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Sample records for diaphyseal forearm fracture-nonunions

  1. Plating in diaphyseal fractures of the forearm.

    PubMed

    Iacobellis, Claudio; Biz, Carlo

    2014-01-23

    Currently, open reduction and internal plate-screw fixation is generally accepted as the gold standard treatment of diaphyseal forearm fractures. The purpose of this retrospective study was to evaluate the clinical and radiographic outcomes of open reduction and internal fixation by using the Locking Compression Plate (LCP) implant system of radial, ulnar or combined shaft fractures of a skeletally mature patients group treated at our institution. We examined 47 patients, 44 men and 3 women, mean age 35 years (range 14-74) operated for diaphyseal fractures of the forearm. Overall 64 segments were treated: 32 ulnar and 32 radial. All patients received 3.5-mm titanium LCPs (Locking Compression Plates) with "combi-holes". Follow-ups included standard X-rays and clinical assessment according to Anderson's criteria and the DASH questionnaire. Mean follow-up was 11 months (range 6-39). The number of the patients who achieved complete consolidation was 43 with a union rate of 91.5%. They showed 37 excellent results and 6 satisfactory results according to Anderson criteria, while non-union occurred in 4 out of 64 segments (2 ulnar and 2 radial) with a non-union rate per patient of 8,5%. The mean score of the DASH scale was 13.5 (range 0-46.7). Our data show that internal plating gives good functional outcomes in the treatment of forearm diaphyseal fractures, as long as the surgical technique is perfect and carried out by expert surgeons. However, further research is desirable to better identify fracture types for which LCPs should be used.

  2. Treatment of Diaphyseal Forearm Fractures in Children

    PubMed Central

    Vopat, Matthew L.; Kane, Patrick M.; Christino, Melissa A.; Truntzer, Jeremy; McClure, Philip; Katarincic, Julia; Vopat, Bryan G.

    2014-01-01

    Both bone forearm fractures are common orthopedic injuries. Optimal treatment is dictated not only by fracture characteristics but also patient age. In the pediatric population, acceptable alignment can tolerate greater fracture displacement due to the bone’s ability to remodel with remaining growth. Generally, these fractures can be successfully managed with closed reduction and casting, however operative fixation may also be required. The optimal method of fixation has not been clearly established. Currently, the most common operative interventions are open reduction with plate fixation versus closed or open reduction with intramedullary fixation. Plating has advantages of being more familiar to many surgeons, being theoretically superior in the ability to restore radial bow, and providing the possibility of hardware retention. Recently, intramedullary nailing has been gaining popularity due to decreased soft tissue dissection; however, a second operation is needed for hardware removal generally 6 months after the index procedure. Current literature has not established the superiority of one surgical method over the other. The goal of this manuscript is to review the current literature on the treatment of pediatric forearm fractures and provide clinical recommendations for optimal treatment, focusing specifically on children ages 3-10 years old. PMID:25002936

  3. Multiple forearm diaphyseal fracture: reduction and plaster cast control at the end of growth

    PubMed Central

    Michelis, Maria Beatrice; Calevo, Maria Grazia; Stella, Marco

    2006-01-01

    The authors followed up 20 patients with multiple diaphyseal fractures of the radius and ulna who were treated nonoperatively and who healed with axial deviation >5° in at least one plane 20.4±6.7 years after radiographic evidence of fracture union. Mean age at follow-up was 28.6±6.4 years. Radiographs were measured soon after reduction, at 10 days from reduction, at the end of treatment, and at follow-up (17/20). Both elbow and forearm range of motion (ROM) were compared with those of the contralateral side. At follow-up, ROM was normal and radiographs showed angular deviations <5°. PMID:17109178

  4. Treatment of Distal Radius Fracture Nonunion With Posterior Interosseous Bone Flap

    PubMed Central

    Saremi, Hossein; Shahryar-Kamrani, Reza; Ghane, Bahareh; Yavarikia, Alireza

    2016-01-01

    Background Nonunion of distal radius fractures is disabling. Treatment is difficult and the results are not predictable. However, posterior interosseous bone flap (PIBF) has been successful in treating forearm nonunion. Objectives To treat distal radius fracture nonunion with PIBF as a new procedure. Patients and Methods This prospective non-randomized cohort study was performed at two hospitals in Tehran between January 2011 and September 2015. PIBFs were applied in nine patients (10 nonunions) with a mean age of 55 years. Union success rate, grip strength, wrist range of motion, and forearm rotation were then evaluated. Results Although four of the patients had a history of infection, all participants achieved fracture union at a mean time of 3.8 months. Grip strength improved by 12.4 kg. There was also 36° improvement in wrist flexion, 20° improvement in wrist extension, 60° improvement in forearm supination, and 46° improvement in forearm pronation. The range of motion and grip strength improvements were significant. Conclusions Pedicled PIBF is a new option for treating distal radius fracture nonunion. The results are predictable in achieving union and good function, and this technique can be successfully used in cases with extensive soft-tissue damage or infection. PMID:27703802

  5. Diaphyseal Fractures of the Forearm in Adults, Plating Or Intramedullary Nailing Is a Better Option for the Treatment?

    PubMed

    Al-Sadek, Tabet A; Niklev, Desislav; Al-Sadek, Ahmed

    2016-12-15

    Fractures of the radius and ulna occupy a large field of the modern traumatology. Therefore, these fractures are a major subject in modern orthopaedics and traumatology. The study of the mechanisms of the trauma, and the pathophysiological changes that occur are of great importance for the development of ever more efficient and varied ways of the treatment and prophylactics of this type of fracture. The aim of this paper was to study the pattern of the diaphyseal fractures of the forearm in adults, to decide the modalities of surgical management, to observe the period of fracture healing clinically and radiologically, as well to study the rehabilitation of the patients. The present study included 45 cases of diaphyseal fractures of both bones forearm in adults presenting to the orthopaedic outpatient department. For all the patients a detailed history was taken. A thorough clinical examination was carried out, required X-rays were taken, and initial treatment was given and admitted as in all patients. After careful pre-operative planning and evaluation for anaesthetic fitness, patients were operated for the fractures of both bone forearms. Twenty-three cases with 46 fractures were treated by open reduction and rigid fixation with DCP & Semi-tubular plates and 22 cases with 44 fractures were treated by closed reduction and fixation with "Talwarkar" intramedullary square nails. United results were found in 100% of plating group vs. 86% in the nailing group. Delayed and non-union results were found in 9% of the nailing group only. Average time to union in weeks was 9.4 weeks in the plating group vs. 10.2 weeks in the nailing group. Open reduction and internal fixation with compression plates with strict adherence to surgical technique is the gold standard method of treatment in both bones forearm fractures with excellent results than closed reduction, internal fixation with "Talwarkar" square nails which is also again a simple method with better results than

  6. Diaphyseal Fractures of the Forearm in Adults, Plating Or Intramedullary Nailing Is a Better Option for the Treatment?

    PubMed Central

    Al-Sadek, Tabet A.; Niklev, Desislav; Al-Sadek, Ahmed

    2016-01-01

    BACKGROUND: Fractures of the radius and ulna occupy a large field of the modern traumatology. Therefore, these fractures are a major subject in modern orthopaedics and traumatology. The study of the mechanisms of the trauma, and the pathophysiological changes that occur are of great importance for the development of ever more efficient and varied ways of the treatment and prophylactics of this type of fracture. AIM: The aim of this paper was to study the pattern of the diaphyseal fractures of the forearm in adults, to decide the modalities of surgical management, to observe the period of fracture healing clinically and radiologically, as well to study the rehabilitation of the patients. MATERIAL AND METHODS: The present study included 45 cases of diaphyseal fractures of both bones forearm in adults presenting to the orthopaedic outpatient department. For all the patients a detailed history was taken. A thorough clinical examination was carried out, required X-rays were taken, and initial treatment was given and admitted as in all patients. After careful pre-operative planning and evaluation for anaesthetic fitness, patients were operated for the fractures of both bone forearms. Twenty-three cases with 46 fractures were treated by open reduction and rigid fixation with DCP & Semi-tubular plates and 22 cases with 44 fractures were treated by closed reduction and fixation with “Talwarkar” intramedullary square nails. RESULTS: United results were found in 100% of plating group vs. 86% in the nailing group. Delayed and non-union results were found in 9% of the nailing group only. Average time to union in weeks was 9.4 weeks in the plating group vs. 10.2 weeks in the nailing group. CONCLUSION: Open reduction and internal fixation with compression plates with strict adherence to surgical technique is the gold standard method of treatment in both bones forearm fractures with excellent results than closed reduction, internal fixation with “Talwarkar” square nails

  7. Predictive factors for re-displacement in diaphyseal forearm fractures in children-role of radiographic indices.

    PubMed

    Asadollahi, Shadi; Pourali, Masoumeh; Heidari, Kamran

    2017-02-01

    Background and purpose - Manipulation and cast immobilization is the primary management for diaphyseal forearm fractures in children, and re-displacement is the most common complication. We wanted (1) to analyze the incidence of re-displacement in a group of children treated with close reduction and casting; (2) to determine predictive factors such as demographics, mechanism of injury, affected bone, fracture pattern, degree of initial displacement and angulation, and reduction accuracy; and (3) to determine the prognostic effect of previously defined radiographic indices. Patients and methods - We prospectively studied 269 consecutive children with closed and complete middle-third diaphyseal fractures treated with close reduction and casting from October 2014 to April 2015. Factors analyzed included demographics, initial fracture features, having a non-anatomical reduction, and the radiographic indices of cast quality. Results - There were 189 fractures of both bones (70%) and 80 solitary fractures (30%). The overall re-displacement rate was 11%. According to multivariable analysis, independent predictors of re-displacement were initial angulation >10° (RR =5) and failure to achieve an anatomical reduction (RR =2). Statistically significant radiographic indices regarding increased rate of re-displacement included cast index ≥0.7 (RR =5), Canterbury index ≥1.1 (RR =3), and 3-point index ≥0.8 (RR =6). Interpretation - Our results suggested that fractures with a higher degree of initial angulation and non-anatomical reduction more often result in re-displacement. Moreover, the casting quality examined with the radiographic indices played an important role in the success of a non-operative management.

  8. Predictive factors for re-displacement in diaphyseal forearm fractures in children—role of radiographic indices

    PubMed Central

    Asadollahi, Shadi; Pourali, Masoumeh; Heidari, Kamran

    2017-01-01

    Background and purpose — Manipulation and cast immobilization is the primary management for diaphyseal forearm fractures in children, and re-displacement is the most common complication. We wanted (1) to analyze the incidence of re-displacement in a group of children treated with close reduction and casting; (2) to determine predictive factors such as demographics, mechanism of injury, affected bone, fracture pattern, degree of initial displacement and angulation, and reduction accuracy; and (3) to determine the prognostic effect of previously defined radiographic indices. Patients and methods — We prospectively studied 269 consecutive children with closed and complete middle-third diaphyseal fractures treated with close reduction and casting from October 2014 to April 2015. Factors analyzed included demographics, initial fracture features, having a non-anatomical reduction, and the radiographic indices of cast quality. Results — There were 189 fractures of both bones (70%) and 80 solitary fractures (30%). The overall re-displacement rate was 11%. According to multivariable analysis, independent predictors of re-displacement were initial angulation >10° (RR =5) and failure to achieve an anatomical reduction (RR =2). Statistically significant radiographic indices regarding increased rate of re-displacement included cast index ≥0.7 (RR =5), Canterbury index ≥1.1 (RR =3), and 3-point index ≥0.8 (RR =6). Interpretation — Our results suggested that fractures with a higher degree of initial angulation and non-anatomical reduction more often result in re-displacement. Moreover, the casting quality examined with the radiographic indices played an important role in the success of a non-operative management. PMID:27841692

  9. Elbow dislocation with ipsilateral diaphyseal forearm bone fracture: A rare injury report with literature review.

    PubMed

    Goni, Vijay; Behera, Prateek; Meena, Umesh Kumar; Gopinathan, Nirmal raj; Akkina, Narendranadh; Arjun, R H H

    2015-01-01

    Dislocation of the elbow along with shaft fractures of both bones of the ipsilateral forearm is a rare injury though elbow dislocation or fracture of the forearm bones may occur separately. Such injuries need a concentric reduction of the dislocation and an anatomical fixation of forearm bones for optimal functional outcomes. We report a case of elbow dislocation with fracture of the lateral condyle of the humerus along with fractures of shafts of the radius and ulna in a 44-year-old female. Closed reduction of the elbow and operative stabilization of all fractures were done with good clinical, radiological and functional outcomes in 2 years follow-up period. A significant degree of force is needed to produce a combined dislocation of a joint and fracture of bones around that joint and these complex injuries may be missed if the clinician is not aware of the possibility of such injuries. The fact that the previously reported cases had a posterolateral dislocation while our case had a posteromedial dislocation and a fracture of the lateral humeral condyle as well makes it unique in its presentation and worth reporting. We have also included an up to date literature review on this topic.

  10. Pediatric diaphyseal forearm fractures: epidemiology and treatment in an urban population during a 10-year period, with special attention to titanium elastic nailing and its complications.

    PubMed

    Lyman, Amanda; Wenger, Daniel; Landin, Lennart

    2016-09-01

    This study aims to describe the epidemiology of pediatric diaphyseal forearm fractures in an urban population and the complications of titanium elastic nailing. The medical records of 456 consecutive fractures were reviewed. The annual incidence was 0.7/1000 children. Eighty-six (19%) fractures in 83 children were titanium elastic nailed. The complication rate was 24%. Dorsal entry to the radius was associated with extensor pollicis longus rupture and radial entry was associated with sensory nerve deficit in three cases each. Seventy-eight (94%) of the operated patients recovered completely. Titanium elastic nailing is effective, but associated with a high rate of complications, most of which resolve spontaneously.

  11. Management and Outcome of Dens Fracture Nonunions in Geriatric Patients.

    PubMed

    Joestl, Julian; Lang, Nikolaus W; Tiefenboeck, Thomas M; Hajdu, Stefan; Platzer, Patrick

    2016-02-03

    Dens fractures are known to have high rates of pseudarthrosis. The aim of this study was to define clinical and radiographic long-term outcomes, specifically in relation to osseous union, cervical spine movement, neurological sequelae, and quality of life, in a geriatric cohort (sixty-five years of age or older) treated operatively or nonoperatively for a dens fracture nonunion. Forty-four patients (twenty-eight women and sixteen men; average age, seventy-two years) met the inclusion criteria and were enrolled in this study. Sixteen patients (36%) underwent operative stabilization with posterior cervical arthrodesis, and twenty-eight (64%) were treated nonoperatively with a predefined protocol. All patients had a post-treatment follow-up period of at least five years. Radiographic evaluation showed osseous union at the site of the C1-C2 arthrodesis in all sixteen patients who had undergone surgical treatment. Clinical follow-up revealed that fourteen had satisfactory results following postoperative rehabilitation. In contrast, radiographic evaluation of the twenty-eight nonoperatively treated patients showed persistence of the pseudarthrosis of the dens in twenty-six and osseous union of the dens in two. All twenty-eight patients (100%) had a satisfactory clinical outcome. C1-C2 arthrodesis was a reliable treatment option for dens fracture nonunions that were unstable, those associated with neurological symptoms, and those causing persistent pain. Clinical and radiographic monitoring was an acceptable nonoperative treatment option but was associated with a very low rate of osseous union of the dens. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  12. Epidemiology of Fracture Nonunion in 18 Human Bones.

