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Grasso MB, McLaughlin J, Amendola MF, Cotterell IHF. Complications Following Ulnar Artery Catheterization for Coronary Angiography. Hand (N Y) 2024; 19:414-418. [PMID: 36168743 PMCID: PMC11067832 DOI: 10.1177/15589447221124241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Use of radial and ulnar access has increased due to its perceived benefits over femoral access. Ulnar artery catheterization can place patients at risk of significant complications, including pseudoaneurysm, expanding hematoma, compartment syndrome, ulnar nerve injury, and critical hand ischemia. The purpose of this study was to describe complications specific to ulnar artery catheterization. METHODS After obtaining institutional review board approval, a retrospective review was performed on all patients who underwent ulnar artery catheterization at our institution between 2019 and 2021. Complications were assessed, and complication rates were compared with previously published studies on ulnar artery catheterization for coronary angiography (percutaneous coronary intervention). RESULTS A total of 41 patients were available for review with a mean age of 59 years. Of these, 17 patients (41%) sustained complications in the immediate postprocedural period. These complications included hematoma (12 patients, 29%), pseudoaneurysm (1 patient, 2%), ulnar artery thrombosis (1 patient, 2%), ulnar neuropathy (3 patients, 7%), arterial damage requiring repair (2 patients, 5%), transient ischemia (3 patients, 7%), and compartment syndrome (2 patients, 5%). Three of these patients (7%) required operative intervention, and several were admitted to the hospital for an additional period of observation. CONCLUSIONS This series highlights the significant risks associated with ulnar artery catheterization for percutaneous procedures. Complications include pseudoaneurysm, expanding hematoma, compartment syndrome, ulnar nerve damage, and critical hand ischemia. Several of these patients required urgent or emergent surgical intervention, with some patients experiencing ongoing ulnar nerve symptoms.
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Affiliation(s)
| | | | - Michael F. Amendola
- Virginia Commonwealth University School of Medicine, Richmond, USA
- Central Virginia Veterans Affairs Health Care System, Richmond, USA
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Stuber J, Filiberto D, Lenart E, Fischer P, Mitchell EL, Byerly S. Management of Traumatic Radial and Ulnar Artery Injuries and Risk Factors for Amputation. J Surg Res 2023; 291:507-513. [PMID: 37540968 DOI: 10.1016/j.jss.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Traumatic injuries to the radial and/or ulnar arteries represent a subset of arterial injuries. In the absence of injury to both forearm arteries, treatment was historically ligation if perfusion was maintained to the hand via the uninjured vessels or adequate collateral vessels. We sought to determine management of traumatic forearm arterial injuries in 2019 and to identify risk factors for major upper extremity amputation. METHODS The American College of Surgeons Trauma Quality Improvement Program database was queried by International Classification of Diseases 10 code for patients with traumatic radial and/or ulnar artery injuries within the year 2019. Patient demographics, Injury Severity Score, time to operating room, type of repair, outcomes, and mortality were collected. Multivariable logistic regression was used to identify risk factors for major upper extremity amputation. RESULTS A total of 4048 patients with traumatic radial and/or ulnar artery injuries were identified. A total of 1907 radial artery operations were performed including repair (59%), ligation (29%), and interposition bypass (12%). A total of 1637 ulnar artery operations were completed including repair (67%), ligation (21%), and interposition bypass (12%). Major upper extremity amputation occurred in 0.6%. Older age (adjusted odds ratio [AOR]: 1.014, 95% confidence interval [CI]: 1.004-1.024, P = 0.0048), blunt mechanism (AOR: 2.457, 95% CI: 1.730-3.497, P < 0.0.0001), and ipsilateral radial and ulnar artery injury (AOR: 2.148, 95% CI: 1.298-3.553, P = 0.0029) were associated with major amputation. Surgical revascularization, time to operating room, fasciotomy, and compartment syndrome were not associated with major amputation, but this may be secondary to Type II error. CONCLUSIONS In the operating room, radial and ulnar artery injuries were managed more often with restoration of flow versus ligation. Older age, blunt mechanism, and ipsilateral radial and ulnar artery injury were associated with major amputation. Amputation rate was low at 3% overall and 0.6% for amputation of the hand or a more proximal level. Upper extremity fracture, upper extremity nerve injury, and ipsilateral radial and ulnar artery injury were associated with need for revision operation.
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Affiliation(s)
- Jacqueline Stuber
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Dina Filiberto
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Emily Lenart
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Peter Fischer
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Erica L Mitchell
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Saskya Byerly
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
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Kumaraswamy MK, Chethan S, Shanthakumar KS, Kamal K. Prospective observational study of clinical outcomes in using posterior interosseous free flap for finger defects. Acta Chir Plast 2023; 65:6-12. [PMID: 37211418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Finger injuries are common in hand and plastic surgery practice. There are various options for reconstructing finger defects. Moderate sized skin defects of the fingers which need flaps are commonly covered using various abdominal flaps. These conventional workhorse flaps are thick, need two-staged procedures and require the hand to be kept in a cumbersome position. The radial artery or the ulnar artery flap need sacrifice a major vessel. To address the above, we have used the posterior interosseous artery free flap to cover finger defects. This was a prospective observational clinical study done on 15 patients admitted to a tertiary level hospital from July 2017 to July 2021. These patients had accidental industrial injuries with a loss of soft tissue on the fingers. There were finger fractures in 6 cases. These patients underwent posterior interosseous artery free flap cover. The flap size ranged from 6 × 3 cm to 10 × 4 cm. We had to cover the donor defects with skin graft in all our cases. Fourteen out of 15 flaps survived, with loss of one flap due to venous congestion. The mean two-point discrimination was 7.8 mm, with a total active motion percentage of more than 70% in 11 out of 15 cases. The posterior interosseous artery flap is a thin and pliable one stage flap, and may not need further flap thinning either, thereby establishing itself as a single stage procedure and moreover not requiring sacrifice a major vessel.
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Pagliari M, Menna CR, Christodoulidis A, Soldà M, Molinari M. Unusual case of hypotenar Hammer Syndrome and carpal tunnel syndrome association. Acta Biomed 2018; 90:158-161. [PMID: 30715017 PMCID: PMC6503399 DOI: 10.23750/abm.v90i1-s.8016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Hypothenar Hammer Syndrome is a relatively rare disease process caused by repetitive stress or injury to the hypothenar eminence leading to chronic injury to the ulnar artery. Our study reports an unusual case. METHODS A 57 years old Plumber presented in April 2016 with a history of constant pain and recurrent paresthesia involving the fingers of the right hand for several months, over the previous 1 year, his hand had become more intolerant of exposure to cold temperatures. Angio-RNM and electromyography were performed and showed a severe double compression of ulnar and median nerve and an ulnar artery deformity without thrombosis. Surgery was performed under sedation and axillary anesthesia. RESULTS After surgery patient' symptoms immediately improved, and within a few months, his hand had normalized. CONCLUSION Hypothenar Hammer Syndrome is a rare disease process which manifests in certain occupations and activities that put undue stress on the hypothenar area. Furthermore, the carpal tunnel syndrome, a pressure damage of the median nerve, caused by repetitive manual tasks with flexion and extension of wrist has been added as well as hypothenar hammer syndrome which are vascular damages of hand caused by shock-type application of force.
