Techniques in hand & upper extremity surgery
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Tech Hand Up Extrem Surg · Jun 2007
Treatment of pediatric supracondylar humerus fractures in the community hospital.
Supracondylar fractures of the humerus are among the most common elbow injuries in the pediatric population. Because of the significant morbidity associated with treating displaced pediatric supracondylar humerus fractures, most community-based orthopedic surgeons prefer to transfer these injuries to specialty children's hospitals. Our intention in writing this article was to document and evaluate the results we obtained using the lateral diverging pin technique to treat patients at our community hospital. In doing so, we set out to determine if our results were comparable to those of specialty hospitals, allowing us in the future to eliminate the inconvenience placed on patients and their families when being transferred to a specialty facility. ⋯ Our results show the change in Baumann angle and loss of range of motion compare favorably with results of studies done at specialty hospitals. We believe that the divergent lateral pinning technique, in combination with postoperative splinting and a sling can provide excellent results while eliminating the risk of injury to the ulnar nerve. With this knowledge, we feel that the advantage to treating these fractures at a community hospital is the elimination of the anxiety, stress, and time spent waiting in the emergency department of multiple hospitals.
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Tech Hand Up Extrem Surg · Jun 2007
Civilian and detainee orthopaedic surgical care at an Air Force theater hospital.
This study is a retrospective analysis of the orthopaedic care rendered to Iraqi citizens, both military and civilian, and detainees in Balad, Iraq, at an Air Force theater hospital. Defining the scope of care for this patient group and emphasizing the differences in care provided for the endemic population in contrast to the rapidly air-evacuated Coalition injured combatant are the primary focus of the study. Approximately 50% of more than 1600 trauma/combat-related injury admissions to Air Force Theater Hospital in Balad, Iraq, from the period of September 2, 2005 through January 18, 2006, were Iraqi citizens and detainees. ⋯ Injured Coalition combatants received high-level damage control orthopaedic care and initial debridements, with external fixation as the single most common means of long-bone fracture stabilization. Civilians and detainees seen at Balad received the same high-level care and much, if not all, of their definitive care while at Air Force Theater Hospital. The care rendered to Iraqi citizens and detainees at an Air Force theater hospital is described, with multiple case examples that reflect a high level of definitive care offered in a war zone.
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Tech Hand Up Extrem Surg · Jun 2007
Transfer of the intercostal nerves to the nerve of the long head of the triceps to recover elbow extension in brachial plexus palsy.
Restoration of elbow flexion is the first goal in brachial plexus injuries. The current procedures using nerve grafts and nerve transfers authorize more extensive repairs, with different possible targets: shoulder, elbow extension, and hand. Elbow extension is important to stabilize the elbow without the contralateral hand and allows achieving a useful grasp. ⋯ Moreover, in case of absence or insufficient (M0 to M2 according to Medical Research Council scoring) recovery of elbow flexion strength by nerve surgery, the reinnervated triceps can be transferred. We present the technique of intercostal nerve transfer to the long head of the triceps branch to restore elbow extension in brachial plexus palsy. Results concerning 10 patients are presented.