Management of severe musculoskeletal injuries of the upper extremity.

Abstract:

:Limb salvage was successful in 25 patients treated for severe grade III upper extremity injuries. In a retrospective review of 20 men and five women, follow-up time averaged 26 months. These high-energy injuries were characterized by massive soft-tissue injury, highly comminuted fractures, and significant neurovascular injury. Farm, industrial, and vehicular accidents accounted for 80% of the cases. Over 50% of the patients had concomitant systemic and/or other significant extremity injuries. Initial treatment consisted of irrigation and debridement and fracture stabilization using external and/or internal fixation. An average of four additional surgical procedures was required to provide soft-tissue coverage and maximum possible functional recovery. Forty-eight percent of the extremities underwent free vascularized or pedicular flaps for coverage or reconstruction. At final follow-up observation, 12% of the extremities rated excellent, 20% rated good, 52% fair, and 16% were poor. Experience gained in managing these severe upper extremity fractures supports the following observations. (a) Grade III open fractures of the upper extremities are frequently associated with significant neural, vascular, and musculotendon injuries. (b) External fixation plays an important role in the stabilization of grossly contaminated fractures. (c) Residual functional disability is common, and most patients do not return to their previous occupation. (d) Staged reconstruction directed toward maximum functional return may take several years.

journal_name

J Orthop Trauma

authors

Levin LS,Goldner RD,Urbaniak JR,Nunley JA,Hardaker WT Jr

subject

Has Abstract

pub_date

1990-01-01 00:00:00

pages

432-40

issue

4

eissn

0890-5339

issn

1531-2291

journal_volume

4

pub_type

杂志文章
  • Split fractures of the lateral tibial plateau: evaluation of three fixation methods.

    abstract::A laboratory study was performed to compare the stability and ultimate strength of three standard fixation techniques for split-type lateral tibial plateau fractures. The three methods of fixation were (a) three 6.5-mm cancellous lag screws with washers; (b) two 6.5-mm cancellous lag screws with washers and an additio...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-199607000-00003

    authors: Koval KJ,Polatsch D,Kummer FJ,Cheng D,Zuckerman JD

    更新日期:1996-01-01 00:00:00

  • Anteroinferior 2.7-mm versus 3.5-mm plating for AO/OTA type B clavicle fractures: a comparative cohort clinical outcomes study.

    abstract:OBJECTIVES:To compare the Disability of the Arm, Shoulder, and Hand (DASH) and Constant scores, time to union, rate of union, patient cosmetic satisfaction rate, and the need for secondary procedures between 2.7- and 3.5-mm anteroinferior plating for Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma A...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e3182693f32

    authors: Galdi B,Yoon RS,Choung EW,Reilly MC,Sirkin M,Smith WR,Liporace FA

    更新日期:2013-03-01 00:00:00

  • Multiplanar Fixation for Patella Fractures Using a Low-Profile Mesh Plate.

    abstract::Patella fractures are challenging orthopaedic injuries. Many commonly used fixation techniques can be ineffective and lead to poor clinical outcomes even with satisfactory reductions and fracture healing. In this investigation, we present the technique of cage plate fixation of patella fractures and the clinical outco...

    journal_title:Journal of orthopaedic trauma

    pub_type: 临床试验,杂志文章

    doi:10.1097/BOT.0000000000000415

    authors: Lorich DG,Warner SJ,Schottel PC,Shaffer AD,Lazaro LE,Helfet DL

    更新日期:2015-12-01 00:00:00

  • Smoking Is Associated With Longer Intensive Care Unit Stays in Spine Trauma Patients.

    abstract:OBJECTIVE:To determine the impact of smoking on intensive care unit (ICU) outcomes in patients who underwent operative fixation for spine trauma. DESIGN:Retrospective cohort study. SETTING:Single academic level I trauma center. PATIENTS:One hundred eighty-one consecutive surgical spine trauma patients from January 2...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001739

    authors: Du JY,Weinberg DS,Moore TA,Vallier HA

    更新日期:2020-07-01 00:00:00

  • Mechanical effects of off-axis insertion of locking screws: should we do it?

    abstract:OBJECTIVES:The purposes of this study were to evaluate the cantilevered bending strength and failure modes of locking screws inserted at various angles in a plate with fully circumferential threaded holes. As an additional measure, the amount of screw head prominence at these angles was also assessed. METHODS:Standard...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000000066

    authors: Cartner JL,Petteys T,Tornetta P 3rd

    更新日期:2014-01-01 00:00:00

  • Does the Angle of the Nail Matter for Pertrochanteric Fracture Reduction? Matching Nail Angle and Native Neck-Shaft Angle.