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Athlani L, De Almeida YK, Maschino H, Dap F, Dautel G. [Hypothenar hammer syndrome: A recurrent case report after surgery]. J Med Vasc 2018; 43:320-324. [PMID: 30217347 DOI: 10.1016/j.jdmv.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 05/25/2018] [Indexed: 11/19/2022]
Abstract
Hypothenar hammer syndrome is a rare entity secondary to ulnar artery damage in the wrist, affecting mainly those exposed to repeated hand-palm trauma. Surgery is discussed in case of severe symptoms, resistant to medical treatment, and/or when anatomical lesions with emboligenic potential are demonstrated in the radiological exams. In this case, resection of the pathological zone with revascularization by autologous vein graft is the best option. We report the case of a 60-year-old patient who had a recurrence of symptoms more than 10 years after the completion of a surgical treatment. There was an aneurysmal thrombosed vein graft with extensive thrombus extending from the ulnar artery upstream of the Guyon's canal to the superficial palmar arch. The digital revascularization was provided by the radial superficial palmar arch and the presence of a collateral vascular supply. This late complication was responsible for compression of the ulnar nerve in Guyon's canal. A new surgery was performed consisting of the resection of the thrombosed zone, including the vein graft, without vascular reconstruction given the good vascularization of all the fingers, and release of the ulnar nerve to the wrist. The operative follow-up was uneventful with the disappearance of pain and sensory-motor deficits. Good digital vascularization was confirmed by imaging at 3 months postoperatively; nerve recovery by electromyogram at 6 months with normal conduction.
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Affiliation(s)
- L Athlani
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, CHU de Nancy, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - Y K De Almeida
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, CHU de Nancy, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - H Maschino
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, CHU de Nancy, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - F Dap
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, CHU de Nancy, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - G Dautel
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, CHU de Nancy, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France.
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Abstract
Cold and White - Hypothenar Hammer Syndrome Abstract. Hypothenar hammer syndrome (HHS) is a condition caused by digital ischemia as a result of repeated trauma to the little finger. Routine diagnosis should include a detailed medical history and a physical examination including Allen's test. Imaging of vascular lesions can be done initially by acral plethysmography and duplex sonography, or directly in the context of angiography (gold standard). Early diagnosis enables effective therapeutic strategies and preventing permanent sequelae. The optimal treatment options are selected depending on the intensity of symptoms, ranging from conservative methods, secondary prevention, through a local thrombolysis up to operational measures.
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Affiliation(s)
- Ewelina Biskup
- 1 Shanghai University of Medicine and Health Sciences, Shanghai, P.R. China
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Seldén A, Hermiz F, Östlund B. [Hypothenar hammer syndrome is rare - or simply an unusually overlooked condition]. Lakartidningen 2016; 113:DYCP. [PMID: 27727416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Hypothenar hammer syndrome is a possibly underdiagnosed but treatable cause of Raynaud's phenomenon and hand ischemia elicited by thombosis or aneurysm secondary to acute or chronic blunt trauma to the ulnar artery at the level of Guyon's canal. This paper provides a summary of the condition with some emphasis on prophylactic and therapeutic aspects.
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Affiliation(s)
- Anders Seldén
- Centre for Occupational and Environmental Medicine - Unit of Occupational Health Stockholm, Sweden Centre for Occupational and Environmental Medicine - Unit of Occupational Health Stockholm, Sweden
| | - Fatin Hermiz
- Örebro University Hospital - Dept of Physiology Örebro, Sweden Örebro University Hospital - Dept of Physiology Örebro, Sweden
| | - Bengt Östlund
- Nyköping Hospital - Dept of Orthopedics Nyköping, Sweden Nyköping Hospital - Dept of Orthopedics Nyköping, Sweden
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Affiliation(s)
- Erkan Goksu
- Department of Emergency Medicine, School of Medicine, Akdeniz University, Antalya, Turkey
| | | | - Fatma Selman
- Department of Emergency Medicine, School of Medicine, Akdeniz University, Antalya, Turkey
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Hoang D, Lin AC, Essilfie A, Minneti M, Kuschner S, Carey J, Ghiassi A. Evaluation of Percutaneous First Annular Pulley Release: Efficacy and Complications in a Perfused Cadaveric Study. J Hand Surg Am 2016; 41:e165-73. [PMID: 27180952 DOI: 10.1016/j.jhsa.2016.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/29/2016] [Accepted: 04/13/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Trigger finger is the most common entrapment tendinopathy, with a lifetime risk of 2% to 3%. Open surgical release of the flexor tendon sheath is a commonly performed procedure associated with a high rate of success. Despite reported success rates of over 94%, percutaneous trigger finger release (PFTR) remains a controversial procedure because of the risk of iatrogenic digital neurovascular injury. This study aimed to evaluate the safety and efficacy of traditional percutaneous and ultrasound (US)-guided first annular (A1) pulley releases performed on a perfused cadaveric model. METHODS First annular pulley releases were performed percutaneously using an 18-gauge needle in 155 digits (124 fingers and 31 thumbs) of un-embalmed cadavers with restored perfusion. A total of 45 digits were completed with US guidance and 110 digits were completed without it. Each digit was dissected and assessed regarding the amount of release as well as neurovascular, flexor tendon, and A2 pulley injury. RESULTS Overall, 114 A1 pulleys were completely released (74%). There were 38 partial releases (24%) and 3 complete misses (2%). No significant flexor tendon injury was seen. Longitudinal scoring of the flexor tendon was found in 35 fingers (23%). There were no lacerations to digital nerves and one ulnar digital artery was partially lacerated (1%) in a middle finger with a partial flexion contracture that prevented appropriate hyperextension. The ultrasound-assisted and blind PTFR techniques had similar complete pulley release and injury rates. CONCLUSIONS Both traditional and US-assisted percutaneous release of the A1 pulley can be performed for all fingers. Perfusion of cadaver digits enhances surgical simulation and evaluation of PTFR beyond those of previous cadaveric studies. The addition of vascular flow to the digits during percutaneous release allows for Doppler flow assessment of the neurovascular bundle and evaluation of vascular injury. CLINICAL RELEVANCE Our cadaveric data align with those of published clinical investigations for percutaneous A1 pulley release.
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Affiliation(s)
- Don Hoang
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Ann C Lin
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anthony Essilfie
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Michael Minneti
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Stuart Kuschner
- Department of Hand Surgery, Cedars Sinai Medical Center, Los Angeles, CA
| | - Joseph Carey
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Alidad Ghiassi
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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10
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Jepsen JR, Røder O. [Bilateral hypothenar hammer syndrome]. Ugeskr Laeger 2015; 177:58-59. [PMID: 25612968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hypothenar hammer syndrome is caused by ulnar artery occlusion subsequent to repeated blunt trauma such as by using the hypothenar as a hammer during work. Allen's test permits the detection of this frequent and often overlooked cause of hand pain and ischaemia. The four bilateral hypothenar hammer syndromes described in this case report occurred after several years of occupational exposure to hard shocks/impacts to the hypothenar from workpieces, which were held with a firm grip.
