Evaluations of Repaired Artery Patency in Forearm Wounds Using the Allen Test, Handheld Doppler and Doppler Ultrasonography / Avaliações do lúmen da artéria reparada em lesões do antebraço usando o teste de Allen, Doppler portátil e ultrassonografia com Doppler

Abstract Objective The purpose of the present study was to evaluate the rate of patency in the postoperative period of arterial injuries of the forearm secondary to penetrating trauma. The injuries were subjected to primary repair and examined with the Allen test and a handheld Doppler device, and the results were later confirmed with Doppler ultrasonography. Methods Eighteen patients were included, with a total of 19 arterial lesions, 14 ulnar lesions, and 5 radial lesions; one patient had lesions on both forearms. All patients underwent surgery and three clinical evaluations: the Allen test and assessment of arterial blood flow by a handheld Doppler device at 4 and 16 weeks after surgery and Doppler ultrasonography performed at 12 weeks after surgery. Results At the first clinical evaluation, 77% of the patients had patency based on the Allen test, and 72% had a pulsatile sound identified by the handheld Doppler device. In the second evaluation, 61% of the patients had patency based on the Allen test, and the rate of pulsatile sound by the handheld Doppler device was 72%, similar to that observed 2 months earlier. Based on the Doppler ultrasonography evaluation (~12 weeks after surgery), the success rate for arteriorrhaphy was 88%. Regarding the final patency (Doppler ultrasonography evaluation) and trauma mechanism, all patients with penetrating trauma had patent arteries. Conclusion We cde that clinical evaluation using a handheld Doppler device and the Allen test is reliable when a patent artery can be palpated. However, if a patent artery cannot be located during a clinical examination, ultrasonography may be required.

Resumo Objetivo O objetivo deste estudo foi avaliar a taxa de perviedade pós-operatória de lesões arteriais do antebraço secundárias a traumatismo penetrante. As lesões foram submetidas a reparo primário e examinadas com o teste de Allen e um dispositivo Doppler portátil; posteriormente, os resultados foram confirmados à ultrassonografia com Doppler. Métodos Dezoito pacientes foram incluídos, com um total de 19 lesões arteriais, 14 lesões ulnares e 5 lesões radiais; um paciente tinha lesões em ambos os antebraços. Todos os pacientes foram submetidos à cirurgia e três avaliações clínicas: o teste de Allen e a avaliação do fluxo sanguíneo arterial com um dispositivo portátil de Doppler na 4ª e 16ª semanas após a cirurgia e ultrassonografia com Doppler 12 semanas após o procedimento. Resultados Na primeira avaliação clínica, 77% dos pacientes apresentavam perviedade segundo o teste de Allen e 72% apresentavam som pulsátil identificado pelo Doppler portátil. Na segunda avaliação, 61% dos pacientes apresentaram perviedade com base no teste de Allen e a taxa de som pulsátil ao Doppler portátil foi de 72%, semelhante à observada 2 meses antes. À ultrassonografia com Doppler (cerca de 12 semanas após a cirurgia), a taxa de sucesso da arteriorrafia foi de 88%. Em relação à perviedade final (avaliação por ultrassonografia com Doppler) e mecanismo de trauma, todos os pacientes com traumatismo penetrante apresentavam artérias pérvias. Conclusão Concluímos que a avaliação clínica com um dispositivo Doppler portátil e o teste de Allen é confiável caso a artéria pérvia possa ser palpada. No entanto, a ultrassonografia pode ser necessária em caso de impossibilidade de localização de uma artéria pérvia durante o exame clínico.

Fracturas metafiso-diafisarias de radio distal en adolescentes: estudio comparativo entre fijación percutánea con clavijas y clavos elásticos de titanio / Closed reduction and percutaneous pinning versus dorsal-entry elastic intramedullary nailing

Objetivo: Comparar los resultados y las complicaciones entre la fijación percutánea con clavijas (FPC) y el enclavado endomedular elástico (EEE). materiales y métodos:Se evaluaron las radiografías para determinar deformidades angulares en la consolidación. Se usó el sistema de Clavien-Dindo adaptado para clasificar las complicaciones. Resultados: El grupo A (FPC) incluyó a 17 pacientes y el grupo B (EEE), a 19. La edad promedio era de 12.5 ± 1.6 años y el seguimiento promedio fue de 27.6 ± 16.6 meses. Los pacientes con EEE requirieron menos tiempo de inmovilización (2.8 ± 1.8 vs. 5.9 ± 1.3 semanas, p 0,00029). Un paciente de cada grupo tuvo una angulación >10° en la consolidación. La tasa de complicaciones fue mayor en el grupo A (18% vs. 5,3%, p 0,27). En el grupo A, hubo 2 complicaciones tipo III (pérdida de corrección) y 2 tipo II (infección y granuloma). Un paciente del grupo B presentó una complicación tipo I (prominencia del implante). Dieciséis pacientes del grupo B se sometieron a una segunda cirugía para extraer el implante. Dos del grupo A requirieron revisión de la fijación por pérdida de alineación. Conclusiones: Ambas técnicas son eficaces para estabilizar fracturas metafiso-diafisarias de radio distal en adolescentes. El EEE tiene la ventaja de una inmovilización más corta y menos complicaciones, pero es más caro y requiere otra cirugía para extraer el implante. La FPC no requiere de anestesia para extraer el implante, aunque sí una inmovilización más prolongada y la tasa de complicaciones es más alta. Nivel de Evidencia: III