    PubMed

    Zura, Robert; Xiong, Ze; Einhorn, Thomas; Watson, J Tracy; Ostrum, Robert F; Prayson, Michael J; Della Rocca, Gregory J; Mehta, Samir; McKinley, Todd; Wang, Zhe; Steen, R Grant

    2016-11-16

    Failure of bone fracture healing occurs in 5% to 10% of all patients. Nonunion risk is associated with the severity of injury and with the surgical treatment technique, yet progression to nonunion is not fully explained by these risk factors. To test a hypothesis that fracture characteristics and patient-related risk factors assessable by the clinician at patient presentation can indicate the probability of fracture nonunion. An inception cohort study in a large payer database of patients with fracture in the United States was conducted using patient-level health claims for medical and drug expenses compiled for approximately 90.1 million patients in calendar year 2011. The final database collated demographic descriptors, treatment procedures as per Current Procedural Terminology codes; comorbidities as per International Classification of Diseases, Ninth Revision codes; and drug prescriptions as per National Drug Code Directory codes. Logistic regression was used to calculate odds ratios (ORs) for variables associated with nonunion. Data analysis was performed from January 1, 2011, to December 31, 2012. Continuous enrollment in the database was required for 12 months after fracture to allow sufficient time to capture a nonunion diagnosis. The final analysis of 309 330 fractures in 18 bones included 178 952 women (57.9%); mean (SD) age was 44.48 (13.68) years. The nonunion rate was 4.9%. Elevated nonunion risk was associated with severe fracture (eg, open fracture, multiple fractures), high body mass index, smoking, and alcoholism. Women experienced more fractures, but men were more prone to nonunion. The nonunion rate also varied with fracture location: scaphoid, tibia plus fibula, and femur were most likely to be nonunion. The ORs for nonunion fractures were significantly increased for risk factors, including number of fractures (OR, 2.65; 95% CI, 2.34-2.99), use of nonsteroidal anti-inflammatory drugs plus opioids (OR, 1.84; 95% CI, 1.73-1.95), operative

  13. Corrective Osteotomy of Malunited Diaphyseal Fractures of the Forearm Simplified Using 3-Dimensional CT Data: Proposal of Our Simple Strategy Through Case Presentation.

    PubMed

    Hamada, Yoshitaka; Gotani, Hiroyuki; Sasaki, Kousuke; Tanaka, Yoshitaka; Egawa, Hiroshi; Kanchanathepsak, Thepparat

    2017-09-01

    Reconstruction of malunited diaphyseal fractures of the forearm is one of the most difficult treatments due to its complicated structure. Widespread usage of Digital Imaging and Communications in Medicine (DICOM) data of 3-dimensional (3D) computed tomography (CT) and 3D printing can make estimating the true plane of the deformity easy. A 21-year-old man with limited supination due to left forearm nonunion deformity initially treated by locking plate fixation was referred to our hospital. We evaluated the deformity by superimposing the mirror image bone model of the contralateral normal bone onto a model of the affected bone and 3D real full-scale bone model. The patient underwent a manual corrective osteotomy according to our planning. He had satisfactory improvement of his symptoms with no complications. We postulated that our simple preoperative simulation and manual osteotomy with the aid of 3D CT reconstruction and 3D real full-scale bone model fit in the clinical practice as a recent trend.

  14. Complications and outcomes of diaphyseal forearm fracture intramedullary nailing: a comparison of pediatric and adolescent age groups.

    PubMed

    Martus, Jeffrey E; Preston, Ryan K; Schoenecker, Jonathan G; Lovejoy, Steven A; Green, Neil E; Mencio, Gregory A

    2013-09-01

    Flexible intramedullary nailing (IMN) has become a popular technique for the management of unstable or open forearm fractures. Recent publications have suggested an increased incidence of delayed union and poor outcomes in older children and adolescents. The objective of this study was to review forearm fractures treated with IMN, comparing the rate of complications and outcomes between the 2 age groups. Our hypothesis was that IMN is an effective technique with a similar rate of complications in both age groups. An Institutional Review Board-approved retrospective review was conducted of pediatric forearm fractures treated from 1998 to 2008 at a single institution. Over the study time period, 4161 pediatric forearm fractures were managed nonoperatively (92%) and 353 were treated operatively with plate, cross-pin, or intramedullary fixation (8%). Patients with inadequate follow-up, cross-pin, or plate fixation were excluded. Medical records were reviewed for indications and complications. Complications were graded with a modification of the Clavien-Dindo classification. Outcomes were judged by a new grading system. A total of 205 forearm fractures treated with IMN in 203 patients were identified. The mean age was 9.7 years (range, 1.7 to 16.2 y) and mean follow-up was 42 weeks. Operative indications were failure of closed treatment in 165 (80%) and open fracture in 40 (20%). Mean time from injury to IMN was 5.9 days (range, 0 to 25 d). Single bone IMN was performed in 40 of 185 both bone fractures (26%); there were 20 single-bone forearm fractures treated with IMN. Open reduction was required in 61/165 (37%) of closed fractures. Asymptomatic delayed union (grade 1 complication) was observed in 9 fractures (4%). More severe complications were noted in 17% (grade 2 to 4 complications). Postoperative compartment syndrome occurred in 3 isolated forearm fractures with a significant younger mean age (6.0 vs. 10 y, P=0.031). Overall, complications were significantly more

  15. Increasing rates of surgical treatment for paediatric diaphyseal forearm fractures: a National Database Study from 2000 to 2012.

    PubMed

    Cruz, A I; Kleiner, J E; DeFroda, S F; Gil, J A; Daniels, A H; Eberson, C P

    2017-06-01

    Purpose fractures are one of the most commonly sustained injuries in children and are often treated non-operatively. The purpose of this study was to estimate the rate of inpatient surgical treatment of paediatric forearm fractures over time using a large, publicly available, national database. The Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) was evaluated between 2000 and 2012. Forearm fractures and surgeries were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) diagnosis and procedure codes. Univariable and multivariable logistic regression were used to determine variables associated with greater proportion of surgical treatment. All statistical analyses were performed using SAS statistical software v.9.4 (SAS Institute Inc., Cary, NC, USA). Statistical significance was set at p < 0.05. The database identified 30 936 forearm fracture admissions. Overall, 19 837 of these patients were treated surgically (64.12%). The percentage of patients treated with surgery increased from 59.3% in 2000 to 70.0% in 2012 (p < 0.001). Multivariable regression analysis found increased age (p < 0.001), more recent year (p < 0.001), male gender (p = 0.003) and admission to a children's hospital (p < 0.001) were associated with an increased proportion of patients receiving surgical treatment. Medicaid payer status was associated with a lower proportion of surgical treatment (p < 0.001). The rate of operative treatment for paediatric forearm fractures admitted to the hospital increased over time. Increased surgical rates were associated with older age, male gender, treatment at a children's hospital and non-Medicaid insurance status.

  16. Corrective Osteotomy for Malunited Diaphyseal Forearm Fractures Using Preoperative 3-Dimensional Planning and Patient-Specific Surgical Guides and Implants.

    PubMed

    Byrne, Ann-Maria; Impelmans, Bianca; Bertrand, Veronique; Van Haver, Annemieke; Verstreken, Frederik

    2017-07-11

    Three-dimensional planning based on computed tomography images of the malunited and the mirrored contralateral forearm allows preoperative simulations of corrective osteotomies, the fabrication of patient-specific osteotomy guides, and custom-made 3-dimensional printed titanium plates. This study aims to assess the precision and clinical outcome of this technique. This was a prospective pilot study with 5 consecutive patients. The mean age at initial injury was 11 years (range, 4-16 years), and the mean interval from the time of injury to the time of corrective surgery was 32 months (range, 7-107 months). Patient-specific osteotomy guides and custom-made plates were used for multiplanar corrective osteotomies of both forearm bones at the distal level in 1 patient and at the middle-third level in 4 patients. Patients were assessed before and after surgery after a mean follow-up of 42 months (range, 29-51 months). The mean planned angular corrections of the ulna and radius before surgery were 9.9° and 10.0°, respectively. The mean postoperative corrections obtained were 10.1° and 10.8° with corresponding mean errors in correction of 1.8° (range, 0.3°-5.2°) for the ulna and 1.4° (range, 0.2°-3.3°) for the radius. Forearm supination improved significantly from 47° (range, 25°-75°) before surgery to 89° (range, 85°-90°) at final review. Forearm pronation improved from 68° (range, 45°-84°) to 87° (range, 82°-90°). In addition, there was a statistically significant improvement in pain and grip strength. This study demonstrates that 3-dimensional planned patient-specific guides and implants allow the surgeon to perform precise corrective osteotomies of complex multiplanar forearm deformities with satisfactory preliminary results. Therapeutic V. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  17. Shock wave therapy compared with intramedullary screw fixation for nonunion of proximal fifth metatarsal metaphyseal-diaphyseal fractures.

    PubMed

    Furia, John P; Juliano, Paul J; Wade, Allison M; Schaden, Wolfgang; Mittermayr, Rainer

    2010-04-01

    The current "gold standard" for treatment of chronic fracture nonunion in the metaphyseal-diaphyseal region of the fifth metatarsal is intramedullary screw fixation. Complications with this procedure, however, are not uncommon. Shock wave therapy can be an effective treatment for fracture nonunions. The purpose of this study was to evaluate the safety and efficacy of shock wave therapy as a treatment of these nonunions. Twenty-three patients with a fracture nonunion in the metaphyseal-diaphyseal region of the fifth metatarsal received high-energy shock wave therapy (2000 to 4000 shocks; energy flux density per pulse, 0.35 mJ/mm(2)), and twenty other patients with the same type of fracture nonunion were treated with intramedullary screw fixation. The numbers of fractures that were healed at three and six months after treatment in each group were determined, and treatment complications were recorded. Twenty of the twenty-three nonunions in the shock wave group and eighteen of the twenty nonunions in the screw fixation group were healed at three months after treatment. One of the three nonunions that had not healed by three months in the shock wave group was healed by six months. There was one complication in the shock wave group (post-treatment petechiae) and eleven complications in the screw-fixation group (one refracture, one case of cellulitis, and nine cases of symptomatic hardware). Both intramedullary screw fixation and shock wave therapy are effective treatments for fracture nonunion in the metaphyseal-diaphyseal region of the fifth metatarsal. Screw fixation is more often associated with complications that frequently result in additional surgery.

  18. Prospective clinical trial of surgical intervention for painful rib fracture nonunion.

    PubMed

    Fabricant, Loic; Ham, Bruce; Mullins, Richard; Mayberry, John

    2014-06-01

    We performed a prospective clinical trial of resection with or without plate fixation for symptomatic rib fracture nonunion three or more months postinjury with 6-month postoperative followup. The McGill Pain Questionnaire (MPQ) and RAND 36 Health Survey were administered and activity level (sedentary, ambulatory, moderately active, vigorous), functional status (disabled, nonphysical labor, physical labor), and work status (employed, unemployed, retired, student) were queried pre- and postoperatively. Twenty-four patients 4 to 197 months (median, 16 months) postinjury underwent surgical intervention for one to four rib fracture nonunions (median, two nonunions). Evidence of intercostal nerve entrapment was present in nine patients (38%). MPQ Present Pain Intensity and Pain Rating Index and RAND 36 Physical Functioning, Role Physical, Social Functioning, Role Social, Bodily Pain, Vitality, Mental Health, and General Health were significantly improved at six months compared with study entry (P < 0.05). Activity levels significantly improved (P < 0.0001) but functional and work status did not change. Twenty-four-hour morphine equivalent dosage of opioids at study entry was 20.3 ± 30.8 (mean ± standard deviation) and at study completion was 9.4 ± 17.5 (P = 0.054). Complications included one wound infection, two partial screw backouts, and one chest wall hernia at one year after resection of adjacent nonunions with significant gaps repaired with absorbable plates. Surgical intervention for rib fracture nonunion may improve chronic pain and disability but without change in functional or work status. Resection of adjacent nonunions with significant gaps may lead to chest wall hernia.

  19. [Deep fascia composite autologous red bone marrow transplantation for the treatment of fracture nonunion].

    PubMed

    Ling, Hui-Min; Wu, Heng-Xuan; Huang, Cui-Ye; Ma, Shi-Qian

    2009-11-01

    According to bone regeneration under the membrane and the bone regeneration deep fascia composite autologous red bone marrow transplantation applied in the treatment of fracture nonunion, in order to find a simple and effective clinical treatment of nonunion. Since March 2006 to March 2009,17 patients of fracture nonunion were treated by the deep fascia composite autologous bone marrow transplantation,included 10 males and 7 females, aged from 7 to 52 years old (means 32 years). There were 10 cases of tibia, 5 cases of radius, 2 cases of clavicle. Injured to admission time was from 7 to 36 months (means 12 months). Ten cases underwent operation for 1 time,5 cases for twice and 2 cases for 3 times. The position of nonunion were all at bone shaft and the condition of the skin and soft tissue was good. X-ray film showed 11 cases of hyperplasia nonunion, 6 cases of shrinking. The original fixation were removed and the intramedullary nail or plate fixation were re-used, and fracture ends were sutured closed by autogenous deep fascia and implanted with autologous red bone marrow. Seventeen patients were followed-up for from 5 months to 2 years with an average of 1 year. Fracture healing time was from 12 to 20 weeks (means 16 weeks). According to the criteria of fracture healing to assess efficacy, the results were excellent in 14 cases, good in 2 cases and poor in 1 case. Deep fascia composite autologous autologous red bone marrow transplantation for the treatment of fracture nonunion is suitable at the bone shaft and good condition of skin and soft tissue. The method has been observed that the fracture healing time is short.

  20. The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection

    PubMed Central

    Tsang, J.; Hopper, G.; Keenan, G.; Simpson, A. H. R. W.

    2016-01-01

    Objectives A successful outcome following treatment of nonunion requires the correct identification of all of the underlying cause(s) and addressing them appropriately. The aim of this study was to assess the distribution and frequency of causative factors in a consecutive cohort of nonunion patients in order to optimise the management strategy for individual patients presenting with nonunion. Methods Causes of the nonunion were divided into four categories: mechanical; infection; dead bone with a gap; and host. Prospective and retrospective data of 100 consecutive patients who had undergone surgery for long bone fracture nonunion were analysed. Results A total of 31% of patients had a single attributable cause, 55% had two causes, 14% had three causes and 1% had all four. Of those (31%) with only a single attributable cause, half were due to a mechanical factor and a quarter had dead bone with a gap. Mechanical causation was found in 59% of all patients, dead bone and a gap was present in 47%, host factors in 43% and infection was a causative factor in 38% of patients. In all, three of 58 patients (5%) thought to be aseptic and two of nine (22%) suspected of possible infection were found to be infected. A total of 100% of previously treated patients no longer considered to have ongoing infection, had multiple positive microbiology results. Conclusion Two thirds of patients had multiple contributing factors for their nonunion and 5% had entirely unexpected infection. This study highlights the importance of identifying all of the aetiological factors and routinely testing tissue for infection in treating nonunion. It raises key points regarding the inadequacy of a purely radiographic nonunion classification system and the variety of different definitions for atrophic nonunion in the current mainstream classifications used for nonunion. Cite this article: L. Mills, J. Tsang, G. Hopper, G. Keenan, A. H. R. W. Simpson. The multifactorial aetiology of fracture nonunion

  1. Hypoxia and Reactive Oxygen Species Homeostasis in Mesenchymal Progenitor Cells Define a Molecular Mechanism for Fracture Nonunion.