    abstract:OBJECTIVES:To determine whether fixation of pertrochanteric hip fractures with cephalomedullary nails (CMNs) with a neck-shaft angle (NSA) less than the native NSA affects reduction and lag screw cutout. DESIGN:Retrospective comparative study. SETTING:Level I trauma center. PATIENTS/PARTICIPANTS:Patients treated wit...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001096

    authors: Parry JA,Barrett I,Schoch B,Yuan B,Cass J,Cross W

    更新日期:2018-04-01 00:00:00

  • Building Networks for Global Clinical Research: The Basics.

    abstract::Over the last several decades, interest in global health across all fields of medicine, including orthopaedic surgery, has grown markedly. Cross-national collaborations are an effective means of conducting high-quality clinical research and offer many advantages over single-center investigations. Successful collaborat...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000000466

    authors: Shearer DW,Volberding PA,Schemitsch EH,Cook GE,Slobogean GP,Morshed S

    更新日期:2015-12-01 00:00:00

  • Internal fixation of the unstable cervical spine using posterior Roy-Camille plates: preliminary report.

    abstract::We reviewed 13 cases of unstable cervical spine treated by stabilization with posterior Roy-Camille plates and fusion. The patients were treated between 1985-1988. Six patients had acute traumatic episodes, three patients had posttraumatic instabilities, one patient had laminectomy for cervical spondylotic myelopathy,...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-198903010-00005

    authors: Ebraheim NA,An HS,Jackson WT,Brown JA

    更新日期:1989-01-01 00:00:00

  • Outcomes of Surgical Treatment of Periprosthetic Acetabular Fractures.

    abstract::Periprosthetic acetabular fractures sustained following acute trauma after total hip arthroplasty are rare and historically have poor outcomes. This article reviews 5 cases and the treatment algorithm used by a single orthopaedic surgeon specializing in acetabular fracture care with a co-surgeon specializing in arthro...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001400

    authors: Hickerson LE,Zbeda RM,Gadinsky NE,Wellman DS,Helfet DL

    更新日期:2019-02-01 00:00:00

  • Arthroplasty Versus Internal Fixation for the Treatment of Undisplaced Femoral Neck Fractures: A Retrospective Cohort Study.

    abstract:OBJECTIVE:To compare the 24-month risk of mortality between arthroplasty and internal fixation for undisplaced femoral neck fractures (FNFs). DESIGN:Retrospective cohort study. SETTING:Secondary data analysis of 2 multinational randomized controlled trials. PARTICIPANTS:Patients aged 50 years or older with a FNF. I...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001940

    authors: Afaq S,OʼHara NN,Schemitsch EH,Bzovsky S,Sprague S,Poolman RW,Frihagen F,Heels-Ansdell D,Bhandari M,Swiontkowski M,Slobogean GP,FAITH Investigators.,HEALTH Investigators.

    更新日期:2020-11-01 00:00:00

  • Biomechanical evaluation of two-part surgical neck fractures of the humerus fixed by an angular stable locked intramedullary nail.

    abstract:OBJECTIVE:The aim of the current study was to see how different interlocking mechanisms would affect construct stability and overall failure in the treatment of two-part surgical neck fractures in the proximal humerus in vitro. METHODS:Left and right bones of eight pairs of fresh-frozen human cadaveric humeri were ass...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e3181ffdf9a

    authors: Horn J,Gueorguiev B,Brianza S,Steen H,Schwieger K

    更新日期:2011-07-01 00:00:00

  • Prognostic reliability of the Hawkins sign in fractures of the talus.

    abstract:OBJECTIVE:To determine the prognostic reliability, sensitivity, and specificity of the Hawkins sign. The Hawkins sign is a subchondral radiolucent band in the talar dome that is indicative of viability at 6 to 8 weeks after a talus fracture. It is visible in the anterior-posterior view, but seldom appears on lateral ra...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e318148c665

    authors: Tezval M,Dumont C,Stürmer KM

    更新日期:2007-09-01 00:00:00

  • Radial Head Replacement Through a Kocher Approach.

    abstract:PURPOSE:Radial head fractures are some of the most common elbow fractures. Fractures with 3 or more fracture fragments have been shown to have worse outcomes when treated with open reduction and internal fixation (ORIF). Radial head replacement offers an alternative treatment for those more comminuted radial head fract...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001537

    authors: Petersen KA,Siesel C,Miller ET

    更新日期:2019-08-01 00:00:00

  • Intraoperative CT and Surgical Navigation for Iliosacral Screws: Technique for Patients With Sacral Dysmorphism.