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Affiliation(s)
- Jørgen Riis Jepsen
- Arbejdsmedicinsk Afdeling, Sydvestjysk Sygehus Esbjerg, Østergade 81-83, 6700 Esbjerg.
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Park MJ, Gans I, Lin I, Levin LS, Bozentka D, Steinberg D. Timing of forearm arterial repair in the well-perfused limb. Orthopedics 2014; 37:e582-6. [PMID: 24972441 DOI: 10.3928/01477447-20140528-60] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 11/25/2013] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the difference in the outcomes of patients with a well-perfused hand who were taken to the operating room (OR) within 6 hours of forearm arterial injury vs patients who were treated in a semiurgent fashion. A review of 201 consecutive patients who were taken to the OR with forearm-level radial or ulnar arterial injury identified 26 patients who had a well-perfused hand at presentation in whom hemostasis was achieved within 15 minutes with manual pressure and no signs of hemodynamic instability. Outcomes of interest included short-version Disabilities of the Arm, Shoulder and Hand (quickDASH) scores and patient-reported cold intolerance. Of the 26 patients, group 1 included 17 patients who were taken to the OR within 6 hours and group 2 included 9 patients who were taken to the OR in a delayed fashion. Minimum follow-up in both groups was 13 months. Average quickDASH score was 24.5 and 14.1 for groups 1 and 2, respectively. Average time spent in the OR was significantly less in group 2 compared with group 1 (1.7 vs 2.8 hours). In the setting of forearm arterial injury with a well-perfused distal limb, there was no difference in functional outcome in patients taken to the OR emergently compared with those who underwent surgery in a delayed manner. With careful evaluation and monitoring, semiurgent operative repair is feasible and may improve certain aspects of patient care and hospital resource use. Outcome measures in this study support semiurgent treatment of these injuries.
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Wu LZ, Gu SL, Zheng YM, Wang C, Yi LJ, Li BW. [Application of free flap pedicled with supracarpal cutaneous branch of ulnar artery in repairing of finger replantation]. Zhongguo Gu Shang 2014; 27:471-474. [PMID: 25241464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate clinical application and clinical outcomes of free flap pedicled with supracarpal cutaneous branch of ulnar artery in repairing of finger replantation with skin defect. METHODS From April 2007 to March 2013,25 patients affected by finger amputation with skin defect were replanted and repaired by free flap pedicled with supracarpal cutaneous branch of ulnar artery. Among them, 18 patients were male and 7 were female,with an average age of 31.5 years old (ranged 16 to 58). The time of trauma to admission ranged from 45 to 210 min (averaged 105). Fifteen patients were complete separted, and 10 patients were non-complete separated. The area of flaps ranged from 3.5 cm x 2.0 cm to 4.5 cm x 3.0 cm, and the vessels were anastomosed through end-to-end. The functional evaluation standard of finger replantation was used to evaluate the postoperative function. RESULTS Twenty-four cases were finally survived. Two flaps occurred vascular crisisin within 48 h after operation, one of which was survived after anti-vasospasm treatment and changing dressing,another was replanted finger for failed to survive. One had infection and healed after changing dressing. Twenty-four cases were followed up from 3 to 38 months with an average of 16.5 months. The appearance and texture of flaps were satisfactory, and the superficial senses of pain and touch were recovered,and two-point discrimination was 5.5 to 11 mm (averaged 7.4 mm). According to functional evaluation standard finger replantationissued by Hand Surgery Association of Chinese Medical Association, 8 cases got excellent results, 14 good and 2 poor. CONCLUSION The free flap pedicled with supracarpal cutaneous branch of ulnar artery can be used in complex finger replantation with skin and vessels defect, which can extend operation indications, recover function and appearance for maximum.
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Prezioso V, Mangiulli T, Bolino G, Sciacca V. About a case of missed diagnosis of a post-traumatic aneurysm in the ulnar artery. Medical-legal aspects in respect to the professional liability. Ann Ital Chir 2014; 85:171-176. [PMID: 24394807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Compartment syndrome of the left hand from a late diagnosed post-traumatic ulnar artery pseudoaneurysm. We report the case of 27 years old boy with a tipping and cutting wound on his left wrist, generating an ulnar artery pseudoaneurysm, that was late diagnosed, and therefore complicated by a compartment syndrome in the wrist. Immediately after the trauma the subject went to the emergency room where the severity of the injury was undestimated; in fact, it was sutured and medicated, without further investigation. When he went to the same hospital for the second time, symptoms (pulsatile mass, redness and irritation of the skin) were interpreted as an infectious process and treated in an incongruous way. Then, when he went to another hospital in which imaging studies (ultrasound) were performed, the pseudo- aneurysm of the ulnar artery was diagnosed and surgically treated. The delay in diagnosis led to a compartment syndrome that is still appreciable as a sensory-motor deficit of the hand, especially of the fourth and fifth finger. This pseudo- aneurysm complication and its debilitating outcomes are known in literature, so the diagnostic delay makes the sanitary staff guilty of the suffered damage.
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Lineaweaver W. Immediate nerve grafts to a median nerve injury in a 7-year-old boy: 5-year follow-up. J Miss State Med Assoc 2013; 54:252-254. [PMID: 24371902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Immediate nerve grafts to traumatic injuries can achieve functional results in selected cases. This report describes 5 cm nerve grafts placed in a median nerve injury ofa 7-year-old boy. Five years later, the patient has a functional motor and sensory outcome.
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Kim DH, Jang JE, Park BK. Anatomical basis of ulnar approach in carpal tunnel injection. Pain Physician 2013; 16:E191-E198. [PMID: 23703418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Local steroid injection may be an effective conservative treatment for carpal tunnel syndrome; however, the use of a blind injection technique can increase the chance of median nerve or ulnar artery injury due to median nerve swelling or the close proximity of the median nerve and ulnar artery around the distal wrist crease. OBJECTIVES The purpose of this study is to investigate the relative location of the median nerve and ulnar artery to the palmaris longus (PL) tendon around the wrist in carpal tunnel syndrome. STUDY DESIGN An observational study. SETTING A university outpatient interventional pain management practice in the Republic of Korea. METHODS Thirty hands of 15 patients with carpal tunnel syndrome and 30 hands of 15 healthy subjects were studied. Ultrasonography was performed to determine the relative relationship of the ulnar artery and median nerve to the PL tendon around the wrist. RESULTS There were statistically significant differences both in the distance from the medial margin of the PL to the medial end of the median nerve and the distance from the medial end of the median nerve to the lateral end of the ulnar artery at all levels of scanning between the 2 groups. LIMITATIONS Limitations include the inclusion of a small number of patients with carpal tunnel syndrome. CONCLUSION It is important to recognize the risk of blind local steroid injection for carpal tunnel syndrome, which is most likely a result of swelling and/or flattening of the median nerve around the distal wrist crease. A real time, ultrasound-guided local steroid injection is preferred as a safe and accurate technique in carpal tunnel syndrome treatment.
