Case presentation: A 10-year-old boy presented to the emergency department (ED) 1 day after sustaining a closed right forearm fracture due to a fall. Examination at our ED revealed intact vascularity and nerve function. Reduction and casting were performed. On follow-up 7 days later, signs of ulnar nerve palsy in the form of decreased sensation in the little ﬁ nger and weak abduction and adduction of the ﬁ ngers were present. The patient was admitted and underwent closed reduction with percutaneous elastic stable intramedullary nailing. We found 14 case reports in the literature with similar case presentations. These fractures are commonly managed conservatively by closed reduction, casting, and rehabilitation. However, in both-bone forearm fractures, management began with observation, with surgical exploration being reserved for non-improving patients.
Forearm fractures are the most common fractures in children (23% of all fractures). In 2003 23,495 inpatient treatments in Germany were caused by a forearm fracture in children or adolescents. Prognosis and treatment deci- sion depend on the doctors estimation of fracture insta- bility. In general stable fractures can be managed by closed reduction and cast immobilisation (conservative therapy) with good prognosis for healing without compli- cations. Instable forearm fractures are either completely displaced or show substantial tendency to shortening in cause of long transverse fractures. Aim of any fracture therapy is to stabilise these fractures to secure bone continuation and original length of the bone. In the past treatment option of first choice for instable forearm fractures has been conservative therapy. Main disadvan- tage of this therapy is the raised risk that the fracture ends could redislocate and a second or third reduction of the fracture will become necessary. After the develop- ment by Firica  and Metaizeau  ESIN became in- creasingly important as a therapy option for the treatment of forearm shaft fractures in children. It is expected that ESIN will provide a better position of the axis, better functional results, a decreased number of attempts of re-reduction and thus a reduced number of x-ray exami- nations. ESIN is an operational intervention performed under anaesthesia in the operating room.
with the HB, augmented by oral oxycodone, provided effective analgesia, including those with completely dis- placed and overriding fractures. This may be because displaced fractures likely have large hematomas, which may enable a more effective HB in comparison with greenstick fractures with little or no hematoma. Most of the patients in this study had distal forearm fractures with epiphyseal, physeal, or metaphyseal involvement. Because of the small number of subjects, we did not compare effectiveness of the HB between these sites or diaphyseal sites or between displaced and nondisplaced fractures.
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Background: Trampoline use is one of the most common causes of recrea- tional injury in children. In recent years, trampoline parks have grown in popularity and may be altering the spectrum of the trampoline-related inju- ries that occur. These parks create increased opportunity for injuries that ap- pear uniquely different from accident patterns seen with home trampoline use. Recent work has suggested this may result in injuries occurring in greater frequency and with increased severity that may result in a greater need of hospital admission and procedural management by subspecialty services. Case Series Presentation: This case series presents three such examples oc- curring after the opening of a trampoline park in our local community: 1) A displaced forearm fracture requiring closed reduction and orthopedic fol- low-up; 2) An ankle fracture necessitating operative reduction and fixation; and 3) A facial injury with tooth avulsion prompting oral surgery consulta- tion and endodontic follow-up. Conclusions: These cases demonstrate the complexity and severity of injury that can occur from trampoline park par- ticipation and should serve to increase awareness among health care provid- ers of these risks to provide appropriate parental counseling and advocate for preventative measures.