Objective: To compare results and complications of closed reduction percutaneous pinning (CRPP) versus dorsal entry elastic intramedullary nails (ESIN). Materials and methods: Radiographs were evaluated to determine angular deformities at the time of radiographic union. Complications were graded with a modification of the Clavien-Dindo classification. Results: The CRPP group consisted of 17 patients (Group A) whereas the ESIN group consisted of 19 patients (Group B). The average age of the patient cohort was 12.5±1.6 years. The average follow-up was 27.6±16.6 months. The demographic data revealed no differences between groups (p> 0.05). Patients treated with ESIN required a shorter immobilization time (2.8±1.8 versus 5.9±1.3 weeks, p 0.00029). One patient in each group presented an angulation >10° at the time of consolidation. The complication rate was higher in group A (18% versus 5.3%, p 0.27). According to the Clavien-Dindo classification, group A presented 2 type II (infection and granuloma), and 2 type III complications (loss of reduction). Group B presented one type I complication (implant prominence). Sixteen patients in group B underwent a second procedure for hardware removal. Two patients (11.8%) in group A required revision due to loss of reduction. Conclusions: Both techniques are effective in stabilizing metaphyseal-diaphyseal fractures of the distal radius in the adolescent population. ESIN has the advantage of requiring a shorter immobilization time and fewer complications but needs a second surgery for implant removal. CRPP does not require anesthesia for implant removal, although it requires a longer postoperative immobilization, and has a higher complication rate. Level of Evidence: III

Revascularización de arteria humeral con vena safena invertida, en traumatismo vascular por arma blanca / Revascularization of the humeral artery with a vein saphenous inverted in vascular trauma by stabbing

Introducción: Los traumatismos vasculares de los miembros son muy frecuentes en la actualidad, cuando no reciben la atención requerida, pueden evolucionar a complicaciones graves: pérdida del miembro y muerte del paciente. Objetivo: Describir la técnica de reparación de la arteria humeral mediante el uso de vena safena, en un caso con traumatismo de la arteria humeral, con compromiso vascular. Caso clínico: Paciente de 37 años de edad con antecedentes de enfermedad psiquiátrica, con diagnóstico de herida por arma blanca con compromiso vascular en antebrazo izquierdo, de cuatro horas de evolución. Al ingreso se encontraba inestable, con choque hipovolémico, miembro cianótico y ausencia de pulsos distales. Se indicó, por vía parenteral, antibióticos, soluciones cristaloides y sangre. En el quirófano se encontró sección de total de la arteria humeral, se realizó revascularización con injerto de vena safena invertida. El paciente evolucionó favorablemente y egresó al tercer día. Once meses después se realizó ecografía dópler y se constató buena permeabilidad del injerto. Conclusiones: La técnica de revascularización con vena safena invertida contribuyó de forma satisfactoria en la supervivencia y calidad de vida del paciente tratado (AU)

Introduction: The vascular traumatisms of the limbs are very frequent at present. When these injuries do not receive the required care they can evolve to serious complications, which includes the loss of the limb or death. Objective: To describe the brachial artery repair technique using the saphenous vein in a case with brachial artery trauma with vascular compromise. Clinical case: 37-year-old patient with a history of psychiatric illness, with a diagnosis of a stab wound with vascular compromise in the left forearm of four hours of evolution. On admission, he was unstable, hypovolemic shock, with cyanotic limb and absence of distal pulses. Intravenous antibiotics, crystalloid solution and blood were indicated. The patient was transferred to the surgery and a total section of the brachial artery was found. The revascularization technique was performed with an inverted saphenous vein graft. The patient evolved favorably and was discharged on the third day. Eleven months later, Doppler ultrasound was performed and good graft patency was confirmed. Conclusions: The inverted saphenous vein revascularization technique contributed satisfactorily to the survival and quality of life of the treated case(AU)

Anatomical Study of the Motor Branches of the Radial Nerve in the Forearm / Estudo anatômico dos ramos motores do nervo radial no antebraço

Abstract Objective To analyze the anatomical variations of the motor branches of the radial nerve in the elbow region. The origin, course, length, branches, motor points and relationships with neighboring structures were evaluated. Materials and Methods Thirty limbs from15 adult cadavers were dissected and prepared by intra-arterial injection of a 10% glycerin and formaldehyde solution. Results The first branch of the radial nerve in the forearm went to the brachioradialis muscle (BR), originating proximally to the division of the radial nerve into superficial branch of the radial nerve (SBRN) and posterior interosseous nerve (PIN) in all limbs. The branches to the extensor carpi radialis longus muscle (ECRL) detached from the proximal radial nerve to its division into 26 limbs, in 2, at the dividing points, in other 2, from the PIN. In six limbs, the branches to the BR and ECRL muscles originated from a common trunk. We identified the origin of the branch to the extensor carpi radialis brevis muscle (ECRB) in the PIN in 14 limbs, in the SBRN in 12, and in the radial nerve in only 4. The branch to the supinator muscle originated from the PIN in all limbs. Conclusion Knowledge of the anatomy of the motor branches of the radial nerve is important when performing surgical procedures in the region (such as the approach of the proximal third and the head of the radius, release of compressive syndromes of the posterior interosseous nerve and radial tunnel, and distal nerve transfers) in order to understand the order of recovery of muscle function after a nerve injury.