    PubMed

    Muinos-López, Emma; Ripalda-Cemboráin, Purificación; López-Martínez, Tania; González-Gil, Ana B; Lamo-Espinosa, José M; Valentí, Andrés; Mortlock, Douglas P; Valentí, Juan R; Prósper, Felipe; Granero-Moltó, Froilán

    2016-09-01

    Fracture nonunion is a major complication of bone fracture regeneration and repair. The molecular mechanisms that result in fracture nonunion appearance are not fully determined. We hypothesized that fracture nonunion results from the failure of hypoxia and hematoma, the primary signals in response to bone injury, to trigger Bmp2 expression by mesenchymal progenitor cells (MSCs). Using a model of nonstabilized fracture healing in transgenic 5'Bmp2BAC mice we determined that Bmp2 expression appears in close association with hypoxic tissue and hematoma during the early phases of fracture healing. In addition, BMP2 expression is induced when human periosteum explants are exposed to hypoxia ex vivo. Transient interference of hypoxia signaling in vivo with PX-12, a thioredoxin inhibitor, results in reduced Bmp2 expression, impaired fracture callus formation and atrophic-like nonunion by a HIF-1α independent mechanism. In isolated human periosteum-derived MSCs, BMP2 expression could be induced with the addition of platelets concentrate lysate but not with hypoxia treatment, confirming HIF-1α-independent BMP2 expression. Interestingly, in isolated human periosteum-derived mesenchymal progenitor cells, inhibition of BMP2 expression by PX-12 is accomplished only under hypoxic conditions seemingly through dis-regulation of reactive oxygen species (ROS) levels. In conclusion, we provide evidence of a molecular mechanism of hypoxia-dependent BMP2 expression in MSCs where interference with ROS homeostasis specifies fracture nonunion-like appearance in vivo through inhibition of Bmp2 expression. Stem Cells 2016;34:2342-2353. © 2016 AlphaMed Press.

  2. Backout of the helical blade of proximal femoral nail antirotation and accompanying fracture nonunion.

    PubMed

    Niikura, Takahiro; Lee, Sang Yang; Matsumoto, Tomoyuki; Fukui, Tomoaki; Kawakami, Yohei; Akisue, Toshihiro; Kuroda, Ryosuke; Kurosaka, Masahiro

    2012-08-01

    This article describes a case of backout of the helical blade, a rare complication of proximal femoral nail antirotation. A 31-year-old man had sustained a trochanteric fracture of his right femur. Fracture fixation using proximal femoral nail antirotation and autologous bone grafting 7 months later were performed at another hospital. However, bony union was not obtained, and the patient's pain and limp persisted. Therefore, he presented to the current authors. A radiograph taken at presentation revealed backout of the helical blade and fracture nonunion. A radiograph taken 1 month later showed a more advanced backout of the helical blade. The authors performed exchange nailing supplemented with transplantation of peripheral blood CD34-positive cells and autologous bone grafting. The proximal femoral nail antirotation was revised to a long gamma 3 nail, and a U-lag screw was used to obtain better stability. The postoperative course was uneventful. The patient regained ambulation without pain or support at 12 weeks postoperatively. Radiographic bony union was completed 9 months postoperatively. At 1-year follow-up, he could run and stand on the previously injured leg and had returned to work. Backout of the helical blade should be considered as a possible complication of proximal femoral nail antirotation. Incomplete fixation of the helical blade is the possible reason for backout. The use of a helical blade in young patients may cause difficulty in insertion and result in incomplete fixation.

  3. Bone fracture nonunion rate decreases with increasing age: A prospective inception cohort study.

    PubMed

    Zura, Robert; Braid-Forbes, Mary Jo; Jeray, Kyle; Mehta, Samir; Einhorn, Thomas A; Watson, J Tracy; Della Rocca, Gregory J; Forbes, Kevin; Steen, R Grant

    2017-02-01

    Fracture nonunion risk is related to severity of injury and type of treatment, yet fracture healing is not fully explained by these factors alone. We hypothesize that patient demographic factors assessable by the clinician at fracture presentation can predict nonunion. A prospective cohort study design was used to examine ~2.5 million Medicare patients nationwide. Patients making fracture claims in the 5% Medicare Standard Analytic Files in 2011 were analyzed; continuous enrollment for 12months after fracture was required to capture the ICD-9-CM nonunion diagnosis code (733.82) or any procedure codes for nonunion repair. A stepwise regression analysis was used which dropped variables from analysis if they did not contribute sufficient explanatory power. In-sample predictive accuracy was assessed using a receiver operating characteristic (ROC) curve approach, and an out-of-sample comparison was drawn from the 2012 Medicare 5% SAF files. Overall, 47,437 Medicare patients had 56,492 fractures and 2.5% of fractures were nonunion. Patients with healed fracture (age 75.0±12.7SD) were older (p<0.0001) than patients with nonunion (age 69.2±13.4SD). The death rate among all Medicare beneficiaries was 4.8% per year, but fracture patients had an age- and sex-adjusted death rate of 11.0% (p<0.0001). Patients with fracture in 14 of 18 bones were significantly more likely to die within one year of fracture (p<0.0001). Stepwise regression yielded a predictive nonunion model with 26 significant explanatory variables (all, p≤0.003). Strength of this model was assessed using an area under the curve (AUC) calculation, and out-of-sample AUC=0.710. A logistic model predicted nonunion with reasonable accuracy (AUC=0.725). Within the Medicare population, nonunion patients were younger than patients who healed normally. Fracture was associated with increased risk of death within 1year of fracture (p<0.0001) in 14 different bones, confirming that geriatric fracture is a major public

  4. Serum N-terminal telopeptide of type I collagen as an early marker of fracture nonunion in rabbits

    PubMed Central

    Lin, Jian-Ping; Shi, Zhan-Jun; Shen, Ning-Jiang; Wang, Jian; Li, Zao-Min; Xiao, Jun

    2016-01-01

    The aim of the present study was to establish an experimental animal model of fracture nonunion, and to investigate the changes in serum biomarker concentrations in fracture nonunion. A total of 20 purebred New Zealand rabbits were divided into two group: A bone defect group and a bone fracture group. In the bone defect group, a 15-mm section of bone (including the periosteum) was removed from the mid-radius, and the medullary cavities were closed with bone wax. In the bone fracture group, the mid-radius was fractured. X-rays were taken and blood samples were collected preoperatively and at 2, 3, 4, 5, 6, 7, 8, 10 and 12 weeks after the surgical procedure. The serum concentrations of osteocalcin (OC) and bone-specific alkaline phosphatase (BSAP) served as markers of bone formation, and those of C-terminal telopeptide of type I collagen (CTX), N-terminal telopeptide of type I collagen (NTX) and tartrate-resistant acid phosphatase 5b (TRACP 5b) served as markers of bone resorption. The concentration levels of the markers were measured using a biotin double-antibody sandwich enzyme-linked immunosorbent assay. In the bone defect group, bone callus was observed on X-ray at 2 weeks in three rabbits and the bone calluses stabilized at 5 weeks; however, none of the bones had healed at 8 weeks. In the bone fracture group, the fracture line was distorted at 2 weeks and bone calluses formed at 6–8 weeks. In the bone defect group, the serum BSAP and TRACP 5b concentrations increased following the surgical procedure, peaked at 4 weeks, began to decrease at 5 weeks and stabilized after 6 weeks. The serum OC concentrations did not change significantly following the surgical procedure. The serum CTX concentrations fluctuated during the first 4 weeks, peaked at 5 weeks, then decreased and stabilized after 6 weeks. The serum NTX concentrations fluctuated during the first 4 weeks, were significantly lower at 5 weeks compared with the other time points and stabilized after 6 weeks

  5. Outcomes and complication rates of different bone grafting modalities in long bone fracture nonunions: a retrospective cohort study in 182 patients

    PubMed Central

    2013-01-01

    Background Novel bone substitutes have challenged the notion of autologous bone grafting as the ‘gold standard’ for the surgical treatment of fracture nonunions. The present study was designed to test the hypothesis that autologous bone grafting is equivalent to other bone grafting modalities in the management of fracture nonunions of the long bones. Methods A retrospective review of patients with fracture nonunions included in two prospective databases was performed at two US level 1 trauma centers from January 1, 1998 (center 1) or January 1, 2004 (center 2), respectively, until December 31, 2010 (n = 574). Of these, 182 patients required adjunctive bone grafting and were stratified into the following cohorts: autograft (n = 105), allograft (n = 38), allograft and autograft combined (n = 16), and recombinant human bone morphogenetic protein-2 (rhBMP-2) with or without adjunctive bone grafting (n = 23). The primary outcome parameter was time to union. Secondary outcome parameters consisted of complication rates and the rate of revision procedures and revision bone grafting. Results The autograft cohort had a statistically significant shorter time to union (198 ± 172–225 days) compared to allograft (416 ± 290–543 days) and exhibited a trend towards earlier union when compared to allograft/autograft combined (389 ± 159–619 days) or rhBMP-2 (217 ± 158–277 days). Furthermore, the autograft cohort had the lowest rate of surgical revisions (17%) and revision bone grafting (9%), compared to allograft (47% and 32%), allograft/autograft combined (25% and 31%), or rhBMP-2 (27% and 17%). The overall new-onset postoperative infection rate was significantly lower in the autograft group (12.4%), compared to the allograft cohort (26.3%) (P < 0.05). Conclusion Autologous bone grafting appears to represent the bone grafting modality of choice with regard to safety and efficiency in the surgical management of long bone fracture nonunions. PMID:24016227

  6. Isolated Diaphyseal Fractures of the Radius in Skeletally Immature Patients

    PubMed Central

    Guitton, Thierry G.; Van Dijk, Niek C.; Raaymakers, Ernst L.

    2009-01-01

    Diaphyseal radius fractures without associated ulna fracture or radioulnar dislocation (isolated fracture of the radius) are recognized in adults but are rarely described in skeletally immature patients. A search of our database (1974–2002) identified 17 pediatric patients that had an isolated fracture of the radius. Among the 13 patients with at least 1 year follow-up, ten were treated with manipulative reduction and immobilization in an above elbow cast and three had initial operative treatment with plate and screw fixation. These 13 patients were evaluated for an average of 18 months (range, 12 to 45 months) after injury using the system of Price and colleagues. The incidence of isolated diaphyseal radius fractures in skeletally immature patients was 0.56 per year in our database and represented 27% of the 63 patients with a diaphyseal forearm fracture. All 13 patients, with at least 1 year follow-up, regained full elbow flexion and extension and full forearm rotation. According to the classification system of Price, all 13 patients (100%) had an excellent result. As in adults, isolated radius fractures seem to occur in children more frequently than previously appreciated. Treatment of isolated radius fractures in skeletally immature patients has a low complication rate, and excellent functional outcomes are the rule. PMID:19859772

  7. Infected forearm nonunion treated by bone transport after debridement

    PubMed Central

    2013-01-01

    Background This is a therapeutic study to evaluate the results of the management of forearm infected nonunion using bone transport with external fixators after debridement. Methods We have retrospectively reviewed a consecutive series of 21 patients from October 1994 to June 2010 in our institution who were treated for the forearm infected nonunion by bone transport with external fixator after debridement. There were 12 males and 9 females. The mean age of the patients was 27.1 years. Of the initial fractures, nonunion of the radius alone invovled in 7 patients, nonunion of the ulna alone invovled in 12, and nonunion of the radius and ulna invovled in 2. Nineteen limbs (85.7%) were in active infected state with sinus and drainage. The mean amount of bone defect was 3.1 cm (range 1.8-4.6 cm) as measured on plain radiographs. Results The mean follow-up was 77.5 months. All patients achieved bony union and were satisfied with the functional and cosmetic outcome. All the infection had been controlled. The mean external fixation index was 42.5 day/cm. The average time for wound healing was 42 days. The mean length gained was 3.5 cm (2.1-5.3 cm). Conclusions The technique of bone transport after debridement is a safe, effective, and minimally invasive treatment for forearm infected nonunion. PMID:24053582

  8. Treatment of chronic (>1 year) fracture nonunion: heal rate in a cohort of 767 patients treated with low-intensity pulsed ultrasound (LIPUS).

    PubMed

    Zura, Robert; Della Rocca, Gregory J; Mehta, Samir; Harrison, Andrew; Brodie, Chris; Jones, John; Steen, R Grant

    2015-10-01

    Established fracture nonunions rarely heal without secondary intervention. Revision surgery is the most common intervention, though non-surgical options for nonunion would be useful if they could overcome nonunion risk factors. Our hypothesis is that low-intensity pulsed ultrasound (LIPUS) can enhance heal rate (HR) in fractures that remain nonunion after one year, relative to the expected HR in the absence of treatment, which is expected to be negligible. We collated outcomes from a prospective patient registry required by the U.S. Food & Drug Administration. Patient data were collected over a 4-year period beginning in 1994 and were individually reviewed and validated by a registered nurse. Patients were only included if they had four data points available: date when fracture occurred; date when LIPUS treatment began; date when LIPUS treatment ended; and a dichotomous outcome of healed vs. failed, assessed by clinical and radiological criteria. Data were used to calculate two derived variables: days to treatment (DTT) with LIPUS, and days on treatment (DOT) with LIPUS. Every validated chronic nonunion patient (DTT>365 days) with complete data is reported. Heal rate for chronic nonunion patients (N=767) treated with LIPUS was 86.2%. Heal rate was 82.7% among 98 patients with chronic nonunion ≥5 years duration, and 12 patients healed after chronic nonunion >10 years (HR=63.2%). There was more patient loss to follow-up, non-compliance, and withdrawal, comparing chronic nonunion patients to all other patients (p<0.0001). Patient age was the only factor associated with failure to heal among chronic nonunions (p<0.004). Chronic nonunion patients averaged 3.1 surgical procedures prior to LIPUS, but some LIPUS-treated patients were able to heal without revision surgery. Among 91 patients who received LIPUS ≥90 days after their last surgery, HR averaged 85.7%, and the time from last surgery to index use of LIPUS averaged 449.6 days. Low-intensity pulsed ultrasound

  9. Forearm Fractures in Children

    MedlinePlus

    .org Forearm Fractures in Children The forearm is the part of the arm between the wrist and the elbow. It is ... two bones: the radius and the ulna. Forearm fractures are common in childhood, accounting for more than ...

  10. [Therapy principles of distal fractures of the forearm in childhood].

    PubMed

    Laurer, H; Sander, A; Wutzler, S; Walcher, F; Marzi, I

    2009-11-01

    Fractures of the forearm in children represent one of the most frequent injuries. Most are monotraumatic occurring during sport or leisure activities. Diagnosis can be made by conventional X-ray examination in 2 planes. Distal forearm fractures are classified into epiphyseolysis and epiphyseal fractures, metaphyseal greenstick and buckle fractures, complete distal radius and forearm fractures as well as Galeazzi lesions. The vast majority of cases without relevant dislocation can be treated with immobilization employing a cast. The remaining fractures have to be repositioned and restored depending on age and degree of dislocation.The state of the art in surgical therapy is the Kirschner wire osteosynthesis after closed reduction. Especially meta-diaphyseal fractures can alternatively be stabilized with plate osteosynthesis or external fixation. Following these therapeutic principles, prognosis is excellent and most of the injuries heal without any functional impairment.

  11. Scintigraphic findings in progressive diaphyseal dysplasia

    SciTech Connect

    Lundy, M.M.; Billingsley, M.L.; Redwine, M.D.; Turnbull, G.L.; Brown, T.J.

    1982-04-01

    A 14-yr-old white male with a severe form of progressive diaphyseal dysplasia (Engelmann-Camurati disease) was referred to our institution for evaluation of splenomegaly, which is not usually associated with the disease. Our studies included Tc-99m bone, bone-marrow, and liver-spleen scans. These scintigraphic findings, along with the probable cause for splenomegaly, are discussed.

  12. Scintigraphic findings in progressive diaphyseal dysplasia

    SciTech Connect

    Lundy, M.M.; Billingsley, J.L.; Redwine, M.D.; Turnbull, G.L.; Brown, T.J.

    1982-04-01

    A 14-yr-old white male with a severe form of progressive diaphyseal dysplasia (Engelmann-Camurati disease) was referred to our institution for evaluation of splenomegaly, which is not usually associated with the disease. Our studies included bone-marrow, and liver-spleen scans. These scintigraphic findings, along with the probable cause for splenomegaly, are discussed.