    abstract::Percutaneous iliosacral screw (IS) fixation for pelvic ring injuries with the use of an O-arm imaging system has been associated with decreased procedure time and improved accuracy of IS screw placement compared with the use of fluoroscopic guidance. Specifically, patients with sacral dysmorphism require identificatio...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001213

    authors: Khan JM,Lara DL,Marquez-Lara A,Rosas S,Hasty E,Pilson HT

    更新日期:2018-08-01 00:00:00

  • Hexapod Stacked Transport for Tibial Infected Nonunions With Bone Loss: Long-Term Functional Outcomes.

    abstract:OBJECTIVES:To analyze long-term functional outcomes in patients with posttraumatic infected tibial nonunions having undergone bone transport with hexapod external fixator. DESIGN:Retrospective cohort study. SETTING:Level 1 trauma center. PATIENTS/PARTICIPANTS:Thirty-eight patients with infected nonunions of the tibi...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001005

    authors: Napora JK,Weinberg DS,Eagle BA,Kaufman BR,Sontich JK

    更新日期:2018-01-01 00:00:00

  • Intraoperative fluoroscopic evaluation of screw placement during pelvic and acetabular surgery.

    abstract::The surgical treatment of pelvic and acetabular fractures can be technically challenging. Various techniques are available for the reconstruction of pelvic and acetabular fractures. Less invasive percutaneous fracture stabilization techniques, with closed reduction or limited open reduction, have been developed and ar...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章,评审

    doi:10.1097/BOT.0b013e318288c0c3

    authors: Yi C,Burns S,Hak DJ

    更新日期:2014-01-01 00:00:00

  • Intramedullary nail fracture compression techniques: when and how to do it?

    abstract::Fracture compression can be achieved in many ways intraoperatively using either screws in compression plates, compression devices, or using intramedullary nails. The use of locked intramedullary nails combines the advantages of indirect fracture fixation and compression with minimal soft tissue disruption. This articl...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章,评审

    doi:10.1097/BOT.0b013e31819f2779

    authors: Tejwani NC

    更新日期:2009-05-01 00:00:00

  • Acute Femoral Nailing and Ipsilateral Knee Spanning External Fixation: Improved Early Stability for Floating Knee Injuries Involving the Tibial Plateau.

    abstract::Ipsilateral femoral shaft and tibial plateau fractures, termed a "floating knee" are rare and challenging injuries. There is limited literature guiding the operative technique and the outcomes associated with these injuries. The author's preferred technique is early intramedullary of the femoral shaft fracture with kn...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001944

    authors: Brown JT,Bergin PF,Prather JW,DiPaolo D,Spitler CA

    更新日期:2020-09-01 00:00:00

  • Importance of Mechanoreceptors and Other Neural Structures Within the Anterior Intermeniscal Ligament in the Etiology of Anterior Knee Pain After Tibial Nailing.

    abstract:BACKGROUND:Anterior knee pain is the most common complication after intramedullary tibial nailing. The cause is often multifactorial and varies among individuals. Violation of the anterior intermeniscal ligament (AIL) during intramedullary tibial nailing might be a possible source of postsurgical anterior knee pain. Al...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001258

    authors: Franke J,Brobeil A,Lips KS,Gattenloehner S,Franke AP,Hohendorff B,Alt V,Schnettler R

    更新日期:2018-10-01 00:00:00

  • Functional and radiographic results of patients with syndesmotic screw fixation: implications for screw removal.

    abstract:OBJECTIVE:Screw fixation of the injured syndesmosis restores stability but may reduce motion. The purpose of this study is to determine whether functional outcomes and radiographic results after ankle fracture are affected by the status of the syndesmosis screw. DESIGN:Retrospective review of a consecutive clinical se...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e3181a9f7a5

    authors: Manjoo A,Sanders DW,Tieszer C,MacLeod MD

    更新日期:2010-01-01 00:00:00

  • The use of antibiotic-impregnated polymethylmethacrylate beads to prevent the evolution of localized infection.

    abstract::The effect of antibiotic bead chains on the evolution of infection cannot be studied entirely in man due to the ethical problems of obtaining valid controls. Therefore, a model of musculoskeletal injury was devised in rabbits by making a paraspinal wound, fracturing a spinous process, and contaminating the wound with ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-199212000-00001

    authors: Seligson D,Mehta S,Voos K,Henry SL,Johnson JR

    更新日期:1992-01-01 00:00:00

  • The biomechanical effect of high-pressure irrigation on diaphyseal fracture healing in vivo.

    abstract:OBJECTIVES:To evaluate the effect of both high-pressure pulsatile lavage and bulb syringe irrigation on the biomechanical parameters of fracture healing using an in vivo open noncontaminated diaphyseal femoral fracture model in rats. BACKGROUND:The utility of high-pressure pulsatile lavage irrigation on soft tissue de...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-200207000-00008

    authors: Adili A,Bhandari M,Schemitsch EH

    更新日期:2002-07-01 00:00:00

  • A new ankle spanning fixator construct for distal tibia fractures: optimizing visualization, minimizing pin problems, and protecting the heel.