Resumo Objetivo Analisar as variações anatômicas dos ramos motores do nervo radial na região do cotovelo. Foram avaliadas a origem, curso, comprimento, ramificações, pontos motores e relações com estruturas vizinhas. Materiais e Métodos Foram dissecados 30 membros de 15 cadáveres adultos, preparados por injeção intra-arterial de uma solução de glicerina e formol a 10%. Resultados O primeiro ramo do nervo radial no antebraço foi para o músculo braquiorradial (BR), que se origina proximalmente à divisão do nervo radial em ramo superficial do nervo radial (RSNR) e nervo interósseo posterior (NIP) em todos os membros. Os ramos para o músculo extensor radial longo do carpo (ERLC) se desprenderam do nervo radial proximalmente à sua divisão em 26 membros, em 2, nos pontos de divisão, em outros 2, do NIP. Em seis, os ramos para os músculos BR e ERLC originavam-se de um tronco comum. Identificamos a origem do ramo para o músculo extensor radial curto do carpo (ERCC) no NIP em 14 membros, no RSNR em 12, e no nervo radial em apenas 4. O ramo para o músculo supinador originou-se do NIP em todos os membros. Conclusão O conhecimento da anatomia dos ramos motores do nervo radial é importante quando se realizam procedimentos cirúrgicos na região, como a abordagem do terço proximal e da cabeça do rádio, a liberação das síndromes compressivas do nervo interósseo posterior e do túnel radial, as transferências nervosas distais, e para entender a ordem de recuperação da função muscular após uma lesão nervosa.

Flap bipedicular no tratamento de lesão cutânea traumática em membro torácico de gato: relato de caso / Bipedicular flap in the treatment of traumatic skin injury in cat thoracic member: case report

O objetivo do presente estudo é relatar a construção de um retalho direto de bolsa bipediculada com fixação apendicular à região torácica para o tratamento de lesões extensas no membro torácico direito de um gato. Foi tratado no Hospital Veterinário Unicesumar Maringá - Paraná, um felino de 1 ano de idade, apresentando lesão no membro torácico, após história de briga com outro animal da mesma espécie. Ao exame físico, apresentava fístula e edema no membro torácico direito. O paciente foi anestesiado e foi realizado o desbridamento das áreas desvitalizadas. Como terapia inicial, a lesão foi tratada como ferida aberta, até a formação de tecido de granulação, para posterior correção do defeito empregando retalho bipediculado em bolsa direta, com fixação temporária do membro à parede torácica. Após duas semanas, o membro foi desimplantado e os pontos foram removidos 21 dias após a aplicação do retalho. O uso do retalho permitiu completa cicatrização da ferida, sem ocorrência de hematomas, necrose ou deiscência de sutura. Conclui-se que a utilização do retalho bipedicular é aplicável ao tratamento de feridas traumáticas em membro torácico de felinos.

The aim of the present study is to report the construction of a direct bipedicled pouch flap with appendicular fixation to the thoracic region for the treatment of extensive lesions in the right thoracic limb of a cat. He was treated on Hospital Veterinário Unicesumar Maringá - Paraná, a 1-year-old feline, presenting injury to the thoracic limb after a history of fighting with another animal of the same species. On physical examination, he presented fistula and edema in the right thoracic limb. The patient was anesthetized and debridement of the devitalized areas was performed. As an initial therapy, the lesion was treated as an open wound until granulation tissue was formed for subsequent correction of the defect using a direct pouch bipedicled flap, with temporary fixation of the limb to the chest wall. After two weeks, the limb was unimplanted and the stitches were removed 21 days after flap application. The use of the flap allowed complete wound healing without bruising, necrosis or suture dehiscence. It is concluded that the use of bipedicular flap is applicable to the treatment of traumatic wounds in feline thoracic limb.

Intramedullary Flexible Nailing for Diaphyseal Fractures of Forearm Bones in Children / Fixação intramedular flexível para fraturas diafisárias dos ossos do antebraço em crianças

Abstract Objectives Most of the fractures of the bones of the forearm in children are successfully treated conservatively with closed reduction and casting. The outcomes remain variable and the patients may require additional fracture manipulation or formal surgical intervention due to residual angulations. The present study assesses the radiological and functional outcomes of treating displaced forearm fractures in children with intramedullary flexible titanium elastic nailing. Methods A total of 31 patients aged between 7 and 15 years old with displaced forearm fractures underwent flexible titanium elastic nailing. The patients were followed-up for a mean period of 8.51 months (range: 6-12 months) and were assessed for radiological and functional outcomes. The Price criteria were used to assess the functional outcome. Results Out of 31 patients, 21 patients underwent closed reduction, and 10 required a minimal opening of the fracture site during reduction. A total of 29 patients had excellent results with normal forearm and elbow range of motion (ROM), and 2 patients had good results. In all patients, good radiological union was seen at an average time of 7.9 weeks. Five patients had minor complications, such as skin irritation over the prominent ulnar nail (n = 2), superficial nail insertion site infection (n = 2), and backing out of the ulnar nail (n = 1), requiring early removal. Conclusion Flexible nailing is an efficient application of internal fixation for shaft fractures of both bones of the forearm in children, enabling early mobilization and return to the normal activities of the patients, with low and manageable complications.