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Affiliation(s)
- Dong Hwee Kim
- Department of Physical Medicine & Rehabiliation, Korea University College of Medicine, Ansan Hospital 516 Gojan-dong, Danwon-gu Ansan-si, Gyeonggi Province, Korea.
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Dreizin D, Jose J. Hypothenar hammer syndrome. Am J Orthop (Belle Mead NJ) 2012; 41:380-382. [PMID: 22900252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Hypothenar hammer syndrome is a rare, but likely underdiagnosed occupational or recreational malady, resulting from repetitive microtrauma to the ulnar artery at the level of Guyon's canal. Significant diagnostic and treatment delays are associated with high morbidity, therefore early recognition is of the utmost importance. We discuss specific imaging features, emphasizing findings at ultrasound, computed tomography, and magnetic resonance imaging, that favor the diagnosis in the appropriate clinical context. Definitive evaluation is made with catheter directed angiography, which remains the gold standard for diagnosis. The range of management options, which depend on the degree of severity and the presence or absence of ulnar artery aneurysm, are also presented.
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Affiliation(s)
- David Dreizin
- University of Miami Miller School of Medicine, Jackson Memorial Hospital, Department of Radiology, Miami, Florida 33136, USA.
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17
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Clemens RK, Husmann M, Amann-Vesti BR, Thalhammer C. [White small finger in a 45 year old teacher]. Praxis (Bern 1994) 2011; 100:171-174. [PMID: 21290375 DOI: 10.1024/1661-8157/a00426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We report the case of a 45 year old teacher with a digital ischemia of the small finger of the right hand. Non invasive diagnostics showed a hypothenar hammer syndrome caused by repetitive trauma due to mechanical working, use of a classical espresso machine and playing drums. Diagnostics, etiology and therapeutic options are discussed.
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Affiliation(s)
- R K Clemens
- Klinik für Angiologie, Universitätsspital Zürich, Zürich
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18
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Skinner R, Hill J. Hiker remembers rescue. Interview by Rose Mary Phillip. Alta RN 2008; 64:22-23. [PMID: 18717416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abstract
Patients with hand and finger pain regularly present to primary care practices. Although a well-known clinical entity to specialists, hypothenar hammer syndrome is an uncommon vascular overuse syndrome that may not be familiar to primary care practices. It is caused by trauma to the palmar portion of the ulnar artery, usually as a result of occupational or sports activities which involve repetitively striking objects with the heel of the hand. In this report we describe two representative cases as well as discuss clinical features, pathogenesis, diagnosis, imaging and management.
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Affiliation(s)
- C Timothy Ablett
- Occupational Health, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
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Abstract
A retrospective review of 42 patients with spaghetti wrist lacerations operated on by the author between June 1997 and May 2005 was completed. A total of 31 males and 11 females, average age of 17.1 years (range, 2-40 years), sustained spaghetti wrist injuries. The most frequent mechanisms of injury were accidental glass lacerations (55%), knife wounds (24%), and electrical saw injuries (11%). An average of 9.16 structures was injured, including 6.95 tendons, 1.4 nerves, and 0.8 arteries. The most frequently injured structures were median nerve (83%), flexor digitorum superficialis 2-4 tendons (81%), flexor digitorum profundus 2-4 tendons (66%), ulnar nerve and ulnar artery (57%), and flexor pollicis longus (40%). Combined flexor carpi ulnaris, ulnar nerve, and ulnar artery (ulnar triad) injuries occurred in 31%, while combined median nerve, palmaris longus, and flexor carpi radialis injuries (radial triad) occurred in 43%. Simultaneous injuries of both median and ulnar nerves occurred in 40.5%. Simultaneous injuries of both ulnar and radial arteries occurred in 14%. Neither artery was injured in 30.9%. Follow-up has ranged from 1 to 8 years, with an average of 46 months. Only four patients have been completely lost to follow-up. Range of motion of all involved digits (tendon function) was excellent in 34 patients, good in 3 patients, and poor in only 1 patient. Opposition was excellent in 31 patients, good in 5 patients, and poor in 2 patients. Intrinsic muscle recovery was subjectively reported to be excellent in 29 patients, good in 7, and fair to poor in 2 patients. Minor deformity (partial clawing) was reported in 4 patients and 1 patient has major deformity (total clawing). Sensory recovery was reported, excellent in 32 patients, good in 5 patients, and fair in only 1 patient.
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Affiliation(s)
- Hassan H Noaman
- Hand and Reconstructive Microsurgical Unit, Orthopaedic Department, Sohag Faculty of Medicine, Sohag University, Egypt.
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21
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Fomin VN. [Treatment of injuries of great vessels of the extremities under conditions of a central regional hospital]. Vestn Khir Im I I Grek 2008; 167:127-128. [PMID: 19241836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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22
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Abstract
Hypothenar hammer syndrome (HHS) is an uncommon form of secondary Raynaud phenomenon, occurring mainly in subjects who use the hypothenar part of the hand as a hammer; the hook of the hamate strikes the superficial palmar branch of the ulnar artery in the Guyon space, leading to occlusion and/or aneurysm of the ulnar artery. In patients with HHS, such injuries of the palmar ulnar artery may lead to severe vascular insufficiency in the hand with occlusion of digital artery. To date, only a few series have analyzed the long-term outcome of patients with HHS. This prompted us to conduct the current retrospective study to 1) evaluate the prevalence of HHS in patients with Raynaud phenomenon and 2) assess the short-term and long-term outcome in patients with HHS. From 1990 to 2006, 4148 consecutive patients were referred to the Department of Internal Medicine at the University of Rouen medical center for evaluation of Raynaud phenomenon using nailfold capillaroscopy. HHS was diagnosed in 47 of these 4148 patients (1.13% of cases).Forty-three patients (91.5%) had occupational exposure to repetitive palmar trauma. The more common occupations were factory worker (21.3%), mason (12.8%), carpenter (10.6%), and metal worker (10.6%); the mean duration of occupational exposure to repetitive palmar trauma at HHS diagnosis was 21 years. One patient (2.1%) had recreational exposure (aikido training) to repetitive trauma of the palmar ulnar artery, and 3 other patients (6.4%) developed HHS related to a single direct injury to the hypothenar area. Clinical manifestations were more often unilateral (87.2%) involving the dominant hand (93%). HHS complications included digital ischemic symptoms (ischemia: n = 21, necrosis: n = 20) and irritation of the sensory branch of the ulnar nerve (n = 11). In HHS patients, angiography demonstrated occlusion of the ulnar artery in the area of the Guyon space (59.6%), aneurysm of the ulnar artery in the area of the Guyon space (40.4%), and embolic multiple occlusions of the digital arteries (57.4%). All patients were advised to change their occupational exposure. They were given vasodilators, including calcium channel blocker (n = 37) and buflomedil (n = 12); 36 patients (76.6%) also received oral platelet aggregation inhibitors. Twenty-one patients with digital ischemia/necrosis were further given hemodilution therapy to reduce the hematocrit level to 35%. In 3 patients with HHS-related digital necrosis who exhibited partial improvement with vasodilators, prostacyclin analog therapy (a 5-day regimen of intravenous prostacyclin analog) was instituted, resulting in complete healing of digital ulcer in these 3 patients. Other conservative treatment options included controlling risk factors (smoking cessation, low-lipid diet, therapy for arterial hypertension) and careful local wound care of fingers in the 20 patients with digital necrosis. Only 2 patients, exhibiting digital necrosis and multiple digital artery occlusions, with nonthrombotic ulnar artery aneurysm underwent reconstructive surgery, that is, resection of the aneurysm with end-to-end anastomosis of the ulnar artery. The median length of follow-up in patients with HHS was 15.9 months. Thirteen patients (27.7%) exhibited clinical recurrences of HHS; the median time of HHS recurrence onset was 11 months. Outcome of HHS relapse was favorable with conservative measures in all cases. Awareness of HHS is required to increase suspicion of the disorder so that further exposure to risk factors like repetitive hypothenar trauma can be avoided for these patients; this is of great importance for their overall prognosis. We found favorable outcomes in most patients after conservative measures were initiated; therefore we suggest that surgery may be undertaken in the subgroup of patients who exhibit partial improvement while receiving conservative therapy. Finally, because we observed recurrence of HHS in 27.7% of patients, we note that HHS patients require close follow-up, including both regular and systematic physical vascular examination.