  13. Forearm neuropathy and pruritus.

    PubMed

    Massey, E W; Massey, J M

    1986-10-01

    Five adult patients (four of them men) had episodic brachioradial pruritus associated with forearm paresthesia and hypalgesia. No cervical, shoulder, or forearm trauma was known. Onset was variable, but two had had the condition for more than ten years. In each, sensory alteration was detectable by pinprick and temperature in the distribution of the posterior cutaneous nerve of the forearm supplying the skin over the proximal portion of the brachioradial muscle. This seems to be a benign neuropathy.

  14. Shock wave therapy of fracture nonunion.

    PubMed

    Alkhawashki, Hazem M I

    2015-11-01

    We have used the principles of extracorporeal shock wave therapy (ESWT) in the treatment of nonunion of fractures in 44 patients (49 bones).There were 35 males and 9 females with a mean age of 34 years(range14-70). Clinical and radiological assessment was performed at regular time intervals with a minimum follow up of 18 months. Most common sites involved were the femur and tibia. The average time from initial fracture treatment to intervention with ESWT was 11.9 months (6 months to 5 years). Thirty eight non-union sites had one session of treatment and the rest (11) had more than one session. Union was successful in 75.5% of cases at a mean time of 10.2 months (range 3-19). Failure in the remaining cases was due to more than 5mm gap, instability, compromised vascularity (type of bone) and deep low grade infection; which was discovered at the time of surgical intervention when no signs of radiological healing occurred after 6 months from treatment. Failing sites were shaft of femur, scaphoid, neck of humerus and neck of femur. No local complications were observed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Bipolar dislocation of the forearm (floating forearm).

    PubMed

    Aşkar, Hüseyin; Ertürk, Cemil; Altay, Mehmet Akif; Akif Altay, Mehmet; Bilge, Ali

    2014-01-01

    Bipolar dislocation of the forearm (floating forearm) is an unusual injury and is therefore often overlooked. We report a 28-year-old male patient who presented at another center with a history of a fall while climbing a tree. The patient's left elbow was treated with closed reduction and immobilization with a long-arm cast brace due to elbow dislocation. However, the patient was admitted with pain and swelling of the wrist to our emergency department the following day. Physical and radiological examination revealed dorsal trans-scaphoid perilunate dislocation. A dorsal incision was performed for open reduction and internal fixation to provide wide surgical exposure. Concomitant occurrence of elbow dislocation and fracture-dislocation of the perilunate is infrequent. Therefore, physicians should be aware of possible additional injuries and current recommended treatment methods.

  16. Functional significance of genetic variation underlying limb bone diaphyseal structure

    PubMed Central

    Wallace, Ian J.; Middleton, Kevin M.; Lublinsky, Svetlana; Kelly, Scott A.; Judex, Stefan; Garland, Theodore; Demes, Brigitte

    2010-01-01

    Limb bone diaphyseal structure is frequently used to infer hominin activity levels from skeletal remains, an approach based on the well-documented ability of bone to adjust to its loading environment during life. However, diaphyseal structure is also determined in part by genetic factors. This study investigates the possibility that genetic variation underlying diaphyseal structure is influenced by the activity levels of ancestral populations and might also have functional significance in an evolutionary context. We adopted an experimental evolution approach and tested for differences in femoral diaphyseal structure in one-week-old mice from a line that had been artificially selected (45 generations) for high voluntary wheel running and unselected controls. As adults, selected mice are significantly more active on wheels and in home cages, and have thicker diaphyses. Structural differences at one week can be assumed to primarily reflect the effects of selective breeding rather than direct mechanical stimuli, given that the onset of locomotion in mice is shortly after day seven. We hypothesized that if genetically determined diaphyseal structure reflects the activity patterns of members of a lineage, then selected animals will have relatively larger diaphyseal dimensions at one week compared to controls. The results provide strong support for this hypothesis and suggest that limb bone cross sections may not always only reflect the activity levels of particular fossil individuals, but also convey an evolutionary signal providing information about hominin activity in the past. PMID:20310061

  17. Variations in the Anatomic Relations of the Posterior Interosseous Nerve Associated with Proximal Forearm Trauma

    PubMed Central

    Calfee, Ryan P.; Wilson, Joyce M.; Wong, Ambrose H.W.

    2011-01-01

    Background: The posterior interosseous nerve is at risk for iatrogenic injury during surgery involving the proximal aspect of the radius. Anatomic relationships of this nerve in skeletally intact cadavers have been defined, but variations associated with osseous and soft-tissue trauma have not been examined. This study quantifies the effect of a simulated diaphyseal fracture of the proximal aspect of the radius and of a radial neck fracture with an Essex-Lopresti injury on the posterior interosseous nerve. Methods: In twenty unembalmed cadaveric upper extremities, the distance from the radiocapitellar joint to the point where the posterior interosseous nerve crosses the midpoint of the axis of the radius (Thompson approach) was recorded in three forearm positions (supination, neutral, and pronation). Specimens were then treated with either proximal diaphyseal osteotomy (n = 10) or radial head excision with simulated Essex-Lopresti injury (n = 10), and the position of the nerve in each forearm position was remeasured. We evaluated the effect of the simulated trauma on nerve position and correlated baseline measurements with radial length. Results: In neutral rotation, the posterior interosseous nerve crossed the radius at a mean of 4.2 cm (range, 2.5 to 6.2 cm) distal to the radiocapitellar joint. In pronation, the distance increased to 5.6 cm (range, 3.1 to 7.4 cm) (p < 0.01). Supination decreased that distance to 3.2 cm (range, 1.7 to 4.5 cm) (p < 0.01). Radial length correlated with each of these measurements (r > 0.50, p = 0.01). Diaphyseal osteotomy of the radius markedly decreased the effect of forearm rotation, as the change in nerve position from supination to pronation decreased from 2.13 ± 0.8 cm to 0.24 ± 0.2 cm (p = 0.001). Proximal migration of the radius following radial head excision was accompanied by similar magnitudes of proximal nerve migration in all forearm positions. Conclusions: Forearm pronation has minimal effect on posterior interosseous

  18. Refractures of the paediatric forearm with the intramedullary nail in situ

    PubMed Central

    van Egmond, Pim W; van der Sluijs, Hans A; van Royen, Barend J; Saouti, Rachid

    2013-01-01

    Forearm fractures in children are common. When conservative treatment fails, internal fixation with Elastic Stable Intramedullary Nailing (ESIN) become the first choice in the operative treatment of diaphyseal forearm shaft fractures. Refractures with the intramedullary nail in situ are known to occur but formal guidelines to guide management in such fractures are lacking. We present a well-documented case of a radius midshaft refracture in a 12-year-old boy with the intramedullary nail in situ, managed by closed reduction. Literature is reviewed for this type of complication, the treatment of 30 similar cases is discussed and a treatment strategy is defined. The refracture of the paediatric forearm fracture with the intramedullary nail in situ is a rare, but probably under recognised complication which is observed in approximately 2.3% of the study population. Closed reduction may be considered in these cases. PMID:24068378

  19. Adult diaphyseal both-bone forearm fractures: A clinical and biomechanical comparison of four different fixations.

    PubMed

    Zhang, X F; Huang, J W; Mao, H X; Chen, W B; Luo, Y

    2016-05-01

    Although there have been a small number of studies reporting single bone fixation of either radius or ulna as well as hybrid fixation, the paucity of data for the hybrid fixation method still remains. Hybrid fixation with plate and IM nailing would achieve good fixation and functional outcome, minimal damage to soft tissues and lower re-fracture risk. Forty cadavers (20 males, 20 females; mean age 68.06, SD 1.58years) were selected in biomechanical study under axial loading, bending loading, and torsional loading. Eighty-seven patients (47 males, 40 females; mean age 38.03±0.88years) were enrolled in the clinical study and randomly received different fixation: both-bone plate fixation or both-bone intramedullary nailing, plate fixation of ulna and intramedullary nailing of radius and intramedullary nailing of ulna and plate fixation of radius. In the biomechanical study, intramedullary nailing of ulna and plate fixation of radius had similar results with that using both-bone plate method under axial, bending and torsional loading (All P>0.05), suggesting the more stable fixation compared with the other two groups (All P<0.05). In clinical research, both-bone intramedullary nailing was related to shortest operative time, smallest wound size and periosteal stripping area compared with other three groups (P<0.05). Patients receiving intramedullary nailing of ulna and plate fixation of radius showed the lowest incidence of postoperative complications and the best functional recovery outcome comparing with other three groups of patients (Both P<0.05). The hybrid fixation method of intramedullary nailing of ulna and plate fixation of radius showed good stability in biomechanics, fewer complications and better functional clinical outcomes. Level II, prospective randomised study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  20. Elastic robust intramedullary nailing for forearm fracture in children

    PubMed Central

    Aidelsburger, Pamela; Grabein, Kristin; Huber, Alois; Hertlein, Hans; Wasem, Jürgen

    2006-01-01

    Background Forearm fractures are the most common fractures in children (23% of all fractures). Basically there are two treatment options available for diaphyseal forearm fractures in children: closed reduction with cast immobilisation (conservative therapy) and the elastic stable intramedullary nailing (ESIN). Treatment decision is influenced by the doctor's estimation of fracture instability. Stable fractures can be treated conservatively whereas instable forearm shaft fractures can be treated according the following three treatment strategies: conservative therapy in an outpatient setting conservative therapy in the operating room in attendance to change to ESIN in case that no stabilisation can be achieved with cast immobilisation immediate treatment with ESIN in the operating room. Objectives Aim of this Health Technology Assessment (HTA) report is to assess and report the published evidence concerning effectiveness and cost-effectiveness of ESIN as a treatment option for diaphyseal forearm fractures in children and to identify future research need. Important parameters for the assessment of effectiveness are objective parameters (axis deviation, losses of motion, and numbers of reductions in case of redislocations) and subjective parameters (pain or impairment in quality of life). Furthermore, a health economic evaluation shall be done which refers to the costs of the different therapy strategies. Methods An extensive, systematic literature search in medical, economic, and HTA literature databases was performed. Relevant data were extracted and synthesised. Results Three cohort studies and seven case series have been identified. Controlled clinical studies, systematic reviews and/or HTA reports that gave evidence to answer the own study question have not been found. The identified studies partly differed in respect of defined indication for ESIN, study population and treatment strategies. For that reason comparability of results was limited. In the majority of

  1. X-Ray Exam: Forearm

    MedlinePlus

    ... Habits for TV, Video Games, and the Internet X-Ray Exam: Forearm KidsHealth > For Parents > X-Ray Exam: Forearm Print A A A What's in ... You Have Questions What It Is A forearm X-ray is a safe and painless test that uses ...

  2. Elastic stable intramedullary nailing in paediatric forearm fractures: the rate of open reduction and complications.

    PubMed

    Makki, Daoud; Matar, Hosam E; Webb, Mark; Wright, David M; James, Leroy A; Ricketts, David M

    2017-09-01

    The aim of this study was to evaluate the rate of open reduction and complications of elastic stable intramedullary nailing (ESIN) in treating unstable diaphyseal forearm fractures in children. We performed a retrospective review of a consecutive series of 102 paediatric patients with a mean age of 9 years (range: 7-14 years) who underwent ESIN of unstable closed forearm fractures at three different centres. Closed reduction of one or both bones was achieved in 68 (67%) patients and open reduction was required in 34 (33%) patients. The rate of open reduction in single-bone fractures (52.2%) was significantly higher than that in both-bone fractures (27.8%) (P=0.04, Fisher's exact test). All the fractures united within 3 months. There were six refractures following nail removal. Five patients had superficial wound infections. Seven patients developed neuropraxia of the sensory branch of the radial nerve. All resolved spontaneously within 3 months of the surgery. ESIN is an effective technique in treating unstable diaphyseal forearm fractures. The need for open reduction should be decided promptly following failed attempts of closed reduction. Single-bone fractures are more likely to require open reduction than both-bone fractures. The radius should be reduced and stabilized first. If open reduction is required, this should be performed through a volar approach rather than a dorsal one.

  3. Multiple forearm robotic elbow configuration

    DOEpatents

    Fisher, John J.

    1990-01-01

    A dual forearmed robotic elbow configuration comprises a main arm having a double elbow from which two coplanar forearms depend, two actuators carried in the double elbow for moving the forearms, and separate, independent end effectors, operated by a cable carried from the main arm through the elbow, is attached to the distal end of each forearm. Coiling the cables around the actuators prevents bending or kinking when the forearms are rotated 360 degrees. The end effectors can have similar or different capabilities. Actuator cannisters within the dual elbow are modular for rapid replacement or maintenance. Coarse and fine resolver transducers within the actuators provide accurate position referencing information.

  4. Experimental healing of distraction osteogenesis comparing metaphyseal with diaphyseal sites.

    PubMed

    Aronson, J; Shen, X

    1994-04-01

    Distraction osteogenesis was performed on 32 adult dogs to compare bone healing at metaphyseal and diaphyseal sites. Sixteen dogs underwent proximal metaphyseal corticotomy and 16 dogs underwent middiaphyseal corticotomy of the left tibiae for gradual lengthening. Each major group was then divided into four subgroups of four dogs each on the basis of zero-, seven-, 14- and 21-day latency periods. The standard radiograph, quantitative computer tomography density, and bone-healing index were used to evaluate new bone formation and consolidation. A distraction rate of 1 mm per day for four weeks created an average elongation of 23.9 +/- 3.7 mm in the metaphyseal groups and 23.8 +/- 2.0 mm in the diaphyseal groups, excluding nine premature consolidations. In the 16 metaphyseal lengthenings, there were six premature consolidations (37.5%): four with a 21-day latency, two with a 14-day latency, and one nonunion (6.2%). In the 16 diaphyseal lengthenings, three fused prematurely (18.7%), two with a 21-day latency and one incomplete corticotomy with a seven-day latency. Three lengthenings of the diaphyseal group resulted in nonunion (18.7%). All animals, metaphyseal and diaphyseal, successfully bridged the distraction gap after a zero-day latency. The bone-healing index showed that new bone consolidation was best with a zero-day latency in metaphyseal (22 +/- 7.6 days/cm) and diaphyseal lengthening (26.5 +/- 6.5 days/cm). Comparing the minimum quantitative computer tomography density ratio of the experimental side with the contralateral side indicated a significant difference at the end of distraction (p = 0.001), at fixator removal (p = 0.001), and when the dogs were killed (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

  5. A Rare Combination Open Fracture Dislocation of Elbow with Open Fracture both Bones Forearm with Radial Nerve Palsy

    PubMed Central

    Shivanna, Deepak; Aski, Bahubali; Manjunath, Dayanand; Bhatnagar, Abhinav

    2014-01-01

    Introduction: The injury pattern of open fracture dislocation of elbow with fracture both bones forearm with radial nerve injury is very rare. Very few reports are there in literature related to this kind of injury. However this combination is first of its kind. This rare injury needs special attention by early intervention and biological fixation to achieve good results. Case Report: A 22 year old female presented to us with history of road traffic accident. On evaluation patient had combination of open fracture dislocation of elbow with open diaphyseal fracture of both forearm bones with radial nerve palsy. The patient was treated in emergency and followed for 2 years. Conclusion: Open fracture dislocation of elbow is a rare entity. Our case additionally had open fracture both the bones forearm with radial nerve palsy. Early intervention and biological fixation with minimal invasion gives good results in terms of range of movements and patient satisfaction. PMID:27298951

  6. Intramedullary nailing of adult isolated diaphyseal radius fractures.

    PubMed

    Köse, Ahmet; Aydın, Ali; Ezirmik, Naci; Topal, Murat; Can, Cahit Emre; Yılar, Sinan

    2016-03-01

    The aim of the present study was to evaluate functional and cosmetic outcomes of adult patients who underwent intramedullary nailing with newly designed intramedullary radius nails for isolated radius diaphyseal fractures. Seventeen adult patients who had undergone intramedullary nailing for radius diaphyseal fractures were retrospectively evaluated. Patients with isolated radius diaphyseal closed fractures were included. Closed reduction was achieved in all patients. Wrist and elbow ranges of movement were calculated at final follow-up. Grip strength was calculated using a hydraulic hand dynamometer. Maximum radial bowing (MRB) and maximum radial bowing localization (MRBL) were calculated for treated and uninjured arms. Functional evaluation was performed using Grace-Eversman evaluation criteria and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score. Of the 17 patients with isolated radius diaphyseal fractures evaluated, 11 (64.7%) were male and 6 (35.3%) were female, with a mean age of 35.76 years (range: 23-61 years). Fractures were right-sided in 11 (64.7%) and left-sided in 6 (35.3%) patients. Mean time to bone union was 10.2 weeks (range: 8-20 weeks). Mean supination was 75.35º (range: 67º-80º), pronation was 85.18º (range: 74º-90º). According to Grace-Eversman evaluation criteria, results were excellent in 16 (94%) and good in 1 (6%) patient. Mean DASH score was 12.58 (3.3-32.5). The gold-standard treatment of adult isolated radius diaphyseal fractures is plate and screw osteosynthesis. However, intramedullary nailing of isolated radius fractures is a good alternative treatment method, with excellent functional results and union rates similar to those of plate and screw osteosynthesis.

