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Christodoulou N, Asimakopoulos D, Kapetanos K, Seah M, Khan W. Principles of management of hand fractures. J Perioper Pract 2023; 33:342-349. [PMID: 36408867 PMCID: PMC10623595 DOI: 10.1177/17504589221119739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The optimal management of hand fractures requires a multidisciplinary approach. Initial assessment should include a thorough medical history and clinical examination, followed by appropriate radiological imaging. These are crucial in determining the appropriate management. Following joint stabilisation to allow fractures to unite, early mobilisation is needed to maximise the functional restoration of the hand. In this review, the principles of operative and non-operative management of these injuries are discussed.
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Affiliation(s)
| | | | | | - Matthew Seah
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, UK
| | - Wasim Khan
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, UK
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2
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Safeek RH, O’Toole A, Furtado WR, Wilhemi BJ, Choo JH. Isolated Ulnar Artery Injury: Indications for and Timing of Operative Intervention. EPLASTY 2022; 22:e37. [PMID: 36160666 PMCID: PMC9490881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background. Penetrating ulnar artery injury at the wrist is typically treated with immediate operative repair. This study reports a missed iatrogenic ulnar artery injury that resulted in the development of an ulnar artery pseudoaneurysm that was later managed with elective operative repair. The diagnosis and treatment of distal upper extremity pseudoaneurysms and the approach to suspected ulnar artery injury are discussed. Suspected isolated ulnar artery injuries without hard signs of bleeding can be managed with close follow-up and elective repair, should complications such as pseudoaneurysm occur.
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Affiliation(s)
- Rachel H Safeek
- School of Medicine, University of Louisville, Louisville, KY
| | - Adam O’Toole
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | | | - Bradon J Wilhemi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Joshua H Choo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
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3
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Cagnolati AF, Andrade FR, Serrano SDC, Barbieri CH, Mazzer N, Nogueira-Barbosa MH. Avaliações do lúmen da artéria reparada em lesões do antebraço usando o teste de Allen, Doppler portátil e ultrassonografia com Doppler. Rev Bras Ortop 2022; 57:455-461. [PMID: 35785117 PMCID: PMC9246535 DOI: 10.1055/s-0041-1729574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/03/2020] [Indexed: 10/25/2022] Open
Abstract
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.
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Affiliation(s)
- Amanda Favaro Cagnolati
- Residência Médica em Cirurgia de Mão, Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Fernanda Ruiz Andrade
- Residência Médica em Cirurgia de Mão, Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Sara Dadona Correia Serrano
- Programa de Cirurgia de Mão, Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Claudio Henrique Barbieri
- Programa de Cirurgia de Mão, Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Nilton Mazzer
- Programa de Cirurgia de Mão, Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Marcello Henrique Nogueira-Barbosa
- Divisão de Radiologia, Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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4
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Gitto L, Bonaccorso L, Bryant SM, Serinelli S. Death caused by a domestic pig attack. Forensic Sci Med Pathol 2021; 17:469-474. [PMID: 34106425 DOI: 10.1007/s12024-021-00376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
The primary medico-legal investigation goal in deaths due to animal attacks is distinguishing between animal-related injuries and potential homicidal wounds. We report the case of a 49-year-old male found dead in his farm's pigsty, where a sow and her piglets were present. At the postmortem examination, numerous, severe blunt force injuries were observed on the body, with special regard to the upper extremities where massive injuries involving soft tissues, bones, and regional vessels, tendons, and nerves were present. The death resulted from severe bleeding from massive upper extremities injuries due to a domestic pig attack. Domestic pigs are usually placid but they can become aggressive if disturbed and attack humans producing severe injuries due to trampling, kicking and biting. Knowing the relevant anatomy, pattern of attack, and morphologies of wounds produced by particular animals can distinguish animal attacks from homicides, as well as attempt to identify the type of animal involved in an unwitnessed attack.
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Affiliation(s)
- Lorenzo Gitto
- Department of Pathology, State University of New York, Upstate Medical University, Syracuse, NY, USA.
| | - Luigi Bonaccorso
- Sapienza University of Rome, Office of Forensic Medicine - Research Unit in Forensic Pathology, Rome, Italy
| | - Stephanie M Bryant
- Department of Pathology, State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Serenella Serinelli
- Department of Pathology, State University of New York, Upstate Medical University, Syracuse, NY, USA
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5
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Sjeklocha L, Gatz JD. Traumatic Injuries to the Spinal Cord and Peripheral Nervous System. Emerg Med Clin North Am 2020; 39:1-28. [PMID: 33218651 DOI: 10.1016/j.emc.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Both blunt and penetrating trauma can cause injuries to the peripheral and central nervous systems. Emergency providers must maintain a high index of suspicion, especially in the setting of polytrauma. There are 2 major classifications of peripheral nerve injuries (PNIs). Some PNIs are classically associated with certain traumatic mechanisms. Most closed PNIs are managed conservatively, whereas sharp nerve transections require specialist consultation for urgent repair. Spinal cord injuries almost universally require computed tomography imaging; some require emergent magnetic resonance imaging. Providers should work to minimize secondary injury. Surgical specialists are needed for closed reduction, surgical decompression, or stabilization.