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Other statistically signi ﬁ cant clinical differences between the groups in- cluded a higher daily calcium dietary intake in case patients. We suspect that the difference in daily calcium intake likely re ﬂ ects the increased overall caloric intake in the case patients. When the daily calcium intake was expressed as a proportion of daily kilocalorie intake (as calcium nutrient density), there was no longer a signi ﬁ cant dif- ference present between the groups. Although calcium intake has been as- sociated with forearm fracture risk in children, 17 other studies have not sup-
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The direct blow theory was actually proposed by Monteggia, who noted that the fracture occurs with a direct blow to the forearm first produces fracture through the ulna. Then, by continued deformation or direct pressure, the radial head is forced anteriorly with respect to the capitellum, causing radial head dislocation. Evans proposed hyperpronation theory based on cadaveric dissections. He proposed that hyperpronation forcibly rotates the radius over middle of the ulna resulting in either anterior dislocation of radial head or fracture of proximal one‑third of radius, along with fracture of shaft of ulna. Tompkins analyzed both the above theories and proposed these injuries were caused by a combination of static and dynamic forces. His study postulated three steps in fracture mechanism: Hyperextension, followed by radial head dislocation due to pull of biceps. Subsequently, weight of body is transferred to the ulna leading to ulnar fracture in tension. Radial head dislocation is a more common than radial neck fracture as annular ligament is more lax. In addition, a combination of Monteggia lesion along with ipsilateral distal forearm fracture is a very rare injury. Such injuries are also called bipolar fractures of the forearm, as described by Castillo Odena . A thorough search for similar injuries was done in literature, and only limited number of similar injuries have been reported so far. The previous injury patterns reported are mostly in combination with radial head dislocation [6, 7, 8, 9, 10], and only six had Monteggia equivalent injuries [3, 11, 12, 13, 14]. Only two cases have been found
In our study, there were three patients with no angulation of radius and ulna at maturity, but they still had about six to ten degrees of supination loss and four to 20 degrees of pronation loss. Good bone remodelling with no angulation on radiograph may not correlate with the return of forearm rotation10-13. This poor correlation between angulation and functional outcome has been shown as well in few studies. In a study by Price et al10, a 13-year old girl with displaced forearm fracture and 10 degrees of radius residual angulation after nine years had a full range of forearm rotation. Another case who was also reported by Price et al10, revealed a 6-year old girl with severe fractures of both right radius and ulna had complete remodelling after four years follow up. However, she lost 30 degrees of forearm pronation despite having no residual angulation of radius and ulna10. These findings have raised few theories regarding the factors that contribute to the limitation of forearm rotation even with complete remodelling and no residual angulation. Length discrepancies, encroachment of the interosseous space and displacement in the cases of closed treatment have been thought as the possible causes. Scarring of the surrounding soft tissue following the fracture produces some tension and encroachment in the interosseous membrane, and this will result in loss of a significant degree of forearm rotation10. We did not consider the rotation of the fracture in our study based on the fact that it was difficult to measure rotational deformity from the radiograph accurately and the rotation was unlikely to be corrected by remodelling9,23. Furthermore, the rotational deformity was accepted within 0 to 45 degrees11. Creaseman et al24, did measure the rotational deformity of the fractures in his study but most other literature measured only the angulation of the fractures 6,7,9,24. They had difficulty in assessing the rotational deformity in their study due to difficulty in getting true tuberosity view 24.
FAM3C, which is predicted to be expressed in osteoblasts and encodes a newly identified cytokine necessary for epithelial to mesenchymal transition and retinal laminar formation in verte- brates . We identified the SNP rs7776725 within the first intron of FAM3C to be genome-wide significant for forearm BMD (P = 8.56 10 215 ) and forearm fracture (P = 8.6 610 29 ). Since the fracture cohorts do not have available BMD data, except for the AOGC cohort, which comprised only 7% of the fracture case population, no meaningful conclusions could be drawn for the independence of the association between fracture and forearm BMD. While candidate gene studies have previously described relationships between genetic variants and fracture [34,35,36], we are aware of only one other variant that has been demonstrated to be genome-wide significant for any type of osteoporotic fracture, arising from the ALDH7A1 gene . Interestingly, SNP rs7776725 in FAM3C was previously reported to be associated with speed of sound (SOS) as analyzed by quantitative ultrasound at the radius (P = 1.0 610 211 ) in an un-replicated GWAS carried out in Asian populations . This SNP was also associated with BMD in a Caucasian population . The high-throughput DEXA and microCT screen which initially identified reduced cortical bone thickness and bone strength in Wnt16 knockout mice failed to observe any skeletal phenotype changes in three independent knockouts of mouse Fam3c. Since the sample size of Fam3c 2/2 mice was small (N = 18), the possibility of a false negative result cannot be excluded. All together, our functional studies indicate that Wnt16 rather than Fam3c is responsible for the observed genetic signal arising from this locus. However, we provide no data as to whether or not gain of functions variants in
