Open Fractures of the Hand with Soft Tissue Loss

Slides:

Advertisements

Similar presentations

Summer Anatomy Lab July 25, 2013 Jennifer Klok

Advertisements

Surgical Technique for Osteocutaneous Pedicle Flap Transfer for Salvage of Transtibial Amputation After Severe Lower-Extremity Injury by Heather A. Vallier,

Thumb Reconstruction Quiz 5 14/6/ years old man Industrial machine accident Stiff fingers and absent thumb Photography and physical examinations.

 Vascular Injuries  Ligament Injuries  Dislocations  Fractures.

REVIEW OF ANATOMY UNDERLYING CARPAL TUNNEL SYNDROME

The Wrist and Finger Joints

ESAT 3600 Fundamentals of Athletic Training

Current Procedure of Double Free Muscle Transfer for Traumatic Total Brachial Plexus Palsy by Kazuteru Doi, Yasunori Hattori, Sotetsu Sakamoto, Chaitanya.

Ulnar-Sided Wrist Pain by Alexander Y. Shin, Mark A. Deitch, Kavi Sachar, and Martin I. Boyer J Bone Joint Surg Am Volume 86(7): July 1, 2004.

Flexor digitorum superficialis O:Medial epicondyle of humerus ulnar head: medial coronoid process radial head: upper 2/3 of anterior border of radius just.

Hand Bones Pisiform Triquetrum Lunate Scaphoid Trapezium Trapezoid

Combined Dorsal and Volar Plate Fixation of Complex Fractures of the Distal Part of the Radius by David Ring, Karl Prommersberger, and Jesse B. Jupiter.

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Treatment of the Severely Injured Upper Extremity*† by AMIT GUPTA, RUSSELL.

.. Fig : - Extensor carpi radialis longus (ECRL), Extensor carpi radialis brevis (ECRB), Extensor carpi ulnaris (ECU), Extensor digitorum communis (EDC),

Muscles of the Anterior Forearm. Objectives Name and identify the muscles in the anterior (flexor/pronator) and posterior (extensor/supinator) compartments.

Scaphoid Fractures: What’s Hot, What’s Not by William B. Geissler, Julie E. Adams, Randy R. Bindra, William D. Lanzinger, and David J. Slutsky J Bone Joint.

The Elbow, Wrist & Hand Hard & Soft Tissue Anatomy.

Functional Bracing for the Treatment of Fractures of the Humeral Diaphysis* by A. SARMIENTO, J. B. ZAGORSKI, G. A. ZYCH, L. L. LATTA, and C. A. CAPPS J.

Operative Treatment of Common Displaced and Unstable Fractures of the Hand by Alan E. Freeland, William B. Geissler, and Arnold-Peter C. Weiss J Bone Joint.

Upper Limb, part II Cubital fossa, Forearm, and Hand

Salvage of a Below-the-Knee Amputation Level Following a Type-IIIB Open Tibial Fracture by Steven J. Morgan, Justin Newman, Kagan Ozer, Wade Smith, and.

Just if you thought you were having a bad day….

Lecture 26-Dorsum of the hand, retinaculum and wrist joint.

DEEP MUSCLES There are five muscles in the deep compartment of the posterior forearm – the supinator, abductor pollicis longus, extensor pollicis brevis,

MANUAL RESISTANCE FOR UPPER LIMB

Fractures of the distal radius

Open Fracture of the Hook of the Left Hamate

Salvage of complications of hallux valgus surgery

Current Management of Metacarpal Fractures

Alain C. Masquelet, MD, Thierry Begue, MD Orthopedic Clinics

Treatment of Phalangeal Fractures

ZONES OF HAND Rose Mary Antony.

Rehabilitative Operation for Motor Neuron Disease: Tendon Transfer for Segmental Muscular Atrophy of the Upper Extremities MEHRSHEED SINAKI, M.D. Mayo.

Volume 41, Issue 1, Pages (January 2010)

Ivan S. Tarkin, MD, Peter A. Siska, MD, Boris A. Zelle, MD

Treatment of Pathologic Fractures

Surgical Management of the Infected Sternoclavicular Joint

Brenden J. Balcik, MD, Aaron J. Monseau, MD, William Krantz, MD

Volume 2, Issue 2, Pages (June 2016)

Dermal regeneration template for deep hand burns: clinical utility for both early grafting and reconstructive surgery E Dantzer, P Queruel, L Salinier,

Combined Free Vascularized Iliac Osteocutaneous Flap and Pedicled Pectoralis Major Myocutaneous Flap for Reconstruction of Anterior Chest Wall Full-Thickness.

