. Langhammer ◽  
Neal C. Chen
Keyword(s):  
Upper Extremity ◽  
Radial Head ◽  
Rating Scale ◽  
Case Series ◽  
Outcome Evaluation ◽  
Pain Severity ◽  
Measurement Information ◽  
Radial Head Arthroplasty ◽  
Patient Reported ◽  
Essex Lopresti

Abstract Objective The main aim of this article is to report 10-year outcomes after Essex-Lopresti injury (ELI). Study Design Retrospective case series. Two level I trauma centers and one associated community hospital from 2003 to 2016. Patients Sixteen patients who sustained an ELI and were treated at one of our three regional hospitals. Intervention Initially, 4 patients (25%) were treated nonoperatively by immobilization and 12 patients (75%) were treated operatively. Proximal surgery included radial head open reduction and internal fixation (ORIF), radial head arthroplasty, radial head excision and forearm ORIF, and wound debridement. Ten patients (63%) were acutely identified with longitudinal forearm instability. Of these, four patients had the distal radioulnar joint pinned. In the other six patients, the forearm was immobilized. Overall, 16 patients underwent a total of 32 revision surgeries. Main Outcome Measure Performance of Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) Physical score, Numeric Rating Scale (NRS) score for pain-severity, and NRS score for satisfaction of overall outcome. Results Follow-up for outcome evaluation was available for 10 patients, at a median of 10 (interquartile range [IQR]: 8.0–12) years after date of injury. The median PROMIS UE Physical score was 36 (IQR: 33–38). Median NRS score for pain-severity on average was 5 (IQR: 0–6). The median NRS score for satisfaction of overall outcome was 7 (IQR: 5–8). Conclusion Patients who sustain an ELI generally have substantial deficits of upper extremity function as measured by PROMIS UE. Early radial head arthroplasty may be beneficial, but further study in a larger cohort is needed. Outcomes of nonoperative treatment and operative treatment were similar and suggest that current surgical treatments are incomplete.

scholarly journals Carpometacarpal Joint Dislocations: Management and Long-Term Outcomes at a Specialized Hand Surgery Center in Latin America

2020 ◽  
Vol 28 (4) ◽  
pp. 210-214
Author(s):  
Jose E. Telich-Tarriba ◽  
Osvaldo I. Guevara-Valmaña ◽  
David F. Navarro-Barquín ◽  
Andre Victor-Baldin
Keyword(s):  
Closed Reduction ◽  
Hand Surgery ◽  
High Energy ◽  
Dash Score ◽  
X Rays ◽  
Percutaneous Pinning ◽  
Carpometacarpal Joint ◽  
Joint Dislocations ◽  
Surgery Center

Carpometacarpal joint dislocations are uncommon hand injuries. These dislocations are usually misdiagnosed due to their non-specific clinical signs and tend to be difficult to identify in simple X-rays. We report our experience in the management of carpometacarpal bone dislocations at a specialized hand surgery center. Patients with carpometacarpal dislocations seen at the emergency department between 2013 and 2017 were included. All patients were treated with either closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF). Postoperative functional assessment was performed at 6 and 18 months using the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Eleven patients were included, 8 (72%) were managed with CRPP and the rest required ORIF (28%). For the functional outcome, we found an average DASH score of 27.9 at the 6 months threshold and of 1.5 at the 18 months threshold. Carpometacarpal dislocations are uncommon and easy to misdiagnose; the hand surgeon should have a high clinical suspicion in patients who sustained high-energy trauma, and imaging studies should be thoroughly evaluated. Closed reduction and percutaneous pinning is a safe and effective treatment option, with long-term good functional results.

scholarly journals The Efficiency of WhatsApp in Teleconsultation of Finger Vascularity in Hand Surgery

2019 ◽  
Vol 12 (03) ◽  
pp. 163-167
Author(s):  
Sreekanth Raveendran ◽  
Binu Prathap Thomas ◽  
Visalakshi Jayaseelan
Keyword(s):  
Confidence Interval ◽  
Upper Extremity ◽  
Clinical Setting ◽  
Hand Surgery ◽  
Modern Medicine ◽  
Extremity Trauma ◽  
Academic Settings ◽  
Upper Extremity Trauma ◽  
Two Phases ◽  
Flap Cover