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Affiliation(s)
- Isabelle Marie
- From Department of Internal Medicine (IM, FH, NC, HL) and Department of Radiology (EP), Rouen University Hospital, Rouen, France
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23
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Abstract
Hypothenar hammer Syndrome (HHS) is a condition characterised by digital ischaemia as a result of repetitive trauma to the hypothenar eminence of the hand. It occurs in people who repeatedly use the palm of the hand as a hammer to push, grind or twist objects. It is a curable and a preventable cause of upper digital ischemia. In this report we present a case of HHS and discuss the causes and pathogenesis of this syndrome. We review the incidence, clinical characteristics, differential diagnosis, investigation and treatment.
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Affiliation(s)
- M Abudakka
- Department of Surgery, Burnley General Hospital, Casterton Avenue BB10 2PQ, East Lancashire Hospitals NHS Trust, UK
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24
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Williams DS. Hypothenar hammer syndrome. J Insur Med 2006; 38:233-5. [PMID: 17076148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Thrombosis of the ulnar artery in the hand is the most common type of upper extremity vascular occlusion. Often caused by constant pounding on the ulnar side of the palm, it is known as hypothenar hammer syndrome.
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Affiliation(s)
- David S Williams
- Ohio National Financial Services, One Financial Way, Cincinnati, OH 45242, USA
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25
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Abstract
Hypothenar hammer syndrome (HHS) is ischemia of the distal ulnar artery caused by injury to the ulnar part of the palmar arch. This disease often involves workers who frequently use the hypothenar part of the hand as a hammer. The aneurysmatic form of HHS represents an indication for operative treatment; the thrombotic form is treated mainly conservatively. In our opinion, the symptomatic thrombotic form represents an indication for operation if symptoms persist during conservative therapy, particularly if symptoms progress. In fresh embolic occlusions, regional thrombolysis is usually successful. We present here the symptomatic treatment and course in two patients with complaints increasing during conservative therapy. The patients reported progressive Raynaud's phenomenon of the fingers. Angiography confirmed corkscrew-like aneurysmatic configuration of the distal ulnar artery and subsequent embolization of digital arteries. In both cases, we removed the source of the embolism with resection of the involved arterial segment and anastomosis with autologous vein grafts.
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Affiliation(s)
- D Klitscher
- Klinik und Poliklinik für Unfallchirurgie der Universitätskliniken Mainz.
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26
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Zyluk A, Walaszek I. [Post-traumatic aneurysm of the ulnar artery--a report of 2 cases]. Chir Narzadow Ruchu Ortop Pol 2005; 70:373-7. [PMID: 16617771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Two cases of post-traumatic aneurysms of the ulnar artery within the hand in patients aged 28 and 45 years are presented. First one developed following blunt trauma of the hypohtenar during use of the screwdriver, other one was caused by puncture, penetrated injury. Both were typically localised at the base of the hypothenar and both were asymptomacic. Presence of the pulsating tumour in the palm was a cause of the medical appointment. Arteriography was performed in both cases that confirmed diagnosis of the aneurysm. Patients were operated on 2 months after initial injury. The aneurysm was resected and ulnar artery was re-anastomosed by vein graft in one case, and by direct suture in the other one. Anticoagulants were administered post-operatively. In both cases the course was uneventful, and phone call one year after operation revealed only some symptoms of cold intolerance in one patient. The likelihood of aneurysm formation as a consequence of blunt and sharp trauma of the hand was suggested as well as the necessity of prompt diagnosis and operative treatment.
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Affiliation(s)
- Andrzej Zyluk
- Klinika Chirurgii Ogólnej i Chirurgii Reki, Pomorska Akademia Medyczna w Szczecinie
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27
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Li LG, Chai JK, Guo ZR, Chen YX, Ouyang ZN, Yang HM, Jia XM, Lu XH, Hu XJ. [Application of digital subtraction angiography and type B ultrasonography in the evaluation of vascular injury in patients with high voltage electrical injury]. Zhonghua Shao Shang Za Zhi 2004; 20:164-7. [PMID: 15308071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To compare the difference between digital subtraction angiography (DSA) and type B ultrasonography in the evaluation of vascular injury in patients inflicted with high voltage electrical injury. METHODS Nineteen patients with high voltage electrical injury of upper limbs were enrolled in the study as burn group, and another 12 healthy volunteers as controls. The endovascular membrane, vascular wall thickness, intra-vascular blood flow and endovascular thrombosis formation of ulnar and radial arteries at wound site and in regions 5, 10 and 15 cm proximal to the wounds were examined by DSA and type B ultrasonography and compared with imagings of healthy volunteers as control. The injury degree of the ulnar and radial arteries was examined during operation for evaluation to corroborate with DSA and ultrasonography findings. Necrotic and/or thrombotic vessels were excised and sent for pathomorphological examination. RESULTS By DSA images abnormal signs as thrombosis, vascular lumen stenosis and blood flow deceleration were found in 14 ulnar and 11 radial arteries, and the signs were more pronounced in ulnar arteries. By type B ultrasonography, abnormal signs as roughing of tunica intima, swelling or exfoliation, thickening of vascular wall, lumen stenosis, decreased blood flow, even necrosis of vascular wall and thrombosis were identified in 19 ulnar and 16 radial arteries in burn group (P < 0.05 approximately 0.01). The blood flow in ulnar artery 5 cm to the approximal part of the wound edge was obvious lower than that of the control (31.60 +/- 13.90 ml/min vs 47.70 +/- 9.60 ml/min, P < 0.05). CONCLUSION Type B ultrasonography and DSA could be helpful in the evaluation of vascular injury in patients inflicted with high voltage electrical injury.