Resumo Objetivos A maioria das fraturas dos ossos do antebraço em crianças é tratada com sucesso de forma conservadora com redução fechada e imobilização gessada. No entanto, alguns pacientes podem necessitar de manipulação adicional da fratura ou intervenção cirúrgica devido a angulações residuais. O presente estudo avalia o resultado clinico e radiológico do tratamento de fraturas com desvio do antebraço em crianças fixadas com haste elástica intramedular de titânio. Métodos Um total de 31 pacientes com idades entre 7 e 15 anos com fraturas com desvio do antebraço foram submetidos a haste elástica de titânio flexível. Os pacientes foram acompanhados por um período médio de 8,51 meses (variação: 6-12 meses) e avaliados quanto aos resultados funcionais pelos critérios de Price e radiológicos. Resultados Dos 31 pacientes, 21 foram submetidos a redução fechada e 10 necessitaram de abertura mínima do local da fratura durante a redução. Um total de 29 pacientes tiveram excelentes resultados com arco de movimento normal, e 2 pacientes apresentaram bons resultados. Em todos os pacientes, a consolidação ocorreu em um tempo médio de 7,9 semanas. Cinco pacientes tiveram complicações menores, como irritação da pele sobre a haste proeminente (n = 2), infecção superficial do local de inserção no rádio (n = 2) e recuo da haste ulnar (n = 1), que exigiu remoção precoce. Conclusão A haste flexível é um método eficiente para tratamento da fratura do antebraço em crianças, permitindo mobilização precoce e retorno às atividades normais dos pacientes, com baixas e tratáveis complicações.

Retalho interósseo posterior reverso do antebraço para o tratamento cirúrgico do trauma elétrico da mão: relato de caso / Reverse posterior interosseous flap of the forearm for the surgical treatment of electric hand trauma: Case report

Introdução: Lesões que acometem as mãos com importante perda cutânea frequentemente requerem retalhos para cobertura precoce, visto que permitem melhor reabilitação. Dentre as opções, o retalho interósseo posterior reverso do antebraço é o mais utilizado para defeitos no dorso da mão e punho, com baixas taxas de complicações. Normalmente, esse retalho não é utilizado para a reconstrução de defeitos em região palmar, já que geralmente não alcança esse local. Relato de caso: Apresentamos o caso de um paciente com queimadura elétrica de terceiro grau, em palma da mão direita, cuja reconstrução foi realizada com o uso do retalho interósseo posterior reverso do antebraço, após debridamentos conservadores, no 14o dia após a queimadura. O paciente apresentou boa evolução pós-operatória, sem complicações ou sequelas funcionais a longo prazo. Conclusão: O retalho interósseo posterior reverso do antebraço permite cobertura adequada de lesões em palma da mão, preservando sua funcionalidade.

Introduction: Lesions affecting the hands with significant skin loss often require flaps for early coverage, as these permit faster healing. Among the various options, the reverse posterior interosseous flap of the forearm is most commonly used for defects involving the back of the hand and wrist due to low complication rates. Normally, this flap is not used for the reconstruction of defects in the palmar region since its distal reach is insufficient. Case report: We present the case of a male patient with third-degree electrical burns on his right palm, whose reconstruction was performed on the 14th day postinjury using the reverse posterior interosseous flap of the forearm after conservative debridement. The patient presented good postoperative evolution, without long-term complications or functional sequelae. Conclusion: The reverse posterior interosseous flap of the forearm permits adequate coverage of palm injuries, preserving its functionality.

Circular saw misuse is related to upper limb injuries: a cross-sectional study

OBJECTIVES: Machinery injuries account for a substantial share of traumatic upper limb injuries (TULIs) affecting young active individuals. This study is based on the hypothesis that there is an important relationship between the improper use of power saws and TULIs. The aim of the study is to assess the prevalence and epidemiology of TULIs caused by power saws and determine the risks related to power saw use. METHODS: A cross-sectional evaluation of medical records from a two-year period was performed. Patients sustaining TULIs related to power saws were analyzed. Data on the epidemiology, site of injury, mechanism of trauma, technical specifications of the tool, cutting material, personal protective equipment, time lost and return to work were obtained. RESULTS: A database search retrieved 193 TULI records, of which 104 were related to power saws. The majority of patients were male (102/104; 98.1%), right-handed (97/104; 93.3%), and manual workers (46/104; 44.2%), with an average age of 46.8 years. The thumb was the most frequently injured site (32/93; 34.4%). Most of the injuries were caused by manual saws (85/104; 81.7%), and masonry saws accounted for 68.2% (58/85) of the cases. Masonry saws improperly used for woodwork resulted in 86.2% (50/58) of the injuries. TULI caused by masonry saws was 5 times higher in manual workers than in other patients. In addition, masonry saws had a risk of kickback 15 times higher than that of other saws, and the risk of injury increased by 5.25 times when the saws were used improperly for wood cutting. CONCLUSIONS: The profile of TULIs related to power saws was demonstrated and was mainly associated with manual saws operated by manual workers that inappropriately used masonry saws for woodworking.

