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upper extremity vascular injuries:Etiology,management and outcome

World Journal of Critical Care Medicine 2024年第2期13卷 159-167页

作者： Nikolaos Stefanou Theodoros Mylonas Fragkiskos A Angelis Christina Arnaoutoglou Sokratis E Varitimidis Zoe H Dailiana department of Orthopaedic surgery Faculty of MedicineSchool of Health SciencesUniversity of ThessalyUniversity Hospital of LarissaLarissa 41500Greece department of hand Upper Extremity and MicrosurgeryIASO ThessaliasLarissa 41500Greece

BACKGROUND Vascular injuries of the upper extremities are considered relatively rare injuries affecting mostly the young population.They often are complex injuries accompanied by other musculoskeletal trauma or trauma in other anatomic locations.Their management is challenging since they can lead to disabilities with major socioeconomic effects.AIM To analyze data about the mechanism of injury,the management algorithm and functional outcomes of vascular injuries of the upper extremity.METHODS One hundred and fifteen patients(96 males and 19 females)with arterial injuries of the upper extremity treated in a tertiary trauma center from January 2003 to December 2022 was conducted.Mean patients’age was 33.7 years and the mean follow up time was 7.4 years.Patients with Mangled extremity Severity Score≥7 and Injury Severity Score≥20,previous upper limb surgery or major trauma and any neuromuscular or psychiatric disease were excluded,from the study.RESULTS A penetrating trauma was the most common cause of injury.The radial artery was the artery injured in most of the cases(37.4%)followed by the ulnar(29.5%),the brachial(12.1%)and the axillary(6%).A simultaneous injury of both of the forearm’s arteries was in 15.6%of the cases.In 93%of the cases there were other concomitant musculoskeletal injuries of the extremity.Tendon lacerations were the most common,followed by nerve injuries.The postoperative functional scores(full Disabilities of the Arm,Shoulder,and hand and VAS)had very satisfactory values.CONCLUSION Although vascular injuries of the upper extremity are rare,they may occur in the context of major combined musculoskeletal trauma.Although a multidisciplinary approach is essential to optimize outcome,the ability of trained hand surgeons to repair all injuries in combined vascular and musculoskeletal upper extremity trauma,excluding isolated vascular injuries,ensures shorter operative times and better functional outcomes.

关键词： upper extremity Vascular injuries Complex injuries Musculoskeletal trauma Mangled extremity

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Anatomic location of the first dorsal extensor compartment for surgical De-Quervain’s tenosynovitis release:A cadaveric study

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World Journal of Orthopedics 2024年第4期15卷 379-385页

作者： Aditya Thandoni William Nicholas Yetter Steven Michael Regal department of Orthopaedic surgery Allegheny Health NetworkPittsburghPA 15212United States

BACKGROUND De-Quervain’s tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist.Patients who fail conservative treatment modalities are candidates for surgical release.However,risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection.Currently,there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy.Thus,this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications.AIM To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions.METHODS Six cadaveric forearms,including four left and two right forearm specimens were dissected.Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon.Distance of the first dorsal compartment from landmarks such as Lister’s tubercle,the wrist crease,and the radial styloid were calculated.Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment,additional compartment subsheaths,number of abductor pollicis longus(APL)tendon slips,and the presence of a pseudo-retinaculum.RESULTS Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm±0.80 mm.The distance from Lister’s tubercle to the distal aspect of the extensor retinaculum was 13.37 mm±2.94 mm.Lister’s tubercle to the start of the first dorsal compartment was 18.43 mm±2.01 mm.The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm±0.99 mm.The retinaculum length longitudinally on average was 26.82 mm±3.34 mm.Four cadaveric forearms had separate extensor pollicis brevis compartments.The average number of APL tendon slips was three.A pseudo-retinaculum was present in four cad

关键词： De-Quervain’s tenosynovitis First extensor compartment Cadaveric study Superficial radial nerve Radial styloid Lister’s tubercle

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Update in combined musculoskeletal and vascular injuries of the extremities

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World Journal of Orthopedics 2022年第5期13卷 411-426页

作者： Nikolaos Stefanou Christina Arnaoutoglou Fotios Papageorgiou Miltiadis Matsagkas Sokratis E Varitimidis Zoe H Dailiana department of Orthopaedic surgery Faculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissa 41500Greece department of Vascular surgery Faculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissa 41500Greece department of hand Upper Extremity and MicrosurgeryIASO ThessaliasLarissa 41500Greece