  7. Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur.

    PubMed

    Black, Dennis M; Kelly, Michael P; Genant, Harry K; Palermo, Lisa; Eastell, Richard; Bucci-Rechtweg, Christina; Cauley, Jane; Leung, Ping Chung; Boonen, Steven; Santora, Arthur; de Papp, Anne; Bauer, Douglas C

    2010-05-13

    A number of recent case reports and series have identified a subgroup of atypical fractures of the femoral shaft associated with bisphosphonate use. A population-based study did not support this association. Such a relationship has not been examined in randomized trials. We performed secondary analyses using the results of three large, randomized bisphosphonate trials: the Fracture Intervention Trial (FIT), the FIT Long-Term Extension (FLEX) trial, and the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly (HORIZON) Pivotal Fracture Trial (PFT). We reviewed fracture records and radiographs (when available) from all hip and femur fractures to identify those below the lesser trochanter and above the distal metaphyseal flare (subtrochanteric and diaphyseal femur fractures) and to assess atypical features. We calculated the relative hazards for subtrochanteric and diaphyseal fractures for each study. We reviewed 284 records for hip or femur fractures among 14,195 women in these trials. A total of 12 fractures in 10 patients were classified as occurring in the subtrochanteric or diaphyseal femur, a combined rate of 2.3 per 10,000 patient-years. As compared with placebo, the relative hazard was 1.03 (95% confidence interval [CI], 0.06 to 16.46) for alendronate use in the FIT trial, 1.50 (95% CI, 0.25 to 9.00) for zoledronic acid use in the HORIZON-PFT trial, and 1.33 (95% CI, 0.12 to 14.67) for continued alendronate use in the FLEX trial. Although increases in risk were not significant, confidence intervals were wide. The occurrence of fracture of the subtrochanteric or diaphyseal femur was very rare, even among women who had been treated with bisphosphonates for as long as 10 years. There was no significant increase in risk associated with bisphosphonate use, but the study was underpowered for definitive conclusions. 2010 Massachusetts Medical Society

  8. The effect of tibial diaphyseal lengthening on the longitudinal growth of the tibia.

    PubMed

    Cai, Gang; Yang, Lang; Saleh, Michael; Coulton, Les

    2007-11-01

    Limb lengthening by tibial callotasis is usually performed in the metaphysis but may cause growth inhibition. Is diaphyseal lengthening more advantageous? Sixteen immature rabbits underwent 30% diaphyseal lengthening by tibial callotasis. The tibial length was measured on radiographs at the end of the distraction period and after an additional 5 weeks. The proximal and distal growth plates were assessed histomorphometrically. Osteotomy stimulated tibial elongation; however, combined with diaphyseal lengthening the stimulation was suppressed resulting in longitudinal growth that matched the control side. In longer lengthenings of limbs diaphyseal callotasis may be more advantageous than metaphyseal by not inhibiting longitudinal growth.

  9. Forearm training attenuates sympathetic responses to prolonged rhythmic forearm exercise

    NASA Technical Reports Server (NTRS)

    Sinoway, L.; Shenberger, J.; Leaman, G.; Zelis, R.; Gray, K.; Baily, R.; Leuenberger, U.

    1996-01-01

    We previously demonstrated that nonfatiguing rhythmic forearm exercise at 25% maximal voluntary contraction (12 2-s contractions/min) evokes sympathoexcitation without significant engagement of metabolite-sensitive muscle afferents (B.A. Batman, J.C. Hardy, U.A. Leuenberger, M.B. Smith, Q.X. Yang and L.I. Sinoway. J. Appl. Physiol. 76: 1077-1081, 1994). This is in contrast to the sympathetic nervous system responses observed during fatiguing static forearm exercise where metabolite-sensitive afferents are the key determinants of sympathetic activation. In this report we examined whether forearm exercise training would attenuate sympathetic nervous system responses to rhythmic forearm exercise. We measured heart rate, mean arterial blood pressure (MAP), muscle sympathetic nerve activity (microneurography), plasma norepinephrine (NE), and NE spillover and clearance (tritiated NE kinetics) during nonfatiguing rhythmic forearm exercise before and after a 4-wk unilateral forearm training paradigm. Training had no effect on forearm mass, maximal voluntary contraction, or heart rate but did attenuate the increase in MAP (increase in MAP: from 15.2 +/- 1.8 before training to 11.4 +/- 1.4 mmHg after training; P < 0.017), muscle sympathetic nerve activity (increase in bursts: from 10.8 +/- 1.4 before training to 6.2 +/- 1.1 bursts/min after training; P < 0.030), and the NE spillover (increases in arterial spillover: from 1.3 +/- 0.2 before training to 0.6 +/- 0.2 nmol.min-1.m-2 after training, P < 0.014; increase in venous spillover: from 2.0 +/- 0.6 before training to 1.0 +/- 0.5 nmol.min-1.m-2 after training, P < 0.037) seen in response to exercise performed by the trained forearm. Thus forearm training reduces sympathetic responses during a nonfatiguing rhythmic handgrip paradigm that does not engage muscle metaboreceptors. We speculate that this effect is due to a conditioning-induced reduction in mechanically sensitive muscle afferent discharge.

  10. Lengthening of congenital forearm stumps.

    PubMed

    Jasiewicz, Barbara; Tesiorowski, Maciej; Kacki, Wojciech; Kasprzyk, Marcin; Zarzycki, Daniel

    2006-05-01

    The Ilizarov device and distraction osteogenesis method became very useful in correction and elongation of forearm defects. Two cases of forearm elongation with congenital transverse defect are described. The construction of the device is provided. During follow-up examination, 2 and 7 years after the treatment, good clinical results were achieved in both patients with the use of upper limb prosthesis employing the patient's own elbow joint. Presented application of the Ilizarov method can significantly improve possibilities for the use of prosthesis in patients with congenital upper limb defects and result in better cosmetic and functional outcome.

  11. Robot Forearm and Dexterous Hand

    NASA Technical Reports Server (NTRS)

    Lovchik, Christopher S.

    2005-01-01

    An electromechanical hand-and-forearm assembly has been developed for incorporation into an anthropomorphic robot that would be used in outer space. The assembly is designed to offer manual dexterity comparable to that of a hand inside an astronaut s suit; thus, the assembly may also be useful as a prosthesis or as an end effector on an industrial robot.

  12. Diaphyseal humeral fractures and intramedullary nailing: Can we improve outcomes?

    PubMed Central

    Garnavos, Christos

    2011-01-01

    While intramedullary nailing has been established as the treatment of choice for diaphyseal fractures of the femur and tibia, its role in the management of diaphyseal humeral fractures remains controversial. The reasons include not only the complicated anatomy and unique biomechanical characteristics of the arm but also the fact that surgical technique and nail designs devised for the treatment of femoral and tibial fractures are being transposed to the humerus. As a result there is no consensus on many aspects of the humeral nailing procedure, e.g., the basic nail design, nail selection criteria, timing of the procedure, and the fundamental principles of the surgical technique (e.g., antegrade/retrograde, reamed/unreamed, and static/dynamic). These issues will be analyzed and discussed in the present article. Proposals aiming to improve outcomes include the categorization of humeral nails in two distinct groups: “fixed” and “bio”, avoidance of reaming for the antegrade technique and utilization of “semi-reaming” for the retrograde technique, guidelines for reducing complications, setting the best “timing” for nailing and criteria for selecting the most appropriate surgical technique (antegrade or retrograde). Finally, suggestions are made on proper planning and conducting clinical and biomechanical studies regarding the use of intramedullary nailing in the management of humeral shaft fractures. PMID:21559099

  13. Low complication rate of elastic stable intramedullary nailing (ESIN) of pediatric forearm fractures: A retrospective study of 202 cases.

    PubMed

    Kruppa, Christiane; Bunge, Pamela; Schildhauer, Thomas A; Dudda, Marcel

    2017-04-01

    Elastic stable intramedullary nailing (ESIN) has been established as state of the art treatment for forearm fractures in children, if operative stabilization is required. Their use has been expanded to single bone shaft fractures, and also more complex injuries such as Monteggia fractures or Monteggia-like lesions. A wide range of complications has been reported in the literature, up to 70% in certain investigations. The purpose of this study was to assess the complication rate after ESIN treatment of forearm fractures in children and adolescents in a representative cohort of patients from a level 1 trauma center in Germany.Between 2000 and 2015, we retrospectively analyzed all patients, up to the age of 16 years, with forearm fractures, who were operatively treated using ESIN in our department of general and trauma surgery. The main outcome measurements were the rates of postoperative complications after ESIN such as re-fracture, malunion, nonunion, tendon lesion, wound infection, and limited range of motion.In all, 201 consecutive patients with 202 forearm fractures were included in this study. Age averaged 9.7 years (range 3-16 years). Fifteen (7.4%) fractures were open. Fractures were 82.2% diaphyseal both-bone forearm fractures. Follow-up averaged 10.2 months (range 0.7-176.3 months). Complications were 10 re-fractures, 2 malunions, 3 extensor pollicis longus tendon ruptures, 1 superficial wound infection, and 2 limited range of motions. Fourteen (6.9%) children required a secondary operative intervention for their complication. Time to implant removal averaged 3.8 months (range 0.4-16.3 months).Elastic stable intramedullary nailing is a minimally invasive and reliable technique with a low complication rate. Both-bone forearm fractures and single bone fractures, and also Monteggia and Monteggia-equivalent fractures can be successfully treated with this method. As a major complication, re-fractures are frequently seen, even with ESIN in situ.

  14. Procedural Sedation With Ketamine Versus Propofol for Closed Reduction of Pediatric Both Bone Forearm Fractures.

    PubMed

    Morrison, Todd; Carender, Chris; Kilbane, Brendan; Liu, Raymond W

    2017-09-06

    Effective treatment of pediatric both bone forearm fractures consists of timely restoration of anatomic alignment with manipulation and immobilization, often accomplished with the aid of procedural sedation in the emergency department setting. The current lack of consensus regarding a safe and optimal regimen may result in inadequate sedation, compromised quality of reduction, or patient harm. The current study was conducted to answer the following questions for pediatric both bone forearm fractures treated with closed reduction with either ketamine or propofol procedural sedation: (1) Is there a difference in the rate of unacceptable alignment 4 weeks after reduction? (2) Is there a difference in the rates of major sedation-related complications? Medical records, data on procedural sedation, and radiographs of 74 skeletally immature patients with diaphyseal or distal metaphyseal both bone forearm fractures treated with manipulation were reviewed (ketamine sedation, 26; propofol sedation, 48). Rates of unacceptable alignment for the 2 cohorts were similar both immediately after reduction and at 4 weeks. Rates of complications of procedural sedation did not differ between cohorts. The duration of procedural sedation was longer and the padding index was greater with ketamine. Malalignment after reduction was more likely in older patients and those with a higher padding index. Although no difference was found in the rates of malalignment or sedation-related complications between fractures reduced with ketamine or propofol sedation, the sedation regimens differ in both procedural duration and padding index. Careful consideration of the risks and benefits of procedural sedation for closed reduction of pediatric forearm fractures is warranted. [Orthopedics. 201x; xx(x):xx-xx.]. Copyright 2017, SLACK Incorporated.

  15. Contralateral tactile masking between forearms.

    PubMed

    D'Amour, Sarah; Harris, Laurence R

    2014-03-01

    Masking effects have been demonstrated in which tactile sensitivity is affected when one touch is close to another on the body surface. Such effects are likely a result of local lateral inhibitory circuits that sharpen the spatial tuning of a given tactile receptor. Mutually inhibitory pathways have also been demonstrated between cortical tactile maps of the two halves of the body. Occasional reports have indicated that touches on one hand or forearm can affect tactile sensitivity at contralateral locations. Here, we measure the spatial tuning and effect of posture on this contralateral masking effect. Tactile sensitivity was measured on one forearm, while vibrotactile masking stimulation was applied to the opposite arm. Results were compared to sensitivity while vibrotactile stimulation was applied to a control site on the right shoulder. Sensitivity on the forearm was reduced by over 3 dB when the arms were touching and by 0.52 dB when they were held parallel. The masking effect depended on the position of the masking stimulus. Its effectiveness fell off by 1 STD when the stimulus was 29 % of arm length from the corresponding contralateral point. This long-range inhibitory effect in the tactile system suggests a surprisingly intimate relationship between the two sides of the body.

  16. [Diagnosis of the scaphoid bone : Fractures, nonunion, circulation, perfusion].

    PubMed

    Kahl, T; Razny, F K; Benter, J P; Mutig, K; Hegenscheid, K; Mutze, S; Eisenschenk, A

    2016-11-01

    The clinical relevance of scaphoid bone fractures is reflected by their high incidence, accounting for approximately 60 % among carpal fractures and for 2-3 % of all fractures. With adequate therapy most scaphoid bone fractures heal completely without complications. Insufficient immobilization or undiagnosed fractures increase the risk of nonunion and the development of pseudarthrosis.X-ray examination enables initial diagnosis of scaphoid fracture in 70-80 % of cases. Positive clinical symptoms by negative x‑ray results require further diagnostics by multi-slice spiral CT (MSCT) or MRI to exclude or confirm a fracture. In addition to the diagnosis and description of fractures MSCT is helpful for determining the stage of nonunion. Contrast enhanced MRI is the best method to assess the vitality of scaphoid fragments.

  17. Which factors affect limitation of pronation/supination after forearm fractures in children? A prospective multicentre study.

