Rollover injuries of the upper extremity

Eleven patients were treated for rollover injuries of the upper extremities from 1971 to 1976 resulting from the rollover accidents of off-road vehicles in rough terrain. Injuries to the volar surfaces of the extremity were most common, but injury to the extensor surfaces seemed to be more severe. Soft-tissue injuries predominated as did injury to the nondominant hand. The majority of patients returned to their original jobs after sometimes prolonged recovery and rehabilitation. A redesign of the rollover cage with interior hand holds could reduce the frequency and severity of these novel injuries.

High tension electrical injury of the upper extremity

A group of 18 patients received a high tension electrical injury of the upper extremity. The over-all results were dismal. Opportunity for improvement appears to lie in a regimen of rapid and complete removal of devitalized skin and muscle, avoidance of contamination and desication and the early provision of blood supply and wound coverage with pedicled flap coverage.

Traumatic closed transection of the biceps brachii in the military parachutist

Static line injury to the military paratrooper's arm occasionally produces an unusual muscle injury: closed transection of the belly of the biceps brachii. A review of twenty-eight untreated paratroopers so injured demonstrated significant residual weakness and deformity. Attempts at late repair resulted in only minimum improvement. The results of twenty fresh injuries treated by either surgical repair or aspiration followed by closed reduction and splinting are presented.

Auger injuries in children

A 6-year review of auger injuries in Manitoba children revealed that 23 children sustained major injuries resulting in amputation of 17 limbs. Auger injuries are the main cause of traumatic amputation in children in Manitoba. Improved safety education for the entire farm family as well as better design of safety shields would decrease this carnage.

Epiphyseal injuries in the growing athlete

The epiphyses and epiphyseal plates are vital structures in the bone development of the growing athlete. The epiphyseal plate is two to five times weaker than the surrounding fibrous tissue in children and adolescents; consequently a force causing a ligamentous tear in adults is likely to cause an epiphyseal plate injury in growing children. Two types of epiphyseal injury that are common in the growing athlete are (a) separation across the epiphyseal plate, which is usually produced by a direct blow to the joint area or by a strong muscular contraction, and (b) traumatic epiphysitis, the more common of the two, which is usually caused by strong, repetitive contraction of a muscle attached to a traction epiphysis. Each epiphyseal site has specific anatomic features and the forces causing injury differ slightly at each site. An improperly treated separation of an intra-articular pressure epiphysis can have a disastrous effect on the proper functioning of the normally well-fitted articulation of bone ends in the joint. Consequently, proper diagnosis and treatment are essential. Traumatic epiphysitis can result in chronic inflammation or fragmentation, or both, if the condition is not arrested. Therefore the athlete must discontinue the activities that are causing the trauma until the inflammation is completely arrested. Absolute rest may even be required.

Icarus's syndrome: new hazards in flight

The British Hang Gliding Association accident report for 1975 reported two deaths. The remaining cases were predominantly limb fractures. The major causes of the injuries were inexperience, high wind speed, turbulence, and stalling. It is contended that the sport is no more risky than is rock climbing, motor-bike racing, skiing, or potholing, yet against these undoubtedly dangerous sports no threat of prohibition exists. The current accident rate in hang gliding could be reduced dramatically by the provision of proper courses of instruction.

[Premature infant with traumatic loss of the left arm and shoulder caused by an ineffective interruption of pregnancy (author's transl)]

A case of a premature infant with traumatic loss of the left arm and shoulder is reported. The trauma was caused by an ineffective interruption of pregnancy.

The role of orthopedist in child abuse and neglect

The diagnosis of child abuse is contingent upon having a high index of suspicion. Orthopedic surgeons and other surgical specialists should be more involved in a team approach for prevention, detection and management in cases of child abuse in the hope of breaking the cycle of this mutilating and often fatal tragedy.

Wringer arm injuries

During a 20-yr period, 483 children 16 yr of age or under were hospitalized for management of a wringer arm injury. Although the majority were indigent, black males, such trauma was frequently sustained by all classes and races as well as by both sexes. Principles of treatment consisted of cleansing the abrasion wound, application of a pressure dressing from axilla to finger tips, elevation, and close observation. With the exception of a destroyed brachial vein in one patien, significant vascular injuries did not occur despite a "medical fixation" on evidences of impaired circulation. Likewise, no fractures were noted even though all patients had x-rays of the full extremity. However, there were six metacarpophalangeal dislocations, five instances of neuropathy, and one traumatic amputation. Major skin sloughs occurred in 18 children, yet only 11 of them required a skin graft.