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Affiliation(s)
- Li-Gen Li
- Burn Institute, The 304th Hospital of PLA, Beijing 100037, P. R. China
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28
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Chai JK, Li LG, Chen YX, Hu XJ, Yang YM. [The application of ultrasonography to estimate blood vessel injury of upper limbs sustaining electric burns]. Zhonghua Wai Ke Za Zhi 2003; 41:932-4. [PMID: 14728837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To explore a new method in estimating extent and degree of arterial injury in upper limbs sustaining high tension electric burns. METHODS Eighteen patients (twenty-four upper limbs) with high tension electricity injury were admitted from December 1998 to September 2002, The damaged limbs consisted of four parts: wrist wound part, 5 cm, 10 cm, 15 cm parts around wrist wound, where the radial and ulnar arteries were detected using B ultrasound and color WP Doppler examination. The changes of endangium, vessel diameter, thickness of the vessel wall and volume of blood flow were recorded respectively. The parameters of normal radial and ulnar arteries were also determined as normal control. RESULTS B ultrasound and color WP Doppler examination showed that the endangium in radial and ulnar arteries become coarse, edema or exfoliation. The vessel wall was thicker than that of the normal control and the thickness was heterogeneity. The vessel wall could be necrosis in severe patient and the vessel cavity was stricture or beaded. Thrombosis or occlusion could occur at the site of severe injury area in vessel. The decrease in volume of blood flow was observed. The condition of the radial and ulnar arteries become well apart from 10 - 15 cm of wrist wound. CONCLUSIONS The ultrasonography can be used to detect the changes in endangium, diameter, thickness of the vessel wall, blood flow volume in injury blood vessel caused by electric burn injury. It is helpful in judging the degree and extent of injury vessel and could be a safe, non-invasive diagnostic method and is worth popularizing.
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Affiliation(s)
- Jia-ke Chai
- The 304th Hospital of Chinese People's Liberation Army, Beijing 100037, China.
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29
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Abstract
BACKGROUND Hypothenar hammer syndrome (HHS) is a cause of vascular insufficiency to the hand and may be manifest as Raynaud's phenomenon. The cause is trauma to the vulnerable portion of the ulnar artery as it passes over the hamate bone, which may result in thrombosis, irregularity or aneurysm formation. AIM This review was undertaken in order to clarify the features of HHS that may differentiate it from hand-arm vibration syndrome. METHODS A tiered review of world literature was undertaken using Medline and EMBase as the primary search engines. Fifty-two relevant articles were critically reviewed. CONCLUSION Colour and temperature changes occur more diffusely in HHS than in classical Raynaud's phenomenon and the absence of the triphasic colour change may alert clinicians to the diagnosis, which may be confirmed by Allen's test. Doppler or arteriographic studies are required for confirmation. It is important to recognize the possibility of HHS in the occupational setting as a potentially curable cause of Raynaud's phenomenon, distinct from hand-arm vibration syndrome. The possibility exists of HHS occurring as a result of repeated hypothenar trauma from vibrating tools, in which case the nature and magnitude of the individual episode of trauma may be more important than the weighted acceleration level of vibration exposure.
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Affiliation(s)
- R A Cooke
- Exeter Nuffield Hospital, Wonford Road, Exeter EX2 4UG, UK.
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30
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Abstract
A case demonstrating a false aneurysm in the palmar segment of the ulnar artery caused by a Fogarty's catheter, which had been inserted during a thrombectomy, is described. The diagnosis was suspected based on a clinical examination, and duplex ultrasonography and computed tomography (CT) confirmed an aneurysm in the palmar segment of the ulnar artery. The patient underwent a successful aneurysmectomy with end-to-end reanastomosis.
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Affiliation(s)
- Yahya Unlü
- Department or Cardiovascular Surgery, Atatürk University, Erzurum, Turkey
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31
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Galati G, Cosenza UM, Sammartino F, Benvenuto E, Caporale A. True aneurysm of the ulnar artery in a soccer goalkeeper: a case report and surgical considerations. Am J Sports Med 2003; 31:457-8. [PMID: 12750143 DOI: 10.1177/03635465030310032201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Gaspare Galati
- Department of Surgery "P. Valdoni," University "La Sapienza," Rome, Italy
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32
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Dorweiler B, Neufang A, Schmiedt W, Hessmann MH, Rudig L, Rommens PM, Oelert H. Limb trauma with arterial injury: long-term performance of venous interposition grafts. Thorac Cardiovasc Surg 2003; 51:67-72. [PMID: 12730813 DOI: 10.1055/s-2003-38986] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In contrast to arterial occlusive disease, data on long-term outcomes after vein grafts in limb trauma with arterial injury are sparse. PATIENTS From 1991 through 2001, 22 trauma victims received 23 interposition vein grafts performed by an interdisciplinary team of trauma and vascular surgeons. Indications included both blunt and penetrating injuries with critical limb ischemia in the majority of cases. RESULTS Operative treatment of the injured vessels (brachial n = 5, radial/ulnar n = 7, popliteal n = 6, tibial n = 3, pedal n = 2) encompassed venous interposition graft of either saphenous (n = 15) or cephalic vein (n = 8). All patients survived the operative procedure. 4 graft occlusions were noted and 3 major amputations had to be performed (one despite patent graft). 13 patients (76%) were available for duplex ultrasound examination after a mean follow-up of 59 months where patent grafts could be detected in all cases. CONCLUSION A multidisciplinary approach ensures optimal treatment strategy of arterial injury in extremity trauma. Interposition vein grafts provide durable long-term results and should be attempted even in single-vessel injuries of forearm and lower leg.
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Affiliation(s)
- B Dorweiler
- Department of Trauma Surgery, University Hospital, Mainz, Germany.
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33
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Affiliation(s)
- Lloyd M Taylor
- Division of Vascular Surgery, Oregon Health & Science University, Portland, Oregon, USA
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34
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Ndoye JM, Armstrong O, Dupas B, Sow ML, Le Borgne J. [Anatomoradiological correlation of the hypothenar hammer syndrome]. Dakar Med 2003; 48:233-6. [PMID: 15776638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Hypothenar hammer syndrome is all the clinical ischemic secondary manifestations in a stenose even one occlusion of traumatic origin of the distal portion of the ulnar artery. Our objective was to underline anatomical substratum of this lesion and to emphasize the interest of the angio M.R.I. in the diagnosis of this syndrome. The radioanatomical study of the distal portion of the ulnar artery were on 10 fresh corpses of both sexes free of traumatic hurt of upperlimb. On 6 anatomical details injected with latex colored with red Congo, three were dissected to the fresh state to the anterior faces of the distal third of the forearm, the wrist and the palmar face of the hand. The three others were subjected to transverse anatomical cuts of carp after freezing. An arterial opacification by injection of lead minium with radioscopic control followed by a radiography in face incidence was realised on 12 upperlimb. The 3 modes of this anatomoradiographic analysis objectivized the nearness of the carpal distal segment of ulnar artery and the hook of the hamate bone. On 7 carps the ulnar artery passed in the balance of the hooked bone, in 5 cases it followed the radial hillside and in twice the artery was mediale. Four details were not exploited for quality reasons of injection or radiographic incidence. By the fact that the carpal portion of ulnar artery be situated in the sagittal plan of the hook or that it be medial or lateral it always passed near this osseous anvil. This anatomical arrangement objectivized well in a transversal plan by the angio magnetic resonance imagering predisposes this arterial segment to the parictal hurts of traumatic origin responsible of stenose in the long-term.