Combined musculoskeletal and vascular injuries of the extremities are conditions in which a multidisciplinary approach is a sine qua non to ensure life initially and limb viability secondarily.Vascular injuries as part of musculoskeletal trauma are usually the result of the release of a high energy load in the wound site so that the prognosis is determined by the degree of soft-tissue damage,duration of limb ischemia,patient’s medical status and presence of associated injuries.The management of these injuries is challenging and requires a specific algorithm of action,because they are usually characterized by increased morbidity,amputation rate,infection,neurological and functional deficits,and they could be life threatening.Although vascular injuries are rare and occur either isolated or in the context of major combined musculoskeletal trauma,the high index of suspicion,imaging control,and timely referral of the patient to organized trauma centers ensure the best functional outcome of the extremity in such challenging cases.Even after a successful initial treatment of a combined trauma pattern,long-term follow-up is crucial to prevent and detect early possible complications.The purpose of this manuscript is to provide an update on diagnosis and treatment of combined musculoskeletal and vascular injuries of the extremities,from an orthopedic point of view.

关键词： Vascular injury Musculoskeletal trauma Combined injury Arterial injury Mangled extremity Limb salvage

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Superficial femoral artery pseudoaneurysm at implantation site of drug eluting stent discovered due to bacteremia:A case report

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World Journal of Clinical Cases 2024年第17期12卷 3194-3199页

作者： Takafumi Akai Shintarou Ninomiya Takanori Kaneko department of Vascular surgery Asahi General HospitalChibaAsahi 289-2511Japan

BACKGROUND Drug-eluting stents(DES)are used to treat lower extremity arterial disease.During DES treatment,aneurysmal degeneration occasionally occurs,especially with fluoropolymer-based DES.However,the incidence of pseudoaneurysms after DES placement is rarely reported in the lower extremity region,although there have been several reports on pseudoaneurysm formation after DES placement in the coronary artery region.CASE SUMMARY We report the case of a 64-year-old man who presented with fever and pain in his left hand after dialysis.Bacteremia was diagnosed by blood culture,and after admission,he developed pain on the medial side of the right thigh.A pseudoaneurysm was observed in the right superficial femoral artery(SFA)at the proximal end of a previously placed DES.The bacteremia was thought to have been caused by a pseudoaneurysm of the left superficial brachial artery,and the pseudoaneurysm of the left superficial brachial artery was removed after antibiotic treatment.The pseudoaneurysm of the right SFA rapidly expanded after admission,but the expansion rate was reduced after infection control.Seven months after the first admission,the pseudoaneurysm of the left SFA was re-moved and in situ revascularization performed using a rifampicin-soaked Dacron graft.CONCLUSION Although pseudoaneurysm after DES placement in the lower extremity region is rare,it must be considered in patients with bacteremia.

关键词： Pseudoaneurysm Drug eluting stent Superficial femoral artery Bacteremia Revascularization Case report

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Restoring After Central Nervous System Injuries:Neural Mechanisms and Translational Applications of Motor Recovery

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Neuroscience Bulletin 2022年第12期38卷 1569-1587页

作者： Zhengrun Gao Zhen Pang Yiming Chen Gaowei Lei Shuai Zhu Guotao Li Yundong Shen Wendong Xu department of hand surgery Huashan HospitalFudan UniversityShanghai 200040China The National Clinical Research Center for Aging and Medicine Fudan UniversityShanghai 200040China department of hand and upper extremity surgery Jing’an District Central HospitalFudan UniversityShanghai 200040China Institutes of Brain Science Fudan UniversityShanghai 200040China State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science Fudan UniversityShanghai 200040China Institute of Automation State Key Laboratory of Management and Control for Complex SystemsChinese Academy of SciencesBeijing 100190China Co-innovation Center of Neuroregeneration Nantong UniversityNantong 226000China Research Unit of Synergistic Reconstruction of upper and Lower Limbs after Brain Injury Chinese Academy of Medical SciencesShanghai 200400China

Central nervous system(CNS)injuries,including stroke,traumatic brain injury,and spinal cord injury,are leading causes of long-term disability.It is estimated that more than half of the survivors of severe unilateral injury are unable to use the denervated limb.Previous studies have focused on neuroprotective interventions in the affected hemisphere to limit brain lesions and neurorepair measures to promote recovery.However,the ability to increase plasticity in the injured brain is restricted and difficult to improve.Therefore,over several decades,researchers have been prompted to enhance the compensation by the unaffected hemisphere.Animal experiments have revealed that regrowth of ipsilateral descending fibers from the unaffected hemisphere to denervated motor neurons plays a significant role in the restoration of motor function.In addition,several clinical treatments have been designed to restore ipsilateral motor control,including brain stimulation,nerve transfer surgery,and brain–computer interface systems.Here,we comprehensively review the neural mechanisms as well as translational applications of ipsilateral motor control upon rehabilitation after CNS injuries.