[Aspects of the pathology of the arm after irradiation of breast cancer]

The complications of modern surgical and radiotherapeutic methods of treating mammary neoplasms are studied on the basis of 36 cases. Although swollen arms are rare nowdays following the development of greater pectoral conservative mammectomy, lesions of the shoulder and post-radiotherapy plexal paralysis represent a heavy price to pay for these methods. Shoulder lesions are of two types with different prognosis : scapulo-humeral periarthritis, which is very frequent (22 cases) and related to post-radiotherapy axillary fibrosis, and glenohumeral radio lesions (2 cases), which result in blockage of the humeral head because of necrosis. The brachial plexus may be injured by high-energy irradiation. These pathological conditions of the plexus (11 cases), often associated with a painful syndrome that is intolerable, objective sensory disorders, and a motor deficiency that is poorly systematized, are difficult to differentiate clinically from cases of paralysis resulting from invasive neoplasms. Often it is possible to distinguish between them only by means of biopsy, which is difficult. Therapy of these plexopathies is difficult and is usually palliative, necessitating, in particular, the use of neurosurgery of the pain (radicotomies and cordotomies) rather than of neurolyses, the results of which are disappointing.

Injuries in long distance, cross country, and downhill skiing

In 981 skiing accidents the type of injury resulting was studied in relation to the skiing activity (long distance, cross country, and downhill) and to the type of boots used. From the patterns of injuries it appears that in downhill skiing not only the velocity but also the particular type of equipment used is responsible for the increased incidence and for the characteristic types of injuries. The alpine ski boot used in downhill skiing, however, seems to protect the ankle joint and the foot from injuries that are more common in cross country and long distance skiing.

Upper extremity wringer injury

A clinical survey of 92 upper extremity wringer injuries over the past four years at the Bexar County Hospital are presented. Our treatment regimen and results are outlined. Complex injuries occurred infrequently (7%). No vascular insufficiency developed and no fasciotomies were required. We are of the opinion that hospitalization is necessary in all but a small number of selected cases. Close observation is necessary to prevent edema progression and further tissue loss. Ninety-two upper extremity compression injuries secondary to washing machine wringers were reviewed. Seventy-six percent of the injuries occurred in persons under 10 years of age. Extremity distribution was equal. Injury occurred below the elbow in 72% of the extremities. Soft tissue injury was manifested by swelling and tenderness in 96%. Twenty-one percent had no violation of the skin. Major avulsion, such as third degree skin loss, crush injury, dislocation, and tendon avulsion, occurred in 8%. The treatment regimen consisted of surgical preparation with Betadine, compressing dressing, and elevation. Observation of the involved extremity is made every hour for development of vascular insufficiency. Fractures and other major injuries were treated as indicated. No fasciotomy was required. No vascular insufficiency developed. SKin slough was present in 16 of 92 extremities and skin graft was required in 5 of the 16. Results of treatment reveal 87% with no functional impairment of the involved extremity. Varying degrees of impairment are present in 6% of the injured extremities with all localized to the major avulsion group of injuries.

Self-mutilation, obsessionality and narcissism

A controlled study of the clinical and biographical features of 22 female repeated self-cutters is described. The results of the assessment of these patients, using the Middlesex Hospital Questionnaire and the Obsessive-Compulsive section of the Tavistock Inventory, is presented. The marked obsessionality of these patients is emphasized and the possible implications of these findings for treatment is discussed.

Injuries caused by rubber bullets: a report on 90 patients

The injuries in 90 patients caused by rubber bullets are described. There was 1 death and 17 people in the series had permanent disabilities or deformities. In 41 patients the injuries necessitated admission to hospital. One fatality outside this series is known. Injuries to the head and neck were frequent and severe.

Speedboat propeller injuries

Six patients are reported who were severely injured by high-speed boat propellers. With reasonable precautions such accidents need never occur, and people should be more aware of these and ensure that safety measures are enforced.