Woman With Hand Pain and Swelling

Outcomes of Hand Fracture Treatments

Intra-Articular Fractures of the Hand

Complications of Hand Fractures and Their Prevention

Ulnar Artery as a Coronary Bypass Graft

Surgical Diseases and Techniques of the Digit

Salvage of complications of hallux valgus surgery

Crystal L. Ramanujam, DPM, Zacharia Facaros, DPM, Thomas Zgonis, DPM

Pediatric Hand Fractures

Open Fractures of the Hand with Soft Tissue Loss

Rehabilitative Strategies Following Hand Fractures

Free Cutaneous and Myocutaneous Flaps in Oral-Maxillofacial Surgery

James T. Marino, MD, Bruce H. Ziran, MD Orthopedic Clinics

Hand-arm vibration syndrome: A rarely seen diagnosis

Lai Jin Lu, Xu Gong, Zhi Gang Liu, Zhi Xin Zhang

Distal revascularization and microvascular free tissue transfer: An alternative to amputation in ischemic lesions of the lower extremity Susan E. Briggs,

Primary use of the index finger for reconstruction of amputated thumbs

A Cadaveric Study of the Posterior Interosseous Nerve and Its Branches at the Level of the Distal Radius Thomas M. Gregory, MD, PhD, Marion Goutard,

Volar Buttress Plating for Dorsal Fracture-Dislocation of the Proximal Interphalangeal Joint With a Central Depressed Fragment: A Preliminary Report of.

Alain C. Masquelet, MD, Thierry Begue, MD Orthopedic Clinics

Volume 27, Issue 4, Pages xiii-xiv (November 2011)

The Biomechanics of Fixation Techniques for Hand Fractures

Functional foot salvage after extensive plantar excision and amputations proximal to the standard transmetatarsal level Kumar R. Patel, MD, Federico.

Catfish Noodling Forearm Injury Requiring Urgent Surgical Treatment: A Case Report and Review of the Literature Courtney R.J. Kaar, BS, Christina Plikaitis,

Restoration of Sensation and Thumb Opposition Using Nerve Transfers Following Resection of a Synovial Sarcoma of the Median Nerve Hollie A. Power, MD,

Hand-arm vibration syndrome: A rarely seen diagnosis

Presentation transcript:

Open Fractures of the Hand with Soft Tissue Loss David Ruta, MD, Kagan Ozer, MD Hand Clinics Volume 29, Issue 4, Pages 551-567 (November 2013) DOI: 10.1016/j.hcl.2013.08.008 Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 1 A 35-year-old patient presented to an outside hospital with a gunshot injury to his left long finger sustaining an open comminuted fracture of the proximal phalanx with bone and soft tissue loss along with laceration of flexor digitorum superficialis and common extensor tendon. He was transferred to our facility following an initial irrigation and temporary K-wire fixation. Hand Clinics 2013 29, 551-567DOI: (10.1016/j.hcl.2013.08.008) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 2 The patient underwent single-stage bone (iliac crest) and soft tissue reconstruction using second dorsal intermetacarpal artery flap. We routinely use Doppler ultrasound to locate the perforator. This flap can be extended more proximally to the dorsal aspect of the wrist joint based on the same pedicle. Hand Clinics 2013 29, 551-567DOI: (10.1016/j.hcl.2013.08.008) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 3 Nine months after his initial surgery, he underwent hardware removal and a tenolysis procedure. These photographs show his final follow-up at 18 months. Hand Clinics 2013 29, 551-567DOI: (10.1016/j.hcl.2013.08.008) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 4 A 29-year-old patient presented with a gunshot injury sustaining open fracture/dislocations of the third and fourth carpometacarpal (CMC) joints with a dorsal soft tissue defect. Bone loss included the base of the third metacarpal and capitellum. Hand Clinics 2013 29, 551-567DOI: (10.1016/j.hcl.2013.08.008) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 5 Following extensive irrigation and debridement, the patient underwent primary bone and soft tissue reconstruction in a single stage. The iliac crest corticocancellous bone graft measuring 1.5 × 3 cm, placed at the CMC joints of the third and fourth digits, can be seen in the left lower corner (arrow). Coverage was performed with an ulnar artery perforator flap harvested along the ulnar border of the forearm and rotated 120°. Common extensor tendons of the third and fourth digits were then repaired. Hand Clinics 2013 29, 551-567DOI: (10.1016/j.hcl.2013.08.008) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 6 The patient shows near-complete range of motion and incorporation of the bone graft 6 months after the surgery. Further remodeling and flattening of the flap is expected up to 12 months after the surgery. Hand Clinics 2013 29, 551-567DOI: (10.1016/j.hcl.2013.08.008) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 7 A 65-year-old gun safety instructor accidentally shot himself, sustaining open fractures of the third and fourth metacarpals with bone and soft tissue loss. Following extensive irrigation and debridement, he underwent iliac crest corticocancellous bone grafting and soft tissue coverage with posterior interosseous flap. Doppler ultrasound is routinely used to locate the perforator, usually at the floor of the fifth dorsal compartment, as marked in the upper left picture. Hand Clinics 2013 29, 551-567DOI: (10.1016/j.hcl.2013.08.008) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 8 Radiographs show complete healing of the bone graft 3 months after the injury. Plate-screw fixation was placed across the CMC joints of the third and fourth digits on the hamate and capitate, which did not result in any motion limitation at the wrist. Hand Clinics 2013 29, 551-567DOI: (10.1016/j.hcl.2013.08.008) Copyright © 2013 Elsevier Inc. Terms and Conditions