    PubMed

    Colaris, Joost W; Allema, Jan Hein; Reijman, Max; de Vries, Mark R; Ulas Biter, L; Bloem, Rolf M; van de Ven, Cees P; Verhaar, Jan A N

    2014-04-01

    Both-bone forearm fractures in children frequently result in a limitation of pronation/supination, which hinders daily activities. The purpose of this prospective multicentre study was to investigate which clinical factors are related to the limitation of pronation/supination in children with a both-bone forearm fracture. In four Dutch hospitals, consecutive children (<16 years) who sustained a both-bone forearm fracture were included. Children were followed up for 6-9 months and data from questionnaires, physical examination and X-rays were collected. Univariate and multivariate logistic regression analyses were used to assess the relationship between limitation of pronation/supination (≥20°) and several clinical factors. A group of 410 children with both-bone forearm fractures were included, of which 10 children missed the final examination (follow-up rate of 97.6%). We found that a re-fracture (odds ratio (OR) 11.7, 95% confidence interval (CI) 1.2; 118.5), a fracture in the diaphysis (OR 3.3, 95% CI 1.4; 7.9) and less physiotherapy during follow-up (OR 0.90, 95% CI 0.82; 0.98) were independently associated with a limitation of pronation/supination of 20° or more. These findings imply that a re-fracture and a diaphyseal located fracture were associated independently of each other with a limitation of pronation/supination in children with a both-bone forearm fracture. Furthermore, in children with severe limitation extensive physiotherapy is associated with better functional outcome. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Which measures of diaphyseal robusticity are robust? A comparison of external methods of quantifying the strength of long bone diaphyses to cross-sectional geometric properties.

    PubMed

    Stock, Jay T; Shaw, Colin N

    2007-11-01

    Measures of diaphyseal robusticity have commonly been used to investigate differences in bone strength related to body size, behavior, climate, and other factors. The most common methods of quantifying robusticity involve external diameters, or cross-sectional geometry. The data derived from these different methods are often used to address similar research questions, yet the compatibility of the resulting data has not been thoroughly tested. This study provides the first systematic comparison of externally derived measures of postcranial robusticity, with those based upon cross-sectional geometry. It includes sections taken throughout the skeleton, comparisons of prediction errors associated with different measurements, and analysis of the implications of different methods of body size standardization on the prediction of relative bone strength. While the results show reasonable correlations between diaphyseal diameters and strengths derived from cross-sectional geometry, considerable prediction errors are found in many cases. A new approach to externally based quantification of diaphyseal robusticity based upon moulding of sub-periosteal contours is proposed. This method maximizes correlation with cross-sectional geometry (r(2) = .998) and minimizes prediction errors in all cases. The results underscore the importance of accurate periosteal measurement in the quantification of bone strength, and suggest that, regardless of theoretical scaling predictions, external area based robusticity estimates involving the product of diaphyseal diameters are most directly comparable to cross-sectional geometric properties when they are standardized using the product of body mass and bone length. (c) 2007 Wiley-Liss, Inc.

  19. Proximal femoral diaphyseal cross-sectional geometry in Orrorin tugenensis.

    PubMed

    Bleuze, M

    2012-06-01

    Functional adaptations in femora attributed to Orrorin tugenensis provide a unique opportunity to examine locomotor behavior very early in the hominin lineage. This study examines relative cortical thickness, cortical area (CA) relative to the polar moment of area (J), and J relative to femoral head superoinferior diameter (FHD) in the proximal femur of O. tugenensis (BAR 1002'00 and BAR 1003'00), and compares patterns in this early hominin with those in a sample of modern humans (N=31), Plio-Pleistocene fossil hominins (N=8), Pan troglodytes troglodytes (N=13), and Pan paniscus (N=3). Relative cortical thickness and CA relative to J in the proximal femur of O. tugenensis are comparable to patterns generally found in other fossil hominins. Proximal femoral diaphyseal J relative to FHD in BAR 1002'00 is similar to patterns found in fossil hominins typically attributed to a non-Homo genus (i.e. SK 82, SK 97, and KNM-ER 738). Cross-sectional geometric patterns in the proximal femur of Orrorin are not unlike those generally found in australopithecines and fossil Homo. While the results of this study cannot confirm unequivocally that Orrorin was an obligate biped, a mode of locomotion comparable to that proposed for australopithecines cannot be ruled out.

  20. A woman with forearm amyotrophy

    PubMed Central

    Sagui, Emmanuel; Correa, Éléonore; Ricobono, Diane; Bregigeon, Michel; Brosset, Christian

    2009-01-01

    We present the case of a 33-year-old woman with benign sporadic monomelic amyotrophy of the distal part of the arm, called Hirayama disease. Clinical features included forearm amyotrophy sparing the brachioradialis muscle, cold paresis and causalgia. Neck magnetic resonance imaging was normal in neutral and flexion position. Electromyography showed denervated patterns in the extensor digitorum communis, and conduction studies ruled out multifocal motor neuropathy. Motor evoked potentials were normal. Serum IgG anti-GM1 antibodies were moderately raised but were negative 8 months later. Outcome was favourable within 15 months, with partial motor recovery. Pathogenesis remains controversial: neck flexion induced myelopathy via chronic anterior horn ischaemia due to forward displacement of the posterior wall of the dura mater, or benign variant of lower motor neuron disease? Whatever the pathomechanism is, the clinical features and outcome are the same. PMID:22171230

  1. A woman with forearm amyotrophy.

    PubMed

    Sagui, Emmanuel; Correa, Eléonore; Ricobono, Diane; Bregigeon, Michel; Brosset, Christian

    2009-01-01

    We present the case of a 33-year-old woman with benign sporadic monomelic amyotrophy of the distal part of the arm, called Hirayama disease. Clinical features included forearm amyotrophy sparing the brachioradialis muscle, cold paresis and causalgia. Neck magnetic resonance imaging was normal in neutral and flexion position. Electromyography showed denervated patterns in the extensor digitorum communis, and conduction studies ruled out multifocal motor neuropathy. Motor evoked potentials were normal. Serum IgG anti-GM1 antibodies were moderately raised but were negative 8 months later. Outcome was favourable within 15 months, with partial motor recovery. Pathogenesis remains controversial: neck flexion induced myelopathy via chronic anterior horn ischaemia due to forward displacement of the posterior wall of the dura mater, or benign variant of lower motor neuron disease? Whatever the pathomechanism is, the clinical features and outcome are the same.

  2. Distal Radioulnar Joint Reaction Force Following Ulnar Shortening: Diaphyseal Osteotomy Versus Wafer Resection.

    PubMed

    Canham, Colin D; Schreck, Michael J; Maqsoodi, Noorullah; Messing, Susan; Olles, Mark; Elfar, John C

    2015-11-01

    To compare how ulnar diaphyseal shortening and wafer resection affect distal radioulnar joint (DRUJ) joint reaction force (JRF) using a nondestructive method of measurement. Our hypothesis was that ulnar shortening osteotomy would increase DRUJ JRF more than wafer resection. Eight fresh-frozen human cadaveric upper limbs were obtained. Under fluoroscopic guidance, a threaded pin was inserted into the lateral radius orthogonal to the DRUJ and a second pin was placed in the medial ulna coaxial to the radial pin. Each limb was mounted onto a mechanical tensile testing machine and a distracting force was applied across the DRUJ while force and displacement were simultaneously measured. Data sets were entered into a computer and a polynomial was generated and solved to determine the JRF. This process was repeated after ulnar diaphyseal osteotomy, ulnar re-lengthening, and ulnar wafer resection. The JRF was compared among the 4 conditions. Average baseline DRUJ JRF for the 8 arms increased significantly after diaphyseal ulnar shortening osteotomy (7.2 vs 10.3 N). Average JRF after re-lengthening the ulna and wafer resection was 6.9 and 6.7 N, respectively. There were no differences in JRF among baseline, re-lengthened, and wafer resection conditions. Distal radioulnar joint JRF increased significantly after ulnar diaphyseal shortening osteotomy and did not increase after ulnar wafer resection. Diaphyseal ulnar shortening osteotomy increases DRUJ JRF, which may lead to DRUJ arthrosis. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Rare Proximal Diaphyseal Stress Fractures of the Fifth Metatarsal Associated With Metatarsus Adductus.

    PubMed

    Wamelink, Kyle E; Marcoux, John T; Walrath, Scott M

    2016-01-01

    Before the report of English surgeon Robert Jones, who sustained a fracture to his fifth metatarsal while dancing around a tent pole, metatarsal fractures were thought to be the result of direct trauma to the foot. The mechanism of metatarsal fractures, in particular, those involving the fifth metatarsal, is now well understood. Patients with an adducted alignment of their forefoot can overload the fifth metatarsal base, putting them at an increased risk of fractures of this bone. Studies have reported that 2 distinct types of proximal diaphyseal or junctional fractures of the fifth metatarsal occur: the acute proximal diaphyseal or transverse proximal diaphyseal fracture and the proximal diaphyseal stress fracture. The radiographic characteristics associated with proximal diaphyseal stress fractures of the fifth metatarsal can vary by the chronicity; however, the findings typically entail a radiolucent fracture line with surrounding reactive sclerosis. In addition, a reduced medullary canal width can be appreciated. In the present retrospective analysis of patients with stress-related trauma to the fifth metatarsal base with an adducted forefoot, 2012 foot trauma cases were reviewed at 3 separate institutions. Of the 2012 cases, 22 (1.11%) met the outlined criteria of stress fractures of the fifth metatarsal base and underlying metatarsus adductus. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Forearm Instability: Anatomy, Biomechanics, and Treatment Options.

    PubMed

    Adams, Julie E

    2017-01-01

    The forearm unit consists of the radius and ulna, a complex and interrelated set of joints (distal radioulnar joint, proximal radioulnar joint) and the soft tissue stabilizers between the 3 bones. Distally, this is represented by the triangular fibrocartilage complex at the wrist, proximally by the annular ligament at the elbow, and in the forearm by the interosseous membrane. Disruptions in any of these structures may lead to forearm instability, with consequences at each of the remaining structures. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. Adamantinoma of the tibia treated with a new intramedullary diaphyseal segmental defect implant.

    PubMed

    Mavrogenis, A F; Sakellariou, V I; Tsibidakis, H; Papagelopoulos, P J

    2009-01-01

    In this case report, a 75-year old male presented with a mass on the anterior surface of the mid-shaft of the right tibia. Imaging studies showed a well-circumscribed radiolucent lesion in the anterior tibial cortex, without soft tissue extension. Plain radiographs and computed tomography scan of the chest were negative. Histological diagnosis was consistent with adamantinoma, a rare primary bone tumour. Wide tumour resection of approximately 16 cm of the tibial diaphysis with a surrounding cuff of normal tissue was performed. The bone defect was reconstructed using an intramedullary diaphyseal segmental defect fixation system. At 26 months post-operatively the patient is alive with no evidence of local recurrence, distant metastases or implant failure. The intramedullary diaphyseal segmental defect fixation system is associated with excellent oncological and functional outcomes. Intra-operative modularity, ease of application, immediate post-operative stability and rapid rehabilitation are the major advantages of this diaphyseal prosthesis.

  6. Factors affecting the incidence of aseptic nonunion after surgical fixation of humeral diaphyseal fracture.

    PubMed

    Ding, Liang; He, Zhimin; Xiao, Haijun; Chai, Leizi; Xue, Feng

    2014-11-01

    Although aseptic nonunion of humeral diaphyseal fracture is rare, it often is debilitating for the patient. Treatment is challenging for the surgeon when nonunion occurs. The purpose of this study was to analyze and identify independent risk factors for aseptic nonunion among patients with humeral diaphyseal fracture undergoing surgical fixation. The medical records of all humeral diaphyseal fracture patients who underwent surgical fixation from January 2005 to January 2011 were reviewed to identify those who developed aseptic nonunion. We performed univariate and multivariate logistic regression to identify independent associations of potential risk factors for aseptic nonunion among patients with surgical humeral diaphyseal fracture. A total of 686 patients were identified, with 659 meeting our inclusion criteria. Among these 659 cases there were 24 cases of septic nonunion, an incidence of 3.6%. The patients were followed for 9-24 months, with an average follow-up period of 14.8 months. In the final regression model, advanced age (odds ratio, 1.09; 95% CI: 1.03-1.14, P = 0.001), smoking (odds ratio, 5.34; 95% CI: 1.05-27.00, P = 0.043), use of NSAIDs (odds ratio, 2.51; 95% CI: 1.80-3.50, P < 0.001), and ASA score (odds ratio, 3.04; 95% CI: 1.06-8.74, P = 0.039) were risk factors for aseptic nonunion of humeral diaphyseal fracture after surgical fixation. This analysis confirms advanced age, smoking, use of NSAIDs, and ASA score were related to an increased risk of aseptic nonunion of humeral diaphyseal fracture after surgical fixation. Patients who have the risk factors identified in this study should be counseled about the possibility of aseptic nonunion occurring after surgical fixation.

  7. Dynamics of wrist and forearm rotations.

    PubMed

    Peaden, Allan W; Charles, Steven K

    2014-08-22

    Human movement generally involves multiple degrees of freedom (DOF) coordinated in a graceful and seemingly effortless manner even though the underlying dynamics are generally complex. Understanding these dynamics is important because it exposes the challenges that the neuromuscular system faces in controlling movement. Despite the importance of wrist and forearm rotations in everyday life, the dynamics of movements involving wrist and forearm rotations are currently unknown. Here we present equations of motion describing the torques required to produce movements combining flexion-extension (FE) and radial-ulnar deviation (RUD) of the wrist and pronation-supination (PS) of the forearm. The total torque is comprised of components required to overcome the effects of inertia, damping, stiffness, and gravity. Using experimentally measured kinematic data and subject-specific impedance parameters (inertia, damping, and stiffness), we evaluated movement torques to test the following hypotheses: the dynamics of wrist and forearm rotations are (1) dominated by stiffness, not inertial or damping effects, (2) significantly coupled through interaction torques due to stiffness and damping (but not inertia), and (3) too complex to be well approximated by a simple, linear model. We found that (1) the dynamics of movements combining the wrist and forearm are similar to wrist rotations in that stiffness dominates over inertial and damping effects (p<0.0001) by approximately an order of magnitude, (2) the DOF of the wrist and forearm are significantly coupled through stiffness, while interactions due to inertia and damping are small, and (3) despite the complexity of the exact equations of motion, the dynamics of wrist and forearm rotations are well approximated by a simple, linear (but still coupled) model (the mean error in predicting torque was less than 1% of the maximum torque). The exact and approximate models are presented for modeling wrist and forearm rotations in future

  8. Surgical Management of Fifth Metatarsal Diaphyseal Fractures: A Retrospective Outcomes Study.

    PubMed

    Thompson, Patrick; Patel, Vivek; Fallat, Lawrence M; Jarski, Robert

    Fifth metatarsal diaphyseal fractures are a common injury treated by foot and ankle surgeons. The limited data on this specific fracture type has promoted nonoperative treatment with immobilization. The primary objective of the present study was to record the radiographic healing time of fifth metatarsal diaphyseal fractures after surgical intervention and present the specific fracture characteristics. The medical records of a series of 64 patients with surgically managed fifth metatarsal diaphyseal fractures were retrospectively reviewed. The data collected consisted of radiographic healing times, fracture characteristics, and patient demographics. The mean average age at injury was 49.23 ± 15.35 years with greatest incidence in females at 73.44%. The mean healing time was 7.73 ± 4.74 weeks, with an overall complication rate of 6.25%. The fractures were classified into 2 specific categories according to the anatomic location. Type I fractures occurred in a significantly older population, were significantly longer in length, and healed faster. The mean displacement and angulation at injury was 3.20 ± 1.22 mm, and 5.89° ± 4.60°, respectively, for all fractures. Of the 64 patients, 1 (1.56%) experienced nonunion, 2 (3.13%) delayed unions, and no malunions. One patient (1.56%) underwent repeat operation for hardware removal. One case (1.56%) of superficial postoperative infection developed and was treated with oral antibiotics. We observed good surgical outcomes with minimal postoperative complications. We also identified 2 specific entities of fifth metatarsal diaphyseal fractures. On the basis of our results, we advocate surgical intervention even for minimally displaced diaphyseal fractures to maintain even weightbearing across the metatarsal parabola. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal fractures in adults.