关键词： Stroke Traumatic brain injury Spinal cord injury Brain-computer interface system Neuroplasticity Ipsilateral motor control Axon regrowth

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Elbow Dislocation in Children: About Two Cases and Review of the Literature

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Open Journal of Pediatrics 2024年第2期14卷 218-226页

作者： Nyanit Bob Dorcas Atangana Cédric Paterson Mantho Fopa Pauline Kouna TsalaIrène Nadine Mvouni Bob Thérèse Raissa Bekima King Francis Ateaze Chrisantus Dikongue Diwondi Audrey Ndongo Réné Akoa Manga Ismael Evoni Molo Tatiana Choupo Guetchuin Stéphane handy Eone Daniel department of surgery and Specialties Faculty of Medecine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon Infant surgery department of Yaounde Central Hospital Yaoundé Cameroon Faculty of Medecine and Pharmaceutical Sciences of Douala Douala Cameroon Troyes Hospital Center Troyes France Vire Normandie Hospital Center Normandie France Traumatology department of Yaounde Central Hospital Yaoundé Cameroon

Background: Elbow dislocations in pediatric patients are rare injuries. This is a therapeutic emergency because a delay in treatment can have disastrous consequences on the functional level of the upper limb. Objective: To present the management of elbow dislocation in children in cases of limited resources. Presentation of the Cases: These were 2 older male children aged 7 and 9 years old, admitted to the emergency room for painful functional impotence of the right elbow after a fall and landing on the right hand. Clinical and radiological examinations were in favor of posterior elbow dislocations. The reductions were carried out under sedation and immobilization in Jersey. According to Robert’s criteria, the functional result was excellent in both patients. Conclusion: Emergency reduction and immobilization whatever the means ensure an excellent functional prognosis even in cases of limited resources.

关键词： Elbow Dislocation Child Diagnosis Treatment Limited Resources

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Postoperative deep shoulder infections following rotator cuff repair

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World Journal of Orthopedics 2017年第8期8卷 612-618页

作者： Kivanc Atesok Peter MacDonald Jeff Leiter Sheila McRae Greg Stranges Jason Old department of Orthopaedic surgery University of Alabama at Birmingham Sports Medicine and upper extremity Reconstruction Fellowship Program Pan Am Clinic Department of Surgery Section of Orthopaedic Surgery University of Manitoba

Rotator cuff repair(RCR) is one of the most commonly performed surgical procedures in orthopaedic surgery. The reported incidence of deep soft-tissue infections after RCR ranges between 0.3% and 1.9%. Deep shoulder infection after RCR appears uncommon, but the actual incidence may be higher as many cases may go unreported. Clinical presentation may include increasing shoulder pain and stiffness, high temperature, local erythema, swelling, warmth, and fibrinous exudate. Generalized fatigue and signs of sepsis may be present in severe cases. Varying clinical presentation coupled with a low index of suspicion may result in delayed diagnosis. Laboratory findings include high erythrocyte sedimentation rate and C-reactive protein level, and, rarely, abnormal peripheral blood leucocyte count. Aspiration of glenohumeral joint synovial fluid with analysis of cell count, gram staining and culture should be performed in all patients suspected with deep shoulder infection after RCR. The most commonly isolated pathogens are Propionibacterium acnes, Staphylococcus epidermidis, and Staphylococcus aureus. Management of a deep soft-tissue infection of the shoulder after RCR involves surgical debridement with lavage and long-term intravenous antibiotic treatment based on the pathogen identified. Although deep shoulder infection after RCR is usually successfully treated, complications of this condition can be devastating. Prolonged course of intravenous antibiotic treatment, extensive soft-tissue destruction and adhesions may result in substantially diminished functional outcomes.