Abstract Background Teleconsultation over the smartphone is now widely used in modern medicine in the management of burns, flap cover, upper extremity trauma, and in the assessment of the feasibility of reimplantation in amputated fingers. The development of the WhatsApp application has enhanced the smartphone's efficiency remarkably to transmit images in clinical and academic settings with its failsafe and encrypted technology. In hand surgery, a teleconsultation technology must communicate details of finger vascularity effectively. However, there is a paucity of evidence on the functionality of these modern teleconsultation technologies in Hand Surgery. Here, the authors have estimated the efficiency of the WhatsApp teleconsultation in the assessment of finger vascularity. Materials and Methods In two phases, the authors transmitted clinical photographs of vascular and avascular fingers to experienced hand surgeons over the WhatsApp and asked them to assess the finger vascularity. The efficiency of the WhatsApp teleconsultation in assessing the details of finger vascularity was estimated from their responses. Results Despite 81.06% of the hand surgeons rating the vascular fingers on the transmitted photographs correctly, only 44.95% detected the avascular digits accurately; that is, 55.05% of the surgeons failed to diagnose the avascularity of fingers. This suggests serious implications in a clinical setting. The intra- and the inter-rater reliability values were 0.232 and 0.6086 (with 95% confidence interval), respectively, which indicated poor reliability of the WhatsApp teleconsultation regarding the assessment of finger vascularity. Conclusion The authors, therefore, conclude that WhatsApp is inadequate in teleconsultation given the value of vascularity details of the fingers in making a diagnosis in hand surgery.

Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage

2009 ◽  
Vol 22 (3) ◽  
pp. 152
Author(s):  
Seung-Ryul Lee ◽  
Jae-Hoon Yang ◽  
June-Kyu Lee ◽  
Hyun-Dae Shin ◽  
Kyung-Cheon Kim ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Damage ◽  
Proximal Tibia ◽  
High Energy ◽  
Soft Tissue Damage ◽  
Tibia Fractures ◽  
Proximal Tibia Fractures ◽  
Severe Soft Tissue

scholarly journals A Prospective Evaluation of Adverse Reactions to Single-Dose Intravenous Antibiotic Prophylaxis During Outpatient Hand Surgery

Hand ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 41-44 ◽  
Author(s):  
Kristin Sandrowski ◽  
David Edelman ◽  
Michael Rivlin ◽  
Christopher Jones ◽  
Mark Wang ◽  
...  
Keyword(s):  
Adverse Reaction ◽  
Single Dose ◽  
Antibiotic Prophylaxis ◽  
Upper Extremity ◽  
Adverse Reactions ◽  
Prophylactic Antibiotic ◽  
Hand Surgery ◽  
Outpatient Setting ◽  
Study Cohort ◽  
Antibiotic Administration

Background: While it is established that routine prophylactic antibiotics are not needed for all hand surgery, some cases do require it. The purpose of this study was to determine the rate of adverse reactions resulting from prophylactic antibiotic administration on patients undergoing outpatient hand and upper extremity surgical procedures. We hypothesize that the rate of complications resulting from the use of antibiotic prophylaxis is smaller than that reported in the currently referenced literature. Methods: We prospectively evaluated 570 consecutive patients undergoing outpatient upper extremity surgery. Patients were excluded if they were on antibiotics prior to surgery, were discharged on antibiotics, or if they wished to be excluded. Nineteen patients were excluded, resulting in a study cohort of 551 patients. Patients were monitored perioperatively, 2 to 3 days postoperatively, during the first postoperative visit and 1 month postoperatively for adverse reactions. The type and timing of the adverse reaction was recorded. Results: Five hundred fifty-one patients were included for evaluation and 8 patients (1.5%) developed an adverse reaction to antibiotics. Five patients (0.9%) reported a rash and 3 patients (0.5%) reported diarrhea within 3 days of surgery. There were no anaphylactic reactions or complications necessitating hospital transfer or admission in the postoperative period. Conclusion: This study represents a prospective investigation designed to determine the rate of adverse reactions to single-dose antibiotics given during outpatient hand surgery. We conclude that the use of intravenous, single-dose prophylactic antibiotic is safe in the outpatient setting for cases that require it.

scholarly journals Traumatic Spondyloptosis Causing Complete Transaction of Spinal Cord

2014 ◽  
Vol 3 (2) ◽  
pp. 38-40
Author(s):  
Abhay Yadav ◽  
Sashmit Sharma
Keyword(s):  
Spinal Cord ◽  
Soft Tissues ◽  
High Energy ◽  
Special Consideration ◽  
Middle Aged ◽  
Rare Presentation ◽  
High Energy Trauma ◽  
Cord Injury ◽  
Very High Energy ◽  
Very High

Traumatic spondyloptosis is a rare presentation and is usually due to very high energy trauma. It is accompanied with cord injury, mostly complete transaction of the cord. In managing such cases special consideration should be given to soft tissues, surrounding structures and organs in the traumatized area. We present a case of traumatic spondyloptosis of D12/L1 in a middle aged gentleman with complete cord transaction. DOI: http://dx.doi.org/10.3126/noaj.v3i2.9527   NOAJ July-December 2013, Vol 3, Issue 2, 38-40

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