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In pediatric forearm fractures casting and conservative treatment follow-up, a displacement and malalignment with complete fracture, quality of the first reduction, and proximal 1/3 fracture. For similar reasons, we believe that instability in the operating room also continues and some fractures require open reduction. Objective: The aim open intervention and to evaluate the 69 patients treated with intramedullary for a pediatric forearm fracture in our clinic were reviewed retrospectively. Information regarding the age, gender, left/right side were obtained from the patients' files, and data regarding preoperative fracture displacement, angulation, localization of radius and ulna fracture, type of injury of the radius fracture, and the level of fracture. lly with radial inclination index and functionally with the Open reduction and fixation were applied to 45 patients (65%). Open reduction was required when the radius fracture was non-transverse, and the fracture localization progressed proximally (p=0.039, 0.049, 0.039). No relationship was found between open reduction with age, side, gender, angled fracture, and displacement. According to the Price criteria, an There was no difference in mini-open fixation regarding union duration and complications. Although the radial inclination index increased in transverse fractures (7.8% ± 1.9), this was not reflected in functional scores. iatric forearm fractures, if the fracture is proximal or not transverse, open reduction is needed mostly and open reduction intramedullary fixation is performed successfully in
Forearm fracture is the most common type of fracture in children presenting to the emergency department (ED) and composes approximately one-quarter of all frac- tures in childhood. 1 Cast immobilization remains the primary treatment for patients with forearm fractures. However, approximately 6% of the patients return unex- pectedly to the ED due to complications related to the cast. 2,3 Some patients return because of a damaged cast (e.g. wet cast, loose cast), while others present with symptoms such as swelling, color change, skin irritation or pain around the distal part of the upper extremity (cast-related pain, CstRP). 3 – 6 Patients who have pain need to be urgently evaluated to rule out neurovascular de ﬁ cit and are treated with analgesics, cast splitting, trimming, or replacement. 7
administration of L-arginine augmented the forearm blood flow response to methacholine in the hypercholesterolemic individuals, but not in the normal subjects. L-arginine did not alter the effect of nitroprusside in either group. D-arginine had no effect on forearm vascular reactivity in either group. It is concluded that endothelium-dependent vasodilation is impaired in hypercholesterolemic humans. This abnormality can be improved acutely by administration of L-arginine, possibly by increasing the synthesis of endothelium-derived relaxing factor.
plethysmography so that the volume of muscle veins could be estimated simultaneously with the volume of cutaneous veins, at a constant venous pressure. With this technique not only are the cutaneous veins markedly constricted but they also are prevented from filling since skin blood flow is abolished. In 10 normal subjects, the venous volume in the elevated control forearm at a congesting pressure of 30 mm Hg (VV) was 3.16 ±0.30 SEM cc/100 cc, while in the iontophoresed arm it was 2.54 ±0.31 cc/100 cc. Thus the forearm cutaneous VV was 1.62 cc/100 cc. With a deep breath, ice to the forehead, and leg exercise, and cutaneous VV decreased 19.8% (P < 0.01), 36.6% (P < 0.01), and 32.6% (P < 0.02), respectively, whereas the muscle VV was not altered significantly. Similar results were observed using the isolated forearm technique and a deep muscle vein. The infusion of epinephrine intra-arterially did not decrease reflex venomotor reactivity until cutaneous blood flow was completely suppressed, indicating that the inability of the veins to react in the iontophoresed arm was not the result of epinephrine diffusion into the muscle bed. Thus, these results indicate that, in the forearm, only cutaneous […]
including how lower bone mineral content and muscle mass increase the risk of injury from an impact (Bennell, et al., 1996; Kelsey et al., 2007; Loud et al., 2007; Magnusson et al., 2001). Burkhart et al. (2013) found that, as the fat mass to bone mineral content ratio decreased in the leg, the risk of injury decreased, presumably due to increases in the strength of the bone that would come with increased bone mineral content, relative to fat mass. Other factors such as rate of loading, pre-existing conditions, repetition, and past history of injury also affect the risk of injury. It has been suggested that the rate of loading decreases and the risk of injury from an impact decreases as tissue mass of the body segment increases (Schinkel-Ivy, Burkhart, & Andrews, 2012). Pre-existing conditions such as osteoporosis increase the risk of injury related to a fall. A higher susceptibility of bone fracture with osteoporosis is caused by a decrease in trabecular and cortical bone density and by a change in structural properties that occur with osteoporosis (Johnell, Gullberg, Allander, & Kanis, 1992). Repetitive impacts, combined with past history of falls, which could damage or weaken the tissues (i.e., bone), increases the risk of a more serious injury such as a bone fracture (Butler, Crowell, & Davis, 2003 & Milner et al., 2006).
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Nine fresh frozen cadaveric upper extremities, resected mid-humerus were used for biomechanical testing (74 7, 9 male, 9 right). Computed tomography (CT) scans, fluoroscopic images were performed and medical histories were reviewed for each specimen to rule out previous forearm injuries, deformities and/or osteoarthritis. The specimens were thawed for approximately 18 hours. Ulnar variance was quantified using fluoroscopy. The radial and ulnar load measurement devices were surgically implanted in the distal forearm bones, being careful to leave all soft tissues intact (Figures 3.1 & 3.2). A volar radial osteotomy was performed and a dorsal bone bridge was left intact to assure the alignment of the distal and proximal bone segments were maintained during insertion of the device. Polymethylmethacrylate, bone cement was injected into the distal trabecular bone and proximal intramedullary canal to improve fixation and the distal plate and proximal stem were secured in place (Figure 2.16). A similar procedure was followed on the medial side of the ulna for device implantation. Ulnar device fixation was achieved with intramedullary stems both proximally and distally (Figure 2.17). The osteotomies were performed as distal as possible while still proximal to the DRUJ to avoid joint disruption. Nylon line (45kg test) was sutured into the tendons of the prime movers proximal to the extensor retinaculum and wrist: biceps, pronator teres (PT), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), extensor carpi ulnaris (ECU), extensor carpi radialis brevis (ECRB), and extensor carpi radialis longus (ECRL) (Ethicon, Somerville, NJ). Guides were secured to the medial and lateral humeral epicondyles and tendon lines were directed through them to maintain physiological lines of action.