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Affiliation(s)
- J M Ndoye
- Laboratoire d'Anatomie et d'Organogenèse. Faculté de Médecine, U.C.A.D. Dakar, Sénégal
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35
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Wali MA. Upper limb vascular trauma in the Asir region of Saudi Arabia. Ann Thorac Cardiovasc Surg 2002; 8:298-301. [PMID: 12472413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
Upper limb vascular trauma is associated with major morbidity and mortality, but little is known about its incidence or nature in the Asir region of southern Saudi Arabia. During the five and a half-year period from May 1996 to December 2001, 27 patients were admitted to Asir Central Hospital (ACH), Abha, Saudi Arabia with upper limb vascular injury. The patients were 21 males and 6 females with a mean age of 27+/-12.6 years. Although penetrating trauma was more frequent than blunt trauma (59%), road traffic accident (RTA) was the most common single mechanism of trauma (33%). The brachial artery was the most frequently affected artery and interposition vein grafting was the most commonly employed type of vascular repair. Fifty-two percent of the patients had associated orthopedic injury and 60% had associated nerve injury. One patient underwent delayed above-elbow amputation and two patients died from other associated injuries. Vascular repair was successful in 24 out of the 26 patients in whom it was attempted (92%). However, the functional outcome of the limbs depended on the presence of associated nerve injury.
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Affiliation(s)
- Mahmoud A Wali
- Department of Surgery, College of Medicine and Medical Sciences, King Khalid University, Abha, Saudi Arabia.
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36
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Abstract
The hypothenar hammer syndrome (HHS) is a rare form of secondary Raynaud's phenomenon in workers who frequently use the ulnar side of the palm as a hammer. Clinically the patient with HHS shows neurologic symptoms such as paresthesia, numbness and pain and signs of vascular insufficiency such as coldness, pallor, discoloration and blanching of the affected ulnar sided fingers. The diagnosis is verified by angiography, showing thrombosis or aneurysm of the distal ulnar artery. We report on the treatment and outcome of 5 patients with HHS. All patients were painfree after treatment. But with the ongoing working habit of using the hand as a hammer there is always the risk of a recurrence. Therefore the job environment has to be changed considerably and the most effort should go into prevention and prophylaxis. If the change of the working habit is not possible, the job is clearly at stake.
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Affiliation(s)
- C Heitmann
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Germany.
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37
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Freiman S, Marom L, Ofer A, Hoffman A, Calif E. Multiple sequential posttraumatic pseudoaneurysms following high-energy injuries: case report and review of the literature. J Orthop Trauma 2002; 16:520-2. [PMID: 12172284 DOI: 10.1097/00005131-200208000-00012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 15-year-old boy sustained severe multisystem injuries from a satchel charge while in his native village in southern Lebanon. After evacuation and resuscitation measures, he had successful intensive multidisciplinary surgical care. His long-bone fractures were stabilized by tubular external fixation systems, and his lacerated right tibialis anterior artery was grafted. Twenty days after injury, he developed a pseudoaneurysm of the left distal ulnar artery, which was surgically resected and the ulnar artery proximally ligated. Two weeks later, a pseudoaneurysm of the left peroneal artery, distal to the knee and coupled with an arteriovenous fistula, was diagnosed. This was treated by fluoroscopic controlled embolization with placement of stents. The patient recovered uneventfully. He was last seen two years after surgery, and no gross vascular compromise of any of his limbs was evident. This appears to be the only reported patient with late-developing multiple posttraumatic pseudoaneurysms after severe blast and shrapnel injuries. This development suggests that late sequelae of blast injuries may be topographically widespread and can evolve months after the injury. As such, these patients should be followed closely with a high degree of suspicion for the appearance of new signs or symptoms.
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Affiliation(s)
- Shay Freiman
- Departments of Orthopaedic Surgery, Diagnostic Radiology, and Vascular Surgery, Rambam Medical Center, Haifa, Israel
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38
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Bacakoglu A, Ozkan MH, Muratli KS, Ekin A. Secondary delayed venous ischemia in flow-through radial forearm free flaps: a novel treatment technique. Plast Reconstr Surg 2002; 110:552-7; discussion 558-9. [PMID: 12142676 DOI: 10.1097/00006534-200208000-00029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Abdulkadir Bacakoglu
- Dokuz Eylul University, School of Medicine, Division of Hand Surgery, Izmir, Turkey.
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39
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Schneider DB, Padilla B, LaBerge JM, Gordon RL, Messina LM, Kerlan RK. SCVIR 2002 film panel case 5: traumatic injury to the circumflex humeral artery. J Vasc Interv Radiol 2002; 13:639-43. [PMID: 12050307 DOI: 10.1016/s1051-0443(07)61661-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Darren B Schneider
- Divisions of Vascular Surgery, University of California, San Francisco, California 94143, USA
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40
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Winterer JT, Ghanem N, Roth M, Schaefer O, Lehnhardt S, Thürl C, Horch RE, Laubenberger J. Diagnosis of the hypothenar hammer syndrome by high-resolution contrast-enhanced MR angiography. Eur Radiol 2002; 12:2457-62. [PMID: 12271385 DOI: 10.1007/s00330-002-1324-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2001] [Revised: 10/01/2001] [Accepted: 10/24/2001] [Indexed: 10/25/2022]
Abstract
Our objective was to describe the imaging features of hypothenar hammer syndrome using minimally invasive contrast-enhanced MR angiography in comparison with oscillography study. In five patients with hypothenar hammer syndrome Gd-BOPTA-enhanced elliptically reordered 3D pulse sequence MR was compared with oscillography findings and clinical symptoms focusing on angiographic appearance of vessel injury, distribution pattern of hand vasculature and joining branches between the radial and ulnar artery supply. All patients showed segmental occlusion at the site of trauma impact with varying involvement of the superficial palmar arch, common volar digital arteries. Embolic disease was present in 50% of patients and could be clearly identified with MRA. Good correspondence was found between angiographic appearance including the presence of collaterals, clinical symptoms and oscillography. Bilateral comparison was helpful in distinguishing between vessel variants and pathology. Bilateral Gd-BOPTA-enhanced MR angiography is a minimally invasive method to depict clearly the localization and extent of vessel injury in hypothenar hammer syndrome providing valuable information about distribution pattern of hand vasculature and presence of collaterals; however, no flow data can be obtained.
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Affiliation(s)
- J T Winterer
- Department of Diagnostic Radiology, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
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41
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Abstract
We are reporting a case of complete ulnar nerve paralysis due to compression from a false aneurysm located in the distal forearm. The aneurysm developed after the patient stabbed himself with a meat hook. The ulnar paralysis developed after a 14-day period of latency. The diagnosis was made using detailed patient history, clinical examination, and a sonogram. Early surgical decompression of the nerve led to complete restitution of all functions.