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Affiliation(s)
- Lucas Sjeklocha
- R Adams Cowley Shock Trauma Center, 22 South Greene Street, Room S4D03, Baltimore, MD 21201, USA
| | - J David Gatz
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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Hinchcliff KM, Ho CN, Meamar P, Irwin CS. Maintained Hand Perfusion in the Setting of Radial and Ulnar Artery Transections: A Report of 2 Cases. JBJS Case Connect 2020; 10:e1900365. [PMID: 32910601 DOI: 10.2106/jbjs.cc.19.00365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Two otherwise healthy male patients presented with lacerations to the volar distal forearm. Both patients had capillary refill at the fingertips and intact Doppler signals of the palmar arch. Computed tomography angiography revealed cessation of flow in the major forearm arteries at the level of the lacerations, with distal reconstitution from the anterior interosseous artery in both cases and from a branch off the ulnar artery in 1 case. The patients underwent operative exploration, where complete transections of the radial and ulnar arteries were found and repaired. CONCLUSIONS In patients without arterial disease, contributions from minor forearm arteries can be sufficient for hand perfusion in the setting of radial and ulnar artery transection.
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Soto JE, Vásquez DM, Rodríguez G, De La Cruz LA. Peripheral Vascular Trauma in Pediatrics: A Case Report and Literature Review. Cureus 2019; 11:e5744. [PMID: 31723505 PMCID: PMC6825465 DOI: 10.7759/cureus.5744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Vascular lesions constitute an important cause of morbidity and mortality, including functional disability. Their poor documentation in the literature suggests a low frequency in the pediatric age range. Herein, we describe the case of an 11-year-old-boy with an isolated radial artery injury. The patient initially presented with active bleeding from a lacerated wound. He was intervened on multiple occasions for hematoma formation and suture dehiscence at a primary care center from his community. During his admission, he required a blood transfusion for active bleeding. Vascular exploration was performed, and radial artery lesion was managed by ligation.
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Affiliation(s)
- Jatnna E Soto
- Department of Pediatrics, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, DOM
| | - Dulce M Vásquez
- Department of Pediatrics, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, DOM
| | - George Rodríguez
- Department of Pediatrics, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, DOM
| | - Luis A De La Cruz
- Cardiovascular Surgery, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, DOM
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Meng LL, Pua U. Endovascular Radial Artery Sacrifice in an Unsalvageable Transradial Access Site Bleeding due to Cutting Balloon Angioplasty. Ann Vasc Dis 2019; 12:240-242. [PMID: 31275483 PMCID: PMC6600103 DOI: 10.3400/avd.cr.18-00081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The radial artery access site laceration is rare. We hereby described a case of radial artery access site laceration during retrieval of a cutting balloon. The bleeding site was not responsive to hemostatic maneuvers such as application of an external blood pressure cuff, balloon inflation, and an external compression bandage and was eventually coil embolized. Sacrifice using endovascular coiling averted surgical ligation which was the alternative.
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Affiliation(s)
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Advancing Basic Bleeding Control. J Emerg Nurs 2018; 44:210-211. [PMID: 29548379 DOI: 10.1016/j.jen.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lebowitz C, Matzon JL. Arterial Injury in the Upper Extremity: Evaluation, Strategies, and Anticoagulation Management. Hand Clin 2018; 34:85-95. [PMID: 29169600 DOI: 10.1016/j.hcl.2017.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Trauma to the upper extremity can present with an associated arterial injury. After patient stabilization, thorough assessment with physical examination and various imaging modalities allows accurate diagnosis of the specific arterial injury. After diagnosis, efficient treatment is necessary to allow limb salvage. Treatment options include ligation, primary repair, graft reconstruction, endovascular repair, and amputation. The final treatment rendered is frequently dependent on injury location and mechanism. With any of the treatment options, complications may occur, including thrombosis. Currently, no validated anticoagulation protocol has been established for managing arterial injuries in the upper extremity.
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Affiliation(s)
- Cory Lebowitz
- Department of Orthopedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ 080084, USA
| | - Jonas L Matzon
- Department of Orthopaedic Surgery, Thomas Jefferson University, Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107, USA.
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