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Incomplete fusion The fusion or non-fusion of the greater horns to the body of the hyoid bone is an easily misinterpreted feature. While it is well-established in the literature that these elements can fuse over time [26, 27], in pathological practise hypermobility is sometimes taken as evidence of a hyoid fracture . Depending on the pathologist ’ s sensitivity and experience, a natural non- union could be mistaken for trauma. Radiologically, a narrow gap between the body and greater horn or incom- plete fusion of the two parts might be mistaken as a frac- ture. The control group has shown several examples of incomplete fusion with a narrow gap still visible at the body-greater horn junction, see Fig. 4 for a transverse section and the volume-rendering of the scan. Both sides
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To date, evaluating specific aspects of forearm crutches has been difficult. In this study, we used a newly developed questionnaire comprising 17 ques- tions categorized into four item categories. While this questionnaire has not been formally validated, cross- correlations among but not within item categories suggest that the item groups indeed assess the differ- ent aspects of pain and comfort of crutch walking in- vestigated in this study. Hence, this questionnaire is very useful for future studies aimed at improving crutch design or for choosing optima crutches for a specific patient.
Each subject (n = 8) was imaged in the proximal forearm whilst positioned upright on a chair fitted with a back and head support, hips and knees at 90° flexion, and the trunk fixed with Velcro strapping. The right upper limb was strapped to a Perspex plate in 90° flexion and 20° abduc- tion at the glenohumeral joint, with the elbow fully extended, 45° forearm supination, and the wrist, hand and fingers in neutral. An active forward head position movement was performed, which included lower cervical spine flexion and upper cervical spine extension.
To evaluate the effects of morphine on the peripheral venous and arterial beds, 69 normal subjects were evaluated before and after the intravenous administration of 15 mg morphine. Venous tone was determined by three independent techniques in 22 subjects. The venous pressure measured in a hand vein during temporary circulatory arrest (isolated hand vein technique) fell from 20.2±1.4 to 13.4±0.9 mm Hg (P < 0.01) 10 min after morphine, indicating that a significant venodilation had occurred. With the acute occlusion technique, morphine induced a reduction in forearm venous tone from 12.8±1.1 to 7.9±2.3 mm Hg/ml/100 ml (P < 0.01). Although forearm venous volume at a pressure of 30 mm Hg (VV) was increased from 2.26±0.17 to 2.55±0.26 ml/100 ml, measured by the equilibration technique, the
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receptors by isometric handgrip for 2 min at 10 and 20% of maximum voluntary contraction resulted in reflex vasoconstriction in the nonexercising arm. Lower body negative pressure at −5 mm Hg produced a threefold augmentation in the forearm vasoconstrictor response to isometric handgrip in the nonexercising arm. This increase in resistance was significantly greater (P < 0.05) than the algebraic sum of the increases in resistance resulting from lower body suction alone plus isometric handgrip alone. Furthermore, it occurred despite a greater rise in arterial pressure, which would be expected to decrease forearm vascular resistance through activation of arterial baroreceptors and […]
The Cutometer MPA 580 applies a 45 kPa suction through a 6 mm aperture in the probe and measures the vertical deformation of the skin as a function of time. One cycle comprises of a constant suction for two seconds, followed by no suction for two seconds. A typical deform- ation curve is shown in Figure 2. For our study, we exam- ined Uf - the maximal deformation under the suction load. Uf was measured in millimeters, and represented a meas- ure of pliability, not the total gain in expanded tissue. Mea- surements were performed 6 cm proximal to the wrist crease on both the volar and dorsal aspects of the pre- expanded donor forearm and the control forearm. Each side of the forearm was measured three times and the aver- age for Uf was taken. In between each measurement, the probe was lifted off the skin and the machine allowed to recalibrate to 45 kPa. The probe was then repositioned on a closely adjacent, previously untested patch of skin.