    PubMed

    Shadgan, Babak; Pereira, Gavin; Menon, Matthew; Jafari, Siavash; Darlene Reid, W; O'Brien, Peter J

    2015-09-01

    We sought to examine the occurrence of acute compartment syndrome (ACS) in the cohort of patients with tibial diaphyseal fractures and to detect associated risk factors that could predict this occurrence. A total of 1,125 patients with tibial diaphyseal fractures that were treated in our centre were included into this retrospective cohort study. All patients were treated with surgical fixation. Among them some were complicated by ACS of the leg. Age, gender, year and mechanism of injury, injury severity score (ISS), fracture characteristics and classifications and the type of fixation, as well as ACS characteristics in affected patients were studied. Of the cohort of patients 772 (69 %) were male (mean age 39.60 ± 15.97 years) and the rest were women (mean age 45.08 ± 19.04 years). ACS of the leg occurred in 87 (7.73 %) of all tibial diaphyseal fractures. The mean age of those patients that developed ACS (33.08 ± 12.8) was significantly lower than those who did not develop it (42.01 ± 17.3, P < 0.001). No significant difference in incidence of ACS was found in open versus closed fractures, between anatomic sites and following IM nailing (P = 0.67). Increasing pain was the most common symptom in 71 % of cases with ACS. We found that younger patients are definitely at a significantly higher risk of ACS following acute tibial diaphyseal fractures. Male gender, open fracture and IM nailing were not risk factors for ACS of the leg associated with tibial diaphyseal fractures in adults. Level IV.

  10. Ulnar nerve paralysis after forearm bone fracture.

    PubMed

    Schwartsmann, Carlos Roberto; Ruschel, Paulo Henrique; Huyer, Rodrigo Guimarães

    2016-01-01

    Paralysis or nerve injury associated with fractures of forearm bones fracture is rare and is more common in exposed fractures with large soft-tissue injuries. Ulnar nerve paralysis is a rare condition associated with closed fractures of the forearm. In most cases, the cause of paralysis is nerve contusion, which evolves with neuropraxia. However, nerve lacerations and entrapment at the fracture site always need to be borne in mind. This becomes more important when neuropraxia appears or worsens after reduction of a closed fracture of the forearm has been completed. The importance of diagnosing this injury and differentiating its features lies in the fact that, depending on the type of lesion, different types of management will be chosen.

  11. [Functional hemitongue reconstruction with free forearm flap].

    PubMed

    Liao, Gui-Qing; Su, Yu-Xiong; Liu, Hai-Chao; Li, Jin; Fahmha, Numan; Ou, De-Ming; Wang, Qin

    2008-07-01

    To investigate the clinical application of free forearm flap in the functional hemitongue reconstruction. From July 2002 to November 2006, 40 patients with tongue cancer underwent hemiglossectomy and primary hemitongue reconstruction with free forearm flaps. In some cases, the lateral antebrachial cutaneous nerves of the flaps were anastomosed with the lingual nerve to restore the flap sensation. All patients recovered uneventfully after surgery with no morbidity in the donor site. All free flaps survived. The average follow-up period was 2 years and 6 months. The aesthetic and functional results were both satisfactory. The swallowing and speech function were almost normal. The flap sensation was partially restored. Good functional hemitongue reconstruction can be achieved with free forearm flaps.

  12. Radiographic Evaluation During Treatment of Pediatric Forearm Fractures: Implications on Clinical Care and Cost.

    PubMed

    Luther, Gaurav; Miller, Patricia; Waters, Peter M; Bae, Donald S

    2016-01-01

    As ≥30% of displaced pediatric forearm fractures demonstrate loss of reduction (LOR) following closed reduction (CR); radiographic follow-up is advocated at 1, 2, 4, and 6 weeks for detection of redisplacement. We hypothesized that there is minimal change in fracture alignment 2 weeks after CR, and consequently, that radiographs at 4 weeks add cost but little value to clinical care. A total of 184 patients enrolled in a prospective study of pediatric forearm fractures including both distal and diaphyseal injuries were evaluated. All were treated with CR, casting, and radiographic evaluation at 1, 2, 4, and 6 weeks postinjury. Primary endpoint was radiographic LOR. Secondary endpoint was need for any intervention. A modified number-needed to treat analysis estimated the utility of the week 4 x-ray in predicting intervention. Relative value unit (RVU) costing, time-derived activity-based costing (TDABC), and billing totals were used for cost analysis. Seventy patients (38%) demonstrated radiographic LOR. Independent predictors of LOR were initial radius displacement >75% (OR=5.40; CI, 2.23-12.60), concomitant ulna fracture (OR=1.71; CI, 1.15-2.54), and dominant arm involvement (OR=2.87; CI, 1.40-5.87). Eighty percent of all LORs occurred within the first 2 weeks. There was no statistically significant change in radiographic alignment after week 2. Of 40 total interventions, all were performed within the first 2 weeks of follow-up. The 4-week x-ray did not influence decision to intervene, and at most, 1 in every 40 patients would require an intervention after week 2. Elimination of the 4-week x-ray would result in a savings of 4.8% (RVU method) to 11.9% (TDABC method) in the overall cost of nonoperative fracture care. There is minimal change in fracture alignment 2 weeks following CR of pediatric forearm fractures, and all interventions are based on early radiographic follow-up. The week 4 x-ray adds little value to clinical decision making, and its elimination

  13. Intraoperative fracture of the femur in revision total hip arthroplasty with a diaphyseal fitting stem.

    PubMed

    Meek, R M Dominic; Garbuz, Donald S; Masri, Bassam A; Greidanus, Nelson V; Duncan, Clive P

    2004-03-01

    In revision total hip arthroplasty, intraoperative split fractures and cortical perforation fractures are becoming a more common concern with the increasing use of diaphyseal fitting cementless stems. The purpose of this study was to evaluate the risk factors and frequency of intraoperative fractures with the use of these stems and their effect on radiographic and functional outcomes. We performed a retrospective case-control study of 211 consecutive patients who had undergone revision hip arthroplasty with a diaphyseal fitting cementless stem between December 1998 and March 2002. Sixty-four patients sustained an intraoperative fracture of the femur. One hundred and fifteen patients were followed for a minimum of two years; function was analyzed with self-administered outcome questionnaires, and radiographs were evaluated for evidence of bone ingrowth into the femoral stem. Risk factors associated with an intraoperative fracture were a substantial degree of preoperative bone loss, a low femoral cortex-to-canal ratio, underreaming of the cortex, and the use of a large-diameter stem. The majority of the diaphyseal undisplaced linear fractures occurred at the distal end of an extended trochanteric osteotomy during stem insertion. Fracture due to cortical perforation occurred most often during cement removal. These intraoperative fractures had no significant effect on the functional outcome or radiographic evidence of bone ingrowth. There was a surprisingly high rate of intraoperative femoral fractures associated with the use of a diaphyseal fitting stem in revision total hip arthroplasty. Identification of risk factors such as preoperative bone loss and a low cortex-to-canal ratio may permit planning to avoid such fractures. However, the final functional and radiographic outcomes appear to have been unaffected by the fracture when it had been managed appropriately. Prognostic study, Level II-1 (retrospective cohort study). See Instructions to Authors for a complete

  14. Amputated limb by cerclage wire of femoral diaphyseal fracture: a case report.

    PubMed

    Won, Yougun; Yang, Kyu-Hyun; Kim, Kwang-Kyoun; Weaver, M J; Allen, Elizabeth M

    2016-12-01

    An entrapment of the femoral artery by cerclage wiring is a rare complication after spiral diaphyseal femoral fractures. We report the case of an 82-year-old female treated by an antegrade intramedullary nailing and multiple cable augmentation, which was then complicated by injury to the femoral artery that resulted in ipsilateral leg necrosis and amputation. The entrapment was caused by direct belting by the cable and resulted in a total obstruction of the femoral artery.

  15. Periosteal versus true cross-sectional geometry: a comparison along humeral, femoral, and tibial diaphyses.

    PubMed

    Macintosh, Alison A; Davies, Thomas G; Ryan, Timothy M; Shaw, Colin N; Stock, Jay T

    2013-03-01

    Cross-sectional geometric (CSG) properties of human long bone diaphyses are typically calculated from both periosteal and endosteal contours. Though quantification of both is desirable, periosteal contours alone have provided accurate predictions of CSG properties at the midshaft in previous studies. The relationship between CSG properties calculated from external contours and "true" (endosteal and periosteal) CSG properties, however, has yet to be examined along the whole diaphysis. Cross-sectional computed tomography scans were taken from 21 locations along humeral, femoral, and tibial diaphyses in 20 adults from a late prehistoric central Illinois Valley cemetery. Mechanical properties calculated from images with (a) artificially filled medullary cavities ("solid") and (b) true unaltered cross-sections were compared at each section location using least squares regression. Results indicate that, in this sample, polar second moments of area (J), polar section moduli (Z(p) ), and cross-sectional shape (I(max) /I(min) ) calculated from periosteal contours correspond strongly with those calculated from cross-sections that include the medullary cavity. Correlations are high throughout most of the humeral diaphysis and throughout large portions of femoral and tibial diaphyses (R(2) = 0.855-0.998, all P < 0.001, %SEE ≤ 8.0, %PE ≤ 5.0), the major exception being the proximal quarter of the tibial diaphysis for J and Z(p). The main source of error was identified as variation in %CA. Results reveal that CSG properties quantified from periosteal contours provide comparable results to (and are likely to detect the same differences among individuals as) true CSG properties along large portions of long bone diaphyses.

  16. Exchange nailing for femoral diaphyseal fracture non-unions: Risk factors for failure.

    PubMed

    Tsang, S T J; Mills, L A; Baren, J; Frantzias, J; Keating, J F; Simpson, A H R W

    2015-12-01

    The aim of this study was to identify risk factors for failure of exchange nailing for femoral diaphyseal fracture non-unions. The study cohort comprised 40 patients with femoral diaphyseal non-unions treated by exchange nailing, of which six were open injuries. The median time to exchange nailing from primary fixation was 8.4 months. The main outcome measures were union, number of secondary fixation procedures required to achieve union and time to union. Multiple causes for non-union were found in 16 (40%) cases, with infection present in 12 (30.0%) patients. Further surgical procedures were required in nine (22.5%) cases, one of whom (2.5%) required the use of another fixation modality to achieve union. Union was ultimately achieved with exchange nailing in 34/37 (91.9%) patients. The median time to union after the exchange nailing was 9.4 months. Cigarette smoking and infection were risk factors for failure of exchange nailing. Multivariate analysis found infection to be the strongest predictor of exchange failure (p<0.05). Exchange nailing is an effective treatment for aseptic femoral diaphyseal fracture non-union. However, 50% of patients undergoing exchange nailing in the presence of infection required at least one further procedure. It is important to counsel patients of this so that they can plan for it and do not consider that the first exchange operation has failed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Drifting Diaphyses: Asymmetry in Diametric Growth and Adaptation Along the Humeral and Femoral Length.

    PubMed

    Maggiano, Isabel S; Maggiano, Corey M; Tiesler, Vera G; Chi-Keb, Julio R; Stout, Sam D

    2015-10-01

    This study quantifies regional histomorphological variation along the human humeral and femoral diaphysis in order to gain information on diaphyseal growth and modeling drift patterns. Three thin sections at 40, 50, and 60% bone length were prepared from a modern Mexican skeletal sample with known age and sex to give a longitudinal perspective on the drifting cortex (12 adults and juveniles total, 7 male and 5 female). Point-count techniques were applied across eight cross-sectional regions of interest using the starburst sampling pattern to quantify percent periosteal and endosteal primary lamellar bone at each diaphyseal level. The results of this study show a posterio-medial drift pattern in the humerus with a posterior rotational trend along the diaphysis. In the femur, we observed a consistent lateral to anteriolateral drift and an increase in primary lamellar bone area of both, periosteal and endosteal origin, towards the distal part of the diaphysis. These observations characterize drifting diaphyses in greater detail, raising important questions about how to resolve microscopic and macroscopic cross-sectional analysis towards a more complete understanding of bone growth and mechanical adaptation. Accounting for modeling drift has the potential to positively impact age and physical activity estimation, and explain some of the significant regional variation in bone histomorphology seen within (and between) bone cross-sections due to differing ages of tissue formation. More study is necessary, however, to discern between possible drift scenarios and characterize populational variation.

  18. Spastic Paralysis of the Elbow and Forearm

    PubMed Central

    Gharbaoui, Idris; Kania, Katarzyna; Cole, Patrick

    2016-01-01

    As the physiologic recovery period concludes, the patient is evaluated for surgical procedures that may rebalance muscle function and correct deformity. Upper extremity function is the product of complex and highly sophisticated mechanisms working in unison, and a careful, systematic preoperative evaluation is critical. A good function of the hand cannot be achieved without adequate position of the shoulder, elbow, forearm, and wrist. The goals of surgery must be practical and clearly understood by the patient and the family. PMID:26869862

  19. Radial forearm free flap pharyngoesophageal reconstruction.

    PubMed

    Azizzadeh, B; Yafai, S; Rawnsley, J D; Abemayor, E; Sercarz, J A; Calcaterra, T C; Berke, G S; Blackwell, K E

    2001-05-01

    This study evaluates the outcome of pharyngoesophageal reconstruction using radial forearm free flaps with regard to primary wound healing, speech, and swallowing in patients requiring laryngopharyngectomy. Retrospective review in the setting of a tertiary, referral, and academic center. Twenty patients underwent reconstruction of the pharyngoesophageal segment using fasciocutaneous radial forearm free flaps. All free flap transfers were successful. An oral diet was resumed in 85% of the patients after surgery. Postoperative pharyngocutaneous fistulas occurred in 4 patients (20%) with 3 resolving spontaneously. Distal strictures also occurred in 20% of the patients. Five patients who underwent tracheoesophageal puncture achieved useful speech. Advantages of radial forearm free flaps for microvascular pharyngoesophageal function include high flap reliability, limited donor site morbidity, larger vascular pedicle caliber, and the ability to achieve good quality tracheoesophageal speech. The swallowing outcome is similar to that achieved after jejunal flap pharyngoesophageal reconstruction. The main disadvantage of this technique relates to a moderately high incidence of pharyngocutaneous fistulas, which contributes to delayed oral intake in affected patients.

  20. Technical implications in proximal forearm transplantation.

    PubMed

    Haddock, Nicholas T; Chang, Benjamin; Bozentka, David J; Steinberg, David R; Levin, Lawrence Scott

    2013-12-01

    The field of vascularized composite allotransplantation has developed for more than a decade. Investigators are defining patient selection criteria, transplant indications, immunologic regimens, and tolerance. The majority of the current reported hand transplantations have been for treatment of distal forearm or hand amputations. In more proximal amputees, the functional outcome of the transplanted arm has some unique variables that require a different surgical approach. We present a single case of bilateral proximal forearm transplantation in effort to describe the unique technical considerations in this complex procedure. The surgical procedure is described in detail. At 19 months, our patient had 4/5 strength of finger and thumb flexors and protective extensor as well as 4/5 wrist flexors and extensors. Our patient had recovery of sensation. Our patient now lives independently and does her lower extremity prosthesis independently using her hands. These results are expected to continue to improve with more time. In hand transplantation, functional results have been very promising. The described approach of forearm transplantation allows the transfer of the entire functional unit, which should optimize the ultimate outcome for these more proximal injuries.