Median nerve entrapment in a callus fracture following a pediatric both-bone forearm fracture: A case report and literature review

Forearm fractures are common injuries in childhood. Median nerve entrapment is a rare complication of forearm fractures, but several cases have been reported in the literature. This case report discusses the diagnosis and management of median nerve entrapment in a 13-year-old male who presented acutely with a both-bone forearm fracture and numbness in the median nerve distribution. Following the delayed diagnosis, surgical exploration revealed complete nerve entrapment and a nerve graft was performed.

Enclavado endomedular elástico para el tratamiento de refracturas de antebrazo en niños / Elastic stable intramedullary nailing for the treatment of forearm refractures in children

Introducción: La diáfisis del antebrazo es el sitio más frecuente de refracturas en niños. Estas lesiones suelen ocurrir en el tercio medio o proximal antes del año de la fractura inicial. Hay poca información sobre el tratamiento de este tipo de lesiones. El objetivo de este estudio fue evaluar los resultados y las complicaciones en pacientes con refracturas de antebrazo que requirieron fijación interna con clavos elásticos endomedulares. Materiales y Métodos: Se registró la siguiente información: datos demográficos, mecanismo de lesión, clasificación, tiempo desde la consolidación de la fractura original hasta la refractura, tipo de reducción y tiempo de consolidación. Los resultados fueron evaluados según la escala propuesta por Martus y las complicaciones, con una adaptación de la clasificación de Clavien-Dindo. Resultados: Se evaluaron 17 pacientes (14 varones) con 17 refracturas de antebrazo (15 cerradas y 2 expuestas). La edad era de 11 años (RIC 7, mín.-máx. 5-15). La lesión ocurrió a las 12 semanas de la fractura inicial (RIC 4.7, mín.-máx. 4-28). El 47% requirió reducción abierta. El tiempo de consolidación fue de 8 semanas (RIC 4, mín.-máx. 6-28). El seguimiento fue de 43 meses (RIC 47, mín.-máx. 12-103). Fue posible evaluar clínicamente a 16 pacientes (1 pérdida en el seguimiento). El resultado fue excelente en 15 casos y regular en uno. Un paciente tuvo pérdida del rango de movilidad (15º); uno, retraso de la consolidación (cúbito) y 3 sufrieron una segunda refractura. Conclusiones: La fijación interna con clavos elásticos endomedulares fue una técnica eficaz para tratar las refracturas de antebrazo en niños. Si bien un alto porcentaje necesita reducción abierta, el tiempo de consolidación y la tasa de complicaciones serían similares a los de las fracturas primarias tratadas con la misma técnica. Nivel de Evidencia: IV

Introduction: Forearm diaphysis is the most frequent site of re-fractures in children. These lesions usually occur in the middle or proximal third within a year of the initial fracture. There is little information on the treatment of this type of lesions. The aim of this study was to evaluate outcomes and complications in patients with forearm re-fractures requiring internal fixation with elastic stable intramedullary nails. Methods: Demographic data, mechanism of injury, classification, time from consolidation of the original fracture to refracture, type of reduction and time of consolidation were documented. Outcomes were evaluated according to Martus scale, and complications were evaluated with an adaptation of Clavien-Dindo classification. Results: Seventeen patients (14 men) with 17 forearm re-fractures (15 closed and 2 open) were identified. Median age was 11 years (IQR 7, min-max 5-15). Lesion occurred 12 weeks after the initial fracture (RIC 4.7, min-max 4-28). Fortyseven percent required open reduction. Union was achieved at 8 weeks (IQR 4, min-max 6-28). Follow-up was 43 months (IQR 47, min-max 12-103). Sixteen patients were clinically evaluated (1 lost at follow-up). Fifteen patients presented excellent results and one had a fair result. One had 15º loss of motion, one had delayed union (ulna) and three patients had a second re-fracture. Conclusions: In this series, elastic stable intramedullary nails represented an effective technique for the treatment of forearm re-fractures in children. Although many require open reduction, time to union and complication rate seem to be similar to primary fractures treated with the same technique. Level of Evidence: IV

Fracturas diafisarias radiocubitales en pacientes pediátricos. Revisión de resultados de tratamiento / Forearm diaphyseal fractures in pediatric patients. Review of treatment results

Resumen: Objetivo: Describir los tipos de fracturas más comunes en pacientes menores de 16 años de edad a nivel de antebrazo y evaluar, dependiendo del nivel de la fractura, el tratamiento con mejores resultados. Material y métodos: Realizamos un análisis retrospectivo para determinar frecuencia de las fracturas de antebrazo en menores de 16 años, en el período de Enero 2013-Julio 2017. Se ingresó en sistema los siguientes diagnósticos: fractura de antebrazo, fractura de radio, fractura de cúbito y fractura radiocubital. Resultados: Se incluyeron 573 pacientes: 413 hombres, 160 mujeres; lado afectado derecho: 230, izquierdo 338, bilateral 5; nivel afectado: 438 distales, 102 medias y 33 proximales. La edad pico de presentación fue a los ocho años. El tratamiento inicial fue conservador en 92%, seguido de reducción cerrada y fijación percutánea con 4.71% y se tuvo 2.4% para reducción abierta y fijación interna con placas. Se tuvo un tratamiento inicial fallido en 3.83% al encontrarse una reducción inadecuada. Discusión: Encontramos que el tratamiento de las fracturas en nuestra institución es conservador en 92%, se usa la reducción cerrada y fijación percutánea sólo en 4.71% y sólo se realiza de primera intención la reducción abierta y fijación interna en 2.4% siendo la mayor prevalencia en pacientes mayores de 12 años con fracturas diafisarias medias radiocubitales.