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Affiliation(s)
- J S Knabl
- Abteilung für Plastische- und Wiederherstellungschirurgie der Universitätsklinik Wien, Germany.
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42
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Lorelli DR, Shepard AD. Hypothenar hammer syndrome: an uncommon and correctable cause of digital ischemia. J Cardiovasc Surg (Torino) 2002; 43:83-5. [PMID: 11803335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Hypothenar hammer syndrome (HHS) is the rare entity of finger ischemia secondary to embolic occlusion of the digital arteries as a result of repetitive trauma to the palmar ulnar artery. We report the case of a young man found to have digital embolic complications from an ulnar artery aneurysm. This is thought to have developed as a result of palmar trauma experienced during military rifle drill exercises.
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Affiliation(s)
- D R Lorelli
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
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Tsapatsaris NP, Jewell ER, Kasparyan NG, Farid M. Images in vascular medicine. Hypothenar hammer syndrome. Vasc Med 2002; 6:121-2. [PMID: 11530964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- N P Tsapatsaris
- Department of Vascular Medicine, Lahey Clinic Medical Center, Burlington, MA 01805, USA
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Brodmann M, Stark G, Aschauer M, Spendel S, Pabst E, Seinost G, Pilger E. Hypothenar hammer syndrome caused by posttraumatic aneurysm of the ulnar artery. Wien Klin Wochenschr 2001; 113:698-700. [PMID: 11603106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The so-called hypothenar hammer syndrome is a rare entity caused by lesions of the ulnar artery secondary to repetitive trauma to the hypothenar eminence, typically found in persons working with vibrating tools. Its clinical symptoms are pain, stiffness and whitening of the smitten fingers, sometimes in combination with Raynaud's syndrome. Angiographic evaluation of the smitten forearm and hand reveals occlusions, kinking, vasospasm and stenoses of the arteries in the hand and fingers. An aneurysm of the ulnar artery causing the hypothenar hammer syndrome is an even more rare morphological finding. The difficult aspect of treating a hypothenar hammer syndrome is to reopen the occluded vessels. Eventually, circulation deteriorates and skin lesions of the fingers may occur. The advantage of an isolated aneurysm of the ulnar artery is that normal circulation can be restored by vascular surgery, for example, with a vessel interponate. Surgical removal of the isolated aneurysm helps to prevent microembolism to the distal arteries and consequent deterioration of peripheral circulation. We report a young patient who presented with clinical symptoms of the hypothenar hammer syndrome and an aneurysm of the distal ulnar artery, diagnosed by magnetic resonance angiography. The only likely cause of the aneurysm was a bicycle accident some months prior to the occurrence of the aneurysm. The patient underwent vascular surgery and has been free of symptoms during six months of follow-up. A control magnetic resonance angiography performed one month after surgery revealed a normal vascular morphology.
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Affiliation(s)
- M Brodmann
- Division of Angiology, Department of Internal Medicine, University Hospital Graz, Austria.
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Velling TE, Brennan FJ, Hall LD, Puckett ML, Reeves TR, Powell CC. Sonographic diagnosis of ulnar artery aneurysm in hypothenar hammer syndrome: report of 2 cases. J Ultrasound Med 2001; 20:921-924. [PMID: 11503929 DOI: 10.7863/jum.2001.20.8.921] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- T E Velling
- Department of Radiology, Naval Medical Center San Diego, California, USA
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Affiliation(s)
- P Loréa
- Department of Orthopaedics, Hôpital Erasme, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium.
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Abstract
It is clear that the late clinical symptomatology and the patency of forearm arterial repairs have been contradictory. This study, during which the relationship between the symptomatology and patency has been studied, explores the influence of the local hemodynamic changes and the effect of microsurgical technique on patency rates. Thirty-five patients with a total of 44 arterial injuries were treated. Hemodynamic studies were done intraoperatively, and all patients were evaluated postoperatively with a neurologic, vascular, clinical examination and by radiodiagnostic methods. An overall patency of 77.2% was found. Color-Doppler ultrasonography (CDU) failed by 14.2% as compared with angiography, which did not fail. High blood pressure on the distal stump led to significantly reduced patency rates. Eight patients without nerve problems were found to be symptomatic as a result of the poor patency rate. Many factors are observed to influence patency rate. The nonpatent forearm artery can be symptomatic in anatomically and hemodynamically varied hands. CDU was more reliable for hemodynamic evaluation; conversely, angiography was more dependable for arterial morphology. The results of this study suggest that to correlate the clinical symptomatology and the patency rates, all arterial repairs should be assessed both clinically and radiodiagnostically.
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Affiliation(s)
- A Bacakoğlu
- Department of Orthopaedics, Division of Hand Surgery, Dokuz Eylül University School of Medicine, Inciralti, Izmir, Turkey.
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Abstract
The unilateral distal arterial lesions still give problems in classification and differential diagnosis specially in younger patients. We report on a 45 years old male patient with an aneurysm of the distal ulnar artery and superficial palmar arch. The chronic occupational trauma of the artery led to the clinical picture of hypothenar hammer syndrome.
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Affiliation(s)
- G A Mürrle
- Abteilung für Gefässchirurgie, Städtisches Klinikum Karlsruhe
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Abstract
Ulnar artery aneurysms distal to the carpal ligament represent an uncommon but uniquely characteristic disease entity. As a result of repetitive palmar trauma, the hypothenar hammer syndrome should be suspected in males with this history and unilateral digital ischemia which spares the thumb. The pathophysiology of this syndrome and its management is reviewed with presentation of an index case.
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Affiliation(s)
- G B Wong
- Division of Plastic and Reconstructive Surgery, University of California, Davis Medical Center, 2221 Stockton Blvd., Sacramento, CA 95817, USA
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Abstract
Single-portal endoscopic carpal tunnel release (Agee technique) was carried out in 148 patients. Of these, 100 were examined clinically and electrophysiologically 1 day before surgery and 1 and 3 months thereafter. Ten patients experienced transient ulnar neuropraxia and two patients complained postoperatively of intense pain in the middle and ring fingers. Three patients suffered residual symptoms. In one of these an incomplete release of the distal portion of the retinaculum flexorum was suspected and later confirmed by magnetic resonance imaging. Another patient had applied for pension due to problems associated with a vertebral fracture in addition to his carpal tunnel symptoms. A third patient with residual symptoms was rheumatic, and upon reexamination 6 months later he was virtually symptom free. Five of the 148 operations were converted to an open procedure due to poor visualization. A review of literature on carpal tunnel release (biportal Chow technique and uniportal Agee technique) uncovered 31 intra- and postoperative complications, including 14 affecting nerve structures, 2 tendon structures, 2 bony structures, and 9 the surrounding tissues. We discuss the most common complications, considering in particular the anatomical characteristics in the carpal tunnel region.
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Affiliation(s)
- L P Müller
- Klinik und Poliklinik für Unfallchirurgie, Johannes Gutenberg Universität-Mainz, Germany.
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