ABSTRACT
Self-adherent elastic wrap dressings are a convenient option to manage pediatric hand and finger injuries. However, when improperly applied, they have the potential to cause devastating complications. We detail in this report 5 cases of dressing-induced ischemic injury to the hand in pediatric patients with a review of the literature. All patients were treated by the senior author between 2007 and 2015 and were retrospectively reviewed for initial injury, frequency of dressing changes, presence of pain, time to evaluation by the orthopedic hand team, treatment, and outcome. Patients' families were contacted for clinical updates and to obtain current photographs. Age at injury ranged from 11 months to 3 years with 2 girls and 3 boys. Only 1 of 5 patients complained of pain or discomfort during the onset of their ischemic injury. Treatment of the ischemic injury included local wound care without surgery in 3 cases (including sympathetic block in 1) and surgical intervention with partial or complete digital amputation in 2 cases. At final follow-up, 2 of the 5 patients reported currently being bothered by the appearance of the injured hand; however, none had persistent pain or difficulty using the hand. Through these examples, health care professionals can be educated on the potentially disastrous complications of improper dressing application in the pediatric population and can be encouraged to share this information with patients' families.
Subject(s)
Finger Injuries/therapy , Fingers/blood supply , Ischemia/etiology , Occlusive Dressings/adverse effects , Wound Healing/physiology , Amputation, Surgical/methods , Child, Preschool , Female , Finger Injuries/diagnosis , Follow-Up Studies , Humans , Infant , Ischemia/physiopathology , Ischemia/surgery , Male , Necrosis/etiology , Necrosis/physiopathology , Necrosis/surgery , Retrospective Studies , Risk Assessment , Sampling Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
The elbow's complex anatomy and synergism of bony and ligamentous stabilizers make physical examination challenging. Adequate elbow assessment is essential for accurate diagnosis and initiating proper treatment. Isolated elbow injuries are rare; fractures should be interpreted as proxies for associated, often unappreciated, soft tissue injuries. A careful elbow examination informs the need for and interpretation of radiological studies, including fluoroscopy, magnetic resonance imaging, and computed tomography scanning.
Subject(s)
Elbow Injuries , Elbow Joint/anatomy & histology , Elbow/anatomy & histology , Joint Diseases/diagnosis , Soft Tissue Injuries/diagnosis , Diagnostic Imaging , Humans , Physical Examination , Range of Motion, ArticularABSTRACT
Endogenous opioid signaling contributes to the neural control of food intake. Opioid signaling is thought to regulate palatability, the reward value of a food item as determined by orosensory cues such as taste and texture. The reward value of a food reflects not only these sensory properties but also the relative value of competing food choices. In the present experiment, we used a consummatory contrast paradigm to manipulate the relative value of a sucrose solution for two groups of rats. Systemic injection of the nonspecific opioid antagonist naltrexone suppressed sucrose intake; for both groups, however, this suppression was selective, occurring only for the relatively more valuable sucrose solution. Our results indicate that endogenous opioid signaling contributes to the encoding of relative reward value.