Abstract: Objective: To describe the most common types of fractures in patients under 16 years of age at the forearm level, and to evaluate depending on the level of the fracture, the treatment with better results. Material and methods: We perform a retrospective analysis to determine the frequency of forearm fractures in patients under 16 years, in the period from January 2013-July 2017. The following diagnoses were entered into the system: forearm fracture, radius fracture, ulnar fracture and bilateral fracture. Results: We included 573 patients: 413 male, 160 females; right affected side: 230, left: 338, bilateral 5. Affected level: 438 distal, 102 mid-shaft and 33 proximal. The peak age of presentation was eight years. The initial treatment was conservative in 92%, followed by closed reduction and percutaneous fixation with 4.71 and 2.4% for open reduction and internal fixation with plates. There was a failed initial treatment at 3.83% when an inadequate reduction was found. Discussion: We found that the treatment of this fractures in our institution is conservative in 92%, closed reduction and percutaneous fixation in 4.71% and open reduction and internal fixation in a 2.4% being The highest prevalence in patients older than 12 years with bilateral mid-shaft fractures.

Ligamentous reconstruction of the interosseous membrane of the forearm in the treatment of instability of the distal radioulnar joint / Reconstrução da membrana interóssea do antebraço no tratamento da instabilidade da articulação da radioulnar distal

ABSTRACT Objectives: To measure the quality of life and clinical outcomes of patients treated with interosseous membrane (IOM) ligament reconstruction of the forearm, using the brachioradialis (BR), and describe a new surgical technique for the treatment of joint instability of the distal radioulnar joint (DRUJ). Methods: From January 2013 to September 2016, 24 patients with longitudinal injury of the distal radioulnar joint DRUJ were submitted to surgical treatment with a reconstruction procedure of the distal portion of the interosseous membrane or distal oblique band (DOB). The clinical-functional and radiographic parameters were analyzed and complications and time of return to work were described. Results: The follow-up time was 20 months (6-36). The ROM averaged 167.92° (93.29% of the normal side). VAS was 2/10 (1-6). DASH was 5.63/100 (1-18). The time to return to work was 7.37 months (3-12). As to complications, one patient had an unstable DRUJ, and was submitted to a new reconstruction by the Brian-Adams technique months. Currently, he has evolved with improved function, and has returned to his professional activities. Three other patients developed problems around the transverse K-wire and were treated with its removal, all of whom are doing well. Conclusion: The new approach presented in this study is safe and effective in the treatment of longitudinal instability of the DRUJ, since it has low rate of complications, as well as satisfactory radiographic, clinical, and functional results. It allows return to social and professional activities, and increases the quality of life of these patients.

RESUMO Objetivos: Mensurar a qualidade de vida e os resultados clínico-funcionais dos pacientes submetidos à reconstrução ligamentar de membrana interóssea (MIO) do antebraço com o uso do braquioestilorradial (BR) e descrever uma nova técnica cirúrgica. Método: De janeiro de 2013 a setembro de 2016, 24 pacientes com lesão longitudinal da articulação radioulnar distal (ARUD) foram submetidos ao tratamento cirúrgico de reconstrução da porção distal da membrana interóssea ou distal oblique band (DOB). Foram analisados os parâmetros clínico-funcionais e radiográficos e descritos as complicações e o tempo de retorno ao trabalho. Resultados: O tempo de seguimento foi de 20 meses [6-36]. A ADM foi em média 167,92° (93,29% do lado normal). A VAS foi 2/10 [1-6]. O DASH foi de 5,63/100 [1-18]. O tempo de retorno ao trabalho foi de 7,37 meses [3-12]. Quanto às complicações, um paciente evoluiu com instabilidade da ARUD e foi submetido a nova reconstrução pela técnica de Brian-Adams. Evoluiu com melhoria funcional e retornou às atividades profissionais. Outros três pacientes evoluíram com problemas ao redor do fio de Kirschner transverso à ARUD e foram tratados com a remoção desse, todos evoluíram bem. Conclusão: A nova abordagem apresentada neste estudo demonstrou-se segura e eficaz no tratamento da instabilidade longitudinal da ARUD, já que apresentou baixa taxa de complicações, bem como resultados radiográficos, clínicos e funcionais satisfatórios, o que melhorou a qualidade de vida desses pacientes.

