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

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Presentation transcript:

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Treatment of the Severely Injured Upper Extremity*† by AMIT GUPTA, RUSSELL A. SHATFORD, THOMAS W. WOLFF, TSU-MIN TSAI, LUIS R. SCHEKER, and L. SCOTT LEVIN J Bone Joint Surg Am Volume 81(11): November 1, 1999 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Figs. 1-A through 1-E: A forty-three-year-old patient who sustained a fracture of the ulna with a large soft-tissue defect, muscle loss, injury of the radial artery, and exposure of the median nerve. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-B Radiographs showing plate fixation of the ulnar fracture. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-C Photograph made after immediate coverage with a lateral arm flap. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-D Photograph showing flexion. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-E Photograph showing extension. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Figs. 2-A and 2-B: A thirty-year-old patient who had complete transmetacarpal amputation of all digits. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-B Radiographs made after replantation, showing stable fixation of all metacarpals with 90– 90 wiring. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Figs. 3-A through 3-D: A twenty-two-year-old patient who was referred from another facility after a gunshot wound to the forearm. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-B Radiograph showing a large segmental defect in the radius. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-C Radiographs made after a flow-through free fibular graft was used to reconstruct the radius. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-D Photograph showing a skin paddle with a fibular flap covering the soft-tissue defect. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Figs. 4-A through 4-F: A sixty-five-year-old patient who sustained a crush injury to the hand with soft-tissue injury and loss of the radial artery. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-B Radiograph showing multiple metacarpal fractures. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-C Photograph showing the hand after débridement. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-D Radiograph made after internal fixation. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-E Photograph showing extension with a lateral arm flap covering the defect. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-F Photograph showing flexion with a lateral arm flap covering the defect. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Figs. 5-A through 5-F: A twenty-one-year-old patient who fell asleep with the hand on a train track. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-B Photograph made after débridement. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-C Photograph made after immediate coverage with a lateral arm flap. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-D Photograph showing the result of the procedure. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-E Photograph showing extension. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-F Photograph showing flexion. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Figs. 6-A through 6-H: A thirty-year-old patient who was injured by a saw. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-B Radiograph showing the injured hand. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-C Radiograph providing a close-up view of the proximal interphalangeal joint of the long finger, showing loss of the radial segment of the joint. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-D Photograph made after the distal interphalangeal joint from the amputated index finger was used as a nonvascularized osteochondral graft to reconstruct the proximal interphalangeal joint of the long finger. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-E Lateral and anteroposterior radiographs showing the completed reconstruction. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-F Lateral and anteroposterior radiographs showing the completed reconstruction. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-G Photographs showing excellent function after the reconstruction. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-H Photographs showing excellent function after the reconstruction. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Figs. 7-A through 7-E: A forty-one-year-old patient who sustained a punch-press injury to the hand. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-B Radiograph showing the injured hand. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-C Photograph made after the operation. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fg. 7-D Photograph showing extension. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-E Photograph showing flexion. AMIT GUPTA et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.