    abstract::Pilon and ankle fractures and ligamentous injuries about the ankle often require external fixation to allow for soft tissue stabilization before definitive surgery. Often used external fixator constructs can cause obscuring of the site of injury on radiographs, pin tract infections, loosening of calcaenal pin fixation...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e3182604639

    authors: Ziran BH,Morrison T,Little J,Hileman B

    更新日期:2013-02-01 00:00:00

  • Biomechanical effects of internal fixation of the distal tibiofibular syndesmotic joint: comparison of two fixation techniques.

    abstract::This biomechanical study compares two methods of internal fixation of the tibiofibular syndesmosis used in Weber type C malleolar fractures of the ankle. The transverse syndesmotic 3.5-mm screw was compared with two 1.5-mm Kirschner wires introduced obliquely across the distal tibiofibular syndesmosis. The influence o...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-199406000-00006

    authors: Peter RE,Harrington RM,Henley MB,Tencer AF

    更新日期:1994-01-01 00:00:00

  • Unstable proximal extraarticular tibia fractures: a biomechanical evaluation of four methods of fixation.

    abstract:OBJECTIVE:To compare the biomechanical stability of extraarticular proximal tibia fractures reconstructed using a double-plate construct, locking plate system, hybrid external fixator, and single lateral periarticular plate, all from the same manufacturer. DESIGN:Standardized proximal tibial fractures (AO classificati...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-200409000-00010

    authors: Peindl RD,Zura RD,Vincent A,Coley ER,Bosse MJ,Sims SH

    更新日期:2004-09-01 00:00:00

  • Intramedullary allograft fibula as a reduction and fixation tool for treatment of complex proximal humerus fractures with diaphyseal extension.

    abstract:SUMMARY:In this study, we present a novel technique for reduction and fixation of complex, unstable proximal humerus fractures with diaphyseal extension with the assistance of fibula allograft. We treated 14 patients using this technique since 2009 and found that it improves the reduction and enhances fixation while ma...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e31829a346d

    authors: Berkes MB,Little MT,Lazaro LE,Cymerman RM,Pardee NC,Helfet DL,Dines JS,Lorich DG

    更新日期:2014-03-01 00:00:00

  • The upper sacral nerve root tunnel: an anatomic and clinical study.

    abstract:OBJECTIVES:To radiographically demonstrate the upper sacral nerve root tunnel (USNRT) in both cadaveric specimens and a clinical cohort and to quantify its clinical relevance. SETTING:Level 1 trauma center and anatomy laboratory. PATIENTS AND PARTICIPANTS:Eleven cadaveric pelves and 23 consecutive patients who underw...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e3181a2e419

    authors: Farrell ED,Gardner MJ,Krieg JC,Chip Routt ML Jr

    更新日期:2009-05-01 00:00:00

  • Deep venous thrombosis complicating rupture of the medial head of the gastrocnemius muscle.

    abstract::Rupture of the medial head of the gastrocnemius muscle ("tennis leg") is an affliction generally associated with athletic activity. The diagnosis is made by careful history and physical examination. Although its findings are characteristic, previous reports have documented misdiagnosis of this lesion as thrombophlebit...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-199406000-00016

    authors: Slawski DP

    更新日期:1994-01-01 00:00:00

  • The treatment of intertrochanteric fractures: results using an intramedullary nail with integrated cephalocervical screws and linear compression.

    abstract:OBJECTIVE:A new device for the treatment of intertrochanteric fractures that uses 2 cephalocervical screws in an integrated mechanism allowing linear intraoperative compression and rotational stability of the head/neck fragment has been developed. The aim of this study was to describe the results using this device for ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 临床试验,杂志文章

    doi:10.1097/BOT.0b013e31819211b2

    authors: Ruecker AH,Rupprecht M,Gruber M,Gebauer M,Barvencik F,Briem D,Rueger JM

    更新日期:2009-01-01 00:00:00

  • Does Value Matter in Orthopaedic Trauma?: A Survey of Orthopaedic Trauma Association Members.

    abstract:OBJECTIVES:With value-based payment models on the horizon, this study was designed to examine the perceptions of value-based care among orthopaedic traumatologists and how they influence their practice. DESIGN:Systems-based survey study. SETTING:Orthopaedic Trauma Association (OTA) research surveys. PARTICIPANTS:OTA...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001622

    authors: Gorman TL,S Albersheim M,Parikh HR,Flagstad IR,Okelana AB,Vang S,Johal H,Cunningham BP

    更新日期:2019-11-01 00:00:00