Ulnar nerve paralysis after forearm bone fracture / Paralisia do nervo ulnar seguida de fratura dos ossos do antebraço

ABSTRACT Paralysis or nerve injury associated with fractures of forearm bones fracture is rare and is more common in exposed fractures with large soft-tissue injuries. Ulnar nerve paralysis is a rare condition associated with closed fractures of the forearm. In most cases, the cause of paralysis is nerve contusion, which evolves with neuropraxia. However, nerve lacerations and entrapment at the fracture site always need to be borne in mind. This becomes more important when neuropraxia appears or worsens after reduction of a closed fracture of the forearm has been completed. The importance of diagnosing this injury and differentiating its features lies in the fact that, depending on the type of lesion, different types of management will be chosen.

RESUMO A paralisia ou lesão nervosa associada à fratura dos ossos do antebraço é rara, é mais comum nas fraturas expostas com grande lesão de partes moles. A paralisia do nervo ulnar é uma condição incomum associada a fraturas fechadas do antebraço. Na grande maioria dos casos, a causa da paralisia é a contusão do nervo, que evolui com neuropraxia. No entanto, devemos sempre estar atentos às lacerações do nervo e ao encarceramento do nervo no foco de fratura. Isso se torna mais importante quando ocorre o surgimento da neuropraxia ou pioria após a feitura da redução da fratura fechada do antebraço. A importância do diagnóstico da lesão e diferenciar suas características estão no fato de que, conforme o tipo de lesão, diferentes tipos de manejo serão escolhidos.

Epidemiology and patterns of the hand and distal forearm fractures at King Abdul-Aziz Medical City, Riyadh, KSA

Objectives: The hand is the most commonly fractured site in the body, as it represents 17-25% of all body fractures. The metacarpal bone of the small finger is the most commonly fractured hand bone. This study aimed to determine the epidemiology and frequency of various fractures of the hand and the distal forearm in adults with a view to identifying patients who required surgical treatment

Methods: This retrospective review examined the medical records of all hand and distal forearm X-rays performed on adult patients who presented to the emergency room of King Abdul-Aziz Medical City from January 2010 to December 2011

Results: In this study, we reviewed 2993 X-rays of the hand and the distal forearm. One-third of these X-rays confirmed fractures [n = 948], and more than two-thirds of these fractures were recorded in male patients [n = 702]. There was no major difference in the distribution of fractures between the left and right hand. Half of these fractures [n = 472] were found in the young age group [18-30 years]. The study showed that the phalanges had the highest proportion of fractures [n = 362, 40%]. Distal forearm fractures represented one-third of all registered fractures [n = 287]. Almost half of the metacarpal fractures were found in the 5th metacarpal [n = 104], confirming that the 5th metacarpal bone is the most commonly fractured bone in the hand. One-fifth of all fractures were surgically managed [n = 190, 20%]

Conclusion: One-third of the reviewed X-rays identified hand and distal forearm fractures. Both hands were affected equally. Patients in the young age group are more prone to have fractures, and phalanges had the highest proportion of fractures followed by the distal forearm

Intramedullary compression device for proximal ulna fracture

Proximal ulna fractures account for 20% of all proximal forearm fractures. Many treatment options are available for such fractures, such as cast immobilisation, plate and screw fixation, tension band wiring and intramedullary screw fixation, depending on the fracture pattern. Due to the subcutaneous nature of the proximal forearm, it is vulnerable to open injuries over the dorsal aspect of the proximal ulna. This may in turn prove challenging, as it is critical to obtain adequate soft tissue coverage to reduce the risk of implant exposure and bony infections. We herein describe a patient with a Gustillo III-B open fracture of the proximal ulna, treated with minimally invasive intramedullary screw fixation using a 6.0-mm cannulated headless titanium compression screw (FusiFIX, Péronnas, France).

Tratamiento de las fracturas de antebrazo en niños y adolescentes con clavo endomedular flexible en el Hospital Universitario de los Andes 2006-2010 / Treatment of forearm fractures in children and adolescents with Flexible Intramedullary Nail in the Andes University hospital 2006-2010

Las fracturas del antebrazo en el niño son muy frecuentes y suponen el 45% de todas las fracturas pediátricas con predominio de varones de 3 a 1 y una mayor incidencia en mayores de 5 años , el manejo de estas fracturas tienen como objetivo, la curación consiguiendo: 1-. Reducción anatómica de los fragmentos con restableciendo de la longitud y rotación ósea, que permitan la prono supinación completa; 2-. Fijación estable que permita movilización inmediata de las articulaciones adyacente. 3-. La restitución de la curvatura radial que influye no solo en resultado funcional de la movilidad si no también en la fuerza de la aprehensión. En este trabajo se realizo una revisión clínica prospectiva en el Hospital Universitario de los Andes de Mérida, durante un lapso de 4 años, desde 2006 al 2010, estudiándose 2.869 casos de fracturas del antebrazos en niños de 2 a 16 años de los cuales 815 casos correspondieron a fracturas diafisarias. El tratamiento aplicado fue de la siguiente manera: Conservador 64%(520/815 casos) con yeso braquio palmar por 6 semanas. Quirúrgico: 36%(295/815 casos), Enclavijado 210/295 casos representando el 71.2%, Placas: 72/295 casos representando el 24.4%, Fijador Externo: 13/295 casos representando el 4.4%(AU)