关键词： Rotator cuff repair Deep shoulder infection Shoulder surgery Postoperative complication

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手外科进入“手-脑新纪元”:改变手,重塑脑

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Science Bulletin 2022年第19期67卷 1932-1934页

作者：冯俊涛顾玉东徐文东 hand surgery department The National Clinical Research Center for Aging and MedicineHuashan HospitalFudan UniversityShanghai 200040China department of hand and upper extremity surgery Center for the Reconstruction of Limb FunctionJing’an District Central HospitalFudan UniversityShanghai 200040China Institutes of Brain Science State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center of Brain ScienceFudan UniversityShanghai 200032China Research Unit of Synergistic Reconstruction of upper and Lower Limbs after Brain Injury Chinese Academy of Medical SciencesBeijing 100730China

Amputated hand,and paralyzed hand,are diseases not on the conventional list of the hand surgery world,but now have gradually become the new direction for hand surgeons.A good example is the advancements in treating amputations after traumatic injury of the upper limb.Targeted muscle reinnervation combined with a highly functional bionic arm can greatly compensate for the missing part of the amputated arm[1],which in general satisfies the need for strength and dexterity in daily life.According to the classic cortical homunculus first drawn by Penfield,the hand area occupied nearly-one-third of the sensorimotor cortex[2].Thus,interventions with the hands enable the modulation of brain function,providing a solution for brain disorders through skillful utilization of brain plasticity.With the recent advancements in neuroscience and biomedical engineering technology,hand surgeons find themselves entering an era with a bigger performance stage than ever before.For paralyzed hand,the most common cause is central neurological diseases such as stroke or cerebral palsy,or paraplegia.Although it is more challenging since surgeons should balance spasticity and motor function at the same time,efforts have been made by hand surgeons around the world,such as hyper selective neurectomy,tendon lengthening or transfer to reduce the spasticity and reconstruct the motor function[3].Considering the fact that the number of patients with paralyzed hands is over 10 million,which far exceeds the traditional nerve injury entity,this area is the potential further direction of hand surgery.In this article,we will discuss the opportunities and pitfalls in the combination of hand surgery techniques and brain-computer-interface(BCI)in treating paralyzed hands from the perspective of hand surgery development.

关键词：手外科 advancement hands

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upper extremity motor function before and after the cerebrospinal fluid tap test in patients with idiopathic normal pressure hydrocephalus: A retrospective study

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中华医学杂志(英文版) 2024年第7期137卷 877-879页

作者： Liu Caiyan Wei Junji Dong Liling Mao Chenhui Li Jie Huang Xinying Hou Bo Feng Feng Cui Liying Gao Jing department of Neurology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing 100730 China department of Neurosurgery department of Neurosurgery and Radiology

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Medico-legal risks associated to hand and wrist trauma

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World Journal of Critical Care Medicine 2022年第1期11卷 40-47页

作者： Dionysia Vasdeki Sokratis E Varitimidis Charalambos Chryssanthakis Nikolaos Stefanou Zoe H Dailiana department of Orthopaedic surgery Faculty of MedicineUniversity of ThessalyLarissa 41500Greece department of Orthopaedics University of ThessaliaLarissa 41110Greece department of Administrative Science and Public Administration National and Kapodistrian University of AthensAthens 10678Greece department of hand Upper Extremity and MicrosurgeryIaso ThessaliasNikaiaLarissa 41500Greece

BACKGROUND Acute hand and wrist injuries are common and may lead to long-term disability if not managed adequately.Claims for negligence have been increasing in medical practice over the past few decades,with hand and wrist injuries and their treatment representing a significant percentage of orthopedic surgery lawsuits.There is no available literature regarding medical malpractice claims in hand and wrist injuries and surgery in Greece.AIM To identify claims related to hand and wrist trauma and surgery and to define the reasons of successful litigations.METHODS We performed a retrospective study of all legal claims of negligence for hand and upper extremity surgery that went to a trial,attributed to all surgical specialties,in Greece for a 20-year period.Data was further analyzed to identify claims related to hand and wrist trauma and surgery.RESULTS There were six malpractice claims related to hand and wrist trauma that ended in a trial.A missed diagnosis,which resulted in failure of initial management of the injury,was the main reason for a claim.Three of the six cases resulted in complete or partial loss of a finger.Two cases are still open,requiring an expert witness’s report,two cases were closed in favor of the defendant,and two cases were closed in favor of the plaintiff with a mean compensation of€2000(€1000-€3000).CONCLUSION Missed diagnosis was the main reason for a malpractice claim.Better understanding of factors leading to successful claims will help surgeons improve their practice to minimize legal implications and litigation.

关键词： hand trauma Wrist trauma Litigation Claim Negligence

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