Forearm fractures in children are very common and account for 45% of all pediatric fractures with a male predominance of 3-1 and an increased incidence in over 5 years, the management of these fractures aim, getting healing : 1 -. Anatomic reduction of the fragments with restoring bone length and rotation, permitting full supination prone; 2 -. Stable fixation that allows early mobilization of the adjacent joints. 3 -. The return of the radial curvature influences not only functional outcome of mobility but also on the strength of apprehension. In this paper a prospective clinical review at the University Hospital of the Andes in Mérida was conducted over a period of 4 years from 2006 to 2010, studying 2,869 cases of forearm fractures in children 2-16 years of which 815 cases corresponded to diaphyseal fractures. The treatment was applied as follows: Conservative 64% (520 cases) with brachial palmar plaster for 6 weeks. Surgical: 36% (295 cases), 210 cases Pegged representing 71.2%, Blocks: 72 cases representing 24.4%, External fixator: 13 cases representing 4.4%(AU)

Manual reduction of children's Monteggia fractures associated with anterior interosseous nerve injury / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical results of the manual reduction in treatment.</p><p><b>METHODS</b>From October 2010 to April 2013,39 children with Monteggia fracture associated with anterior interosseous nerve injury were treated by manual reduction and fixation on buckling rotation backward,including 17 females and 22 males with an average age of 6.3 years old ranging from 3.2 to 11 years old. Among them, 15 cases were on the right side and 24 cases on the left. The course of disease was 40 minutes to 8 days (averaged 1.5 days). There were 7 cases with skateboard injured, 13 cases with stumble injured, 11 cases with falling injured,8 cases with air bed injured. According to Bado classification, 13 cases were type II, 22 cases were type III, 4 cases were type IV.</p><p><b>RESULTS</b>The distal forefinger showed exercise normally in 34 cases at 3 weeks after treatment, and the patients restored normal activities at 6 weeks after treatment. All patients were follow-up from 54 days to 6 months (averaged 67 days. According to Mayo elbow functional evaluation standard,the scoring result was 19.62±1.35 in activity, 45.00 ± 0.00 in pain, 9.87 ± 0.80 in stability, 25.00±0.00 in strength, 99.49 ±1.92 in total. The outcome of all patients was excellent and good evaluation results.</p><p><b>CONCLUSION</b>If the anterior interosseous nerve injury could be identified early and treated timely, patients could gradually restore reasonable function and recover with satisfactory results. Raising understanding of anterior interosseous nerve injury can effectively reduce misdiagnosis.</p>

Uso de clavos endomedulares flexibles de titanio para el tratamiento de fracturas diafisarias de antebrazo en pacientes pediátricos / Use of elastic intramedullary nailing in the treatment of pediatric diaphyseal forearm fractures

Objetivo: Evaluar el resultado del tratamiento de niños con fractura desplazada de antebrazo mediante la estabilización con clavos endomedulares flexibles de titanio. Materiales y Métodos: Se evaluaron, en forma retrospectiva, 13 pacientes (edad promedio 11 años; rango 6-15). Se realizó una evaluación comparativa entre el antebrazo operado y el antebrazo sano contralateral. La evaluación radiológica comparó la longitud del radio, y la ubicación y magnitud del lugar de máxima curvatura del radio entre ambos antebrazos. La evaluación funcional comparó el rango de pronosupinación del antebrazo. El seguimiento promedio fue de 37 meses (rango 12-68). Resultados: La longitud del radio operado fue de 18,1 cm y la del radio contralateral sano, de 18,1 cm (p = 1). La localización del lugar de máxima curvatura del radio se ubicó a nivel del 66,8 por ciento de la longitud en el radio operado y a nivel del 61,5 por ciento de la longitud en el radio contralateral no operado (p <0,01). La magnitud de la máxima curvatura del radio fue del 6,2 por ciento y del 6,7 por ciento de la longitud total del radio, en el antebrazo operado y en el no operado, respectivamente (p = 0,26). La pronación del antebrazo operado fue de 87,7 grados y la del contralateral sano, de 88,3 grados (p = 0,26). La supinación fue de 89,9 grados y de 90,9 grados en el antebrazo operado y en el no operado, respectivamente (p = 0,49). Conclusiones: El tratamiento de niños con fracturas desplazadas de antebrazo mediante la estabilización con clavos endomedulares flexibles produce resultados radiológicos y funcionales similares a los del antebrazo contralateral sano. Nivel de Evidencia: III.

Background: To evaluate the results of flexible intramedullary nailing for the treatment of pediatric displaced forearm fractures. Methods: We retrospectively evaluated 13 patients (average age 11 years; range 6-15). Radiographically we compare radial length and the amount and location of maximum radial bow between the operate forearm and the contralateral normal side. Functional results compared range of pronosupination between both forearms. Average follow-up was 37 months (range 12-68). Results: The length of the operated radius was 18.1 cm and that of the contralateral normal radius was 18.1 cm (p = 1). The location of maximum radial bow differed significantly between the operated and the contralateral radius (p <0.01). No statistically difference was found in the amount of maximum radial bow between both forearms (p = 0.26). Forearm pronation was 87.7° on the operated side and 88.3° on the contralateral forearm (p = 0.26). Forearm supination was 89.9° and 90.9°, respectively (p = 0.49). Conclusions: The use of flexible intramedullary nailing for the treatment of pediatric displaced forearm fractures gives radiographic and functional results similar to those of the normal contralateral forearm. Level of Evidence: III.