  1. Forearm sympathetic withdrawal and vasodilatation during mental stress in humans.

    PubMed Central

    Halliwill, J R; Lawler, L A; Eickhoff, T J; Dietz, N M; Nauss, L A; Joyner, M J

    1997-01-01

    1. In humans, mental stress elicits vasodilatation in the muscle vascular beds of the forearm that may be neurally mediated. We sought to determine the extent to which this vasodilatation is due to sympathetic withdrawal, active neurogenic vasodilatation, or beta-adrenergically mediated vasodilatation. 2. We simultaneously measured forearm blood flow and muscle sympathetic nerve traffic to the forearm during mental stress in humans. In a second study, we measured forearm blood flow responses to mental stress after selective blockade of alpha-adrenergic neurotransmission in one forearm. In a final study, we measured forearm blood flow responses to mental stress after unilateral anaesthetic blockade of the stellate ganglion, alone or in combination with selective beta-adrenergic receptor blockade of the forearm. 3. During mental stress, muscle sympathetic nerve activity decreased from 5113 +/- 788 to 1509 +/- 494 total integrated activity min-1 (P < 0.05) and forearm vascular resistance decreased from 96 +/- 29 to 33 +/- 7 mmHg (dl of tissue) min ml-1 (P < 0.05). Considerable vasodilation was still elicited by mental stress after selective blockade of alpha-adrenergic neurotransmission. Vasodilatation also occurred during mental stress after stellate ganglion blockade. This dilatation was reduced by selective blockade of beta-adrenergic receptors in the forearm. 4. Our results support a role for both sympathetic withdrawal and beta-adrenergic vasodilatation as the major causes of the forearm vasodilatation during mental stress in humans. PMID:9350631

  2. Taxonomic identification of Lower Pleistocene fossil hominins based on distal humeral diaphyseal cross-sectional shape

    PubMed Central

    2015-01-01

    The coexistence of multiple hominin species during the Lower Pleistocene has long presented a challenge for taxonomic attribution of isolated postcrania. Although fossil humeri are well-suited for studies of hominin postcranial variation due to their relative abundance, humeral articular morphology has thus far been of limited value for differentiating Paranthropus from Homo. On the other hand, distal humeral diaphyseal shape has been used to justify such generic distinctions at Swartkrans. The potential utility of humeral diaphyseal shape merits larger-scale quantitative analysis, particularly as it permits the inclusion of fragmentary specimens lacking articular morphology. This study analyzes shape variation of the distal humeral diaphysis among fossil hominins (c. 2-1 Ma) to test the hypothesis that specimens can be divided into distinct morphotypes. Coordinate landmarks were placed on 3D laser scans to quantify cross-sectional shape at a standardized location of the humeral diaphysis (proximal to the olecranon fossa) for a variety of fossil hominins and extant hominids. The fossil sample includes specimens attributed to species based on associated craniodental remains. Mantel tests of matrix correlation were used to assess hypotheses about morphometric relationships among the fossils by comparing empirically-derived Procrustes distance matrices to hypothetical model matrices. Diaphyseal shape variation is consistent with the hypothesis of three distinct morphotypes (Paranthropus, Homo erectus, non-erectus early Homo) in both eastern and southern Africa during the observed time period. Specimens attributed to non-erectus early Homo are unique among hominids with respect to the degree of relative anteroposterior flattening, while H. erectus humeri exhibit morphology more similar to that of modern humans. In both geographic regions, Paranthropus is characterized by a morphology that is intermediate with respect to those morphological features that differentiate

  3. Comparison of intramedullary nail and plate fixation in distal tibia diaphyseal fractures close to the mortise.

    PubMed

    Yavuz, Umut; Sökücü, Sami; Demir, Bilal; Yıldırım, Timur; Ozcan, Cağrı; Kabukçuoğlu, Yavuz Selim

    2014-05-01

    In this study, we aimed to compare the functional and radiological results of intramedullary nailing and plate fixation techniques in the surgical treatment of distal tibia diaphyseal fractures close to the ankle joint. Between 2005 and 2011, 55 patients (32 males, 23 females; mean age 42 years; range 15 to 72 years) who were treated with intramedullary nailing (21 patients) or plate fixation (34 patients) due to distal tibia diaphyseal fracture were included in the study. The average follow-up period was 27.6 months (range, 12-82 months). The patients were evaluated with regard to nonunion, malunion, infection, and implant irritation. The AOFAS (American Orthopaedic Foot and Ankle Society) scale was used for the clinical evaluation. No statistically significant difference was found between the two surgical methods with respect to unification time, AOFAS score, accompanying fibula fracture, material irritation, and malunion. Nine patients had open fractures, and these patients were treated with plate fixation (p=0.100). Nonunion developed in three patients who were treated with plates. Infection occurred in one patient. Anterior knee pain was significantly higher in patients who were treated with intramedullary nails. There was no malunion in any patient. As the distal fragment is not long enough, plate fixation technique is usually preferred in the treatment of distal tibia diaphyseal fractures. In this study, we observed that if the surgical guidelines are followed carefully, intramedullary nailing is an appropriate technique in this kind of fracture. The malunion rates are not significantly increased, and it also has the advantages of being a minimally invasive surgery with fewer wound problems.

  4. Titanium elastic nailing in diaphyseal femoral fractures of children below six years of age

    PubMed Central

    Donati, Fabrizio; Mazzitelli, Giuseppe; Lillo, Marco; Menghi, Amerigo; Conti, Carla; Valassina, Antonio; Marzetti, Emanuele; Maccauro, Giulio

    2017-01-01

    AIM To report the clinical and radiographic results of titanium elastic nail (TEN) in diaphyseal femoral fractures of children below age of six years. METHODS A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn’s scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion (ROM), functional status, complications, and parent’s satisfaction. RESULTS Sixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation < 10°. Complete functional recovery (hip and knee ROM, ability to run and jump on the operated limb) occurred in 95.7% of cases. Complications included two cases of superficial infection of the TEN entry point, one case of refracture following a new trauma, and one TEN mobilization. According to the Flynn’s scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent’s satisfaction level of 9.1/10. CONCLUSION TEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age. PMID:28251066

  5. Atypical Fractures are Mainly Subtrochanteric in Singapore and Diaphyseal in Sweden: A Cross-Sectional Study.

    PubMed

    Schilcher, Jörg; Howe, Tet Sen; Png, Meng Ai; Aspenberg, Per; Koh, Joyce S B

    2015-11-01

    We have previously noted a dichotomy in the location of atypical fractures along the femoral shaft in Swedish patients, and a mainly subtrochanteric location of atypical fractures in descriptions of patients from Singapore. These unexpected differences were now investigated by testing the following hypotheses in a cross-sectional study: first, that there is a dichotomy also in Singapore; second, that the relation between subtrochanteric and diaphyseal location is different between the two countries; third, that the location is related to femoral bow. The previously published Swedish sample (n = 151) was re-measured, and a new Singaporean sample (n = 75) was established. Both samples were based on radiographic classification of all femoral fractures in women above 55 years of age. The distance between the fracture line and the lesser trochanter was measured. Femoral bow was classified as present or absent on frontal radiographs. Frequency distribution of the measured distances was analyzed using the Bayesian information criterion to choose the best description of the observed variable distribution in terms of a compilation of normally distributed subgroups. The analysis showed a clear dichotomy of the fracture location: either subtrochanteric or diaphyseal. Subtrochanteric fractures comprised 48% of all fractures in Singapore, and 17% in Sweden (p = 0.0001). In Singapore, femoral bow was associated with more fractures in the diaphyseal subgroup (p = 0.0001). This was not seen in Sweden. A dichotomous location of atypical fractures was confirmed, because it was found also in Singapore. The fractures showed a different localization pattern in the two countries. This difference may be linked to anatomical variations, but might also be related to cultural differences between the two populations that influence physical activity.

  6. Treatment of Ipsilateral Distal Humerus and Diaphyseal Ulna Fractures by Using an Olecranon Osteotomy and Intramedullary Nail.

    PubMed

    Köse, Ahmet; Aydin, Ali; Ezirmik, Naci; Yildirim, Ömer Selim

    2016-05-01

    To evaluate the results of treatment of an osteotomy of the olecranon and an ulnar diaphyseal fracture with a single nail, in cases with an ipsilateral ulnar diaphyseal fracture and a comminuted fracture of the distal humerus. Retrospective clinical study. University-affiliated teaching hospital. Eight patients with comminuted fractures of the distal humerus and ipsilateral ulnar diaphyseal fractures were included. Using a transolecranon approach, internal fixation of the distal humeral fracture with medial and lateral plates was performed. The ulnar diaphyseal fracture and additional osteotomy were fixed using a locked intramedullary nail. Subjective pain assessment was performed by using a visual analog scale (VAS). There were 6 (75%) male and 2 (25%) female patients, with a mean age of 40.9 (range, 32-56) years. The mean follow-up period was 24.6 (range, 12-36) months. All patients achieved union of the ulnar diaphyseal fracture and olecranon osteotomy. Union of the distal humeral fracture was observed in 7 (87.5%) patients. The mean time to union was 16.3 (range, 12-22) weeks, mean visual analog scale score was 1.8 (range, 0-3), median elbow performance score was 85 (range, 70-95), and median disabilities of the arm, shoulder, and hand score was 17.9 (range, 5-45.8). Osteotomy of the olecranon and ulnar diaphyseal fracture using an intramedullary nail was a cosmetically advantageous and safe technique that enabled rehabilitation during the early postoperative period. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  7. The pattern of femoral diaphyseal fractures in children admitted in Sarawak General Hospital.

    PubMed

    Rasit, A H; Mohammad, A W; Pan, K L

    2006-02-01

    Trend towards changing the face of management for pediatric femoral fractures tends to advocate operative treatment. This study was undertaken to review our current practice in the wake of recent progress in the management of pediatric femoral fractures. Fifty patients with femoral diaphyseal fracture treated in Sarawak General Hospital were reviewed retrospectively after an average follow-up of 2.6 years. There were 36 boys and 14 girls, with a mean age of 6.2 years (range five months to 14 years). Children under six years of age constituted the majority of the patients. Half of the fractures were caused by road traffic accident. Nine patients had associated injuries. The most common site of fracture was at the middle third (N=31). The treatment regimens were delayed hip spica (DHS) in 16, immediate hip spica (IHS) in 24, plate osteosynthesis (PO) in five, titanium elastic nailing (TEN) in five, and external fixation (EF) in one. The minimum hospital stay was two days, and the maximum 33 days (mean, 9.7 days). Malunion was the commonest complication. Conservative treatment is the preferred option for children under six years of age. It is cost-effective with minimal complication. The other treatment options are reserved for specific indication in older children. Diaphyseal fractures of the femur in children can be adequately managed non-operatively.

  8. Femoral diaphyseal endoprosthetic reconstruction after segmental resection of primary bone tumours.

    PubMed

    Hanna, S A; Sewell, M D; Aston, W J S; Pollock, R C; Skinner, J A; Cannon, S R; Briggs, T W R

    2010-06-01

    Segmental resection of malignant bone disease in the femoral diaphysis with subsequent limb reconstruction is a major undertaking. This is a retrospective review of 23 patients who had undergone limb salvage by endoprosthetic replacement of the femoral diaphysis for a primary bone tumour between 1989 and 2005. There were 16 males and seven females, with a mean age of 41.3 years (10 to 68). The mean overall follow-up was for 97 months (3 to 240), and 120 months (42 to 240) for the living patients. The cumulative patient survival was 77% (95% confidence interval 63% to 95%) at ten years. Survival of the implant, with failure of the endoprosthesis as an endpoint, was 85% at five years and 68% (95% confidence interval 42% to 92%) at ten years. The revision rate was 22% and the overall rate of re-operation was 26%. Complications included deep infection (4%), breakage of the prosthesis (8%), periprosthetic fracture (4%), aseptic loosening (4%), local recurrence (4%) and metastases (17%). The 16 patients who retained their diaphyseal endoprosthesis had a mean Musculoskeletal Tumour Society score of 87% (67% to 93%). They were all able to comfortably perform most activities of daily living. Femoral diaphyseal endoprosthetic replacement is a viable option for reconstruction following segmental resection of malignant bone disease. It allows immediate weight-bearing, is associated with a good long-term functional outcome, has an acceptable complication and revision rate and, most importantly, does not appear to compromise patient survival.

  9. Electromagnetic Navigation in Distal Locking of Long Diaphyseal Interlocking Intramedullary Nailing.

    PubMed

    Zhou, Zhentao; Zhou, Xiaozhong; Shan, Bingchen; Zhou, Haibin; Lu, Zhengfeng; Dong, Qirong

    2016-12-01

    To describe the applications and effects of electromagnetic navigation (EN) technology in distal locking for the treatment of long diaphyseal fracture (LDF) with interlocking intramedullary nailing (IIN). An interventional study. The Second Affiliated Hospital of Soochow University, China, from March 2013 to July 2014. Patients who underwent IIN-LDF were selected. Twenty-four (50%) of whom were operated under EN guidance (group A) and the other 24 (50%) under conventional targeting guidance (group B). The distal locking time and X-ray irradiation time of the two groups were compared. Each group included 16 (33.3%) cases of femoral fracture and 8 (16.7%) cases of tibial fracture. The success rate of distal locking in group A was higher than that in group B (95.8% vs. 83.3%, p=0.045). There were statistically significant differences in the distal locking time and X-ray irradiation time of femoral intramedullary nailing between the two groups (p=0.027 and p=0.001, respectively). There were no statistically significant differences in the distal locking time and X-ray irradiation time of tibial intramedullary nailing between the two groups (p=0.347 and p=0.056, respectively). EN-IN was advantageous as it enabled easy targeting, significantly reduced intraoperative fluoroscopy and operation time and small trauma and had other advantages when used for treating LDFs, especially femoral diaphyseal fractures.

  10. Novel 3D hexapod computer-assisted orthopaedic surgery system for closed diaphyseal fracture reduction.

    PubMed

    Tang, Peifu; Hu, Lei; Du, Hailong; Gong, Minli; Zhang, Lihai

    2012-03-01

    Long-bone fractures are very common in trauma centers. The conventional Arbeitsgemeindschaft fur Osteosynthesefragen (AO) technique contributes to most fracture healing problems, and external fixation technology also has several disadvantages, so new techniques are being explored. A novel hexapod computer-assisted fracture reduction system based on a 3D-CT image reconstruction process is presented for closed reduction of long-bone diaphyseal fractures. A new reduction technique and upgraded reduction device are described and the whole system has been validated. Ten bovine femoral fracture models were used with random fracture patterns. Tests results were as follows: residual deviation 1.24 + 0.65 mm for the axial deflection, 1.19 + 0.37 mm for the translation, 2.34 + 1.79° for the angulation, and 2.83 + 0.9° for the rotation. The reduction mechanism has the advantages of high positioning, reduction and computer accuracy, and intra-operative stability for both patients and surgical team. With further investigation, it could be applied in many kinds of long-bone diaphyseal fractures. Copyright © 2011 John Wiley & Sons, Ltd.

  11. Effect of dynamization on gap healing of diaphyseal fractures under external fixation.

    PubMed

    Claes, L E; Wilke, H-J; Augat, P; Rübenacker, S; Margevicius, K J

    1995-07-01

    We asked whether dynamization of externally fixed diaphyseal fractures could improve bone healing in comparison to rigid fixation of fractures having similar remaining gap sizes. To answer this question we evaluated metatarsal osteotomies in 12 sheep. The osteotomy with a 0.6-mm gap was stabilized with a specially designed high bending and torsional stiffness external ring fixator. Osteotomies in six sheep were stabilized rigidly (axial movement < 0.06 mm) or dynamically (axial movement 0.15-0.34 mm). The cyclical axial interfragmentary movement was caused by the load-bearing of the operated limb. With increasing healing time, the initially allowed movement was decreased by callus formation around the osteotomy. The reduction in interfragmentary movement was measured and monitored by a linear variable displacement transducer at the external fixator and a telemetry system. After 9 weeks the sheep were sacrificed and the healed bones were investigated biomechanically and histomorphologically. Compared to the rigidly fixed osteotomies, the dynamized osteotomies showed significantly (P < 0.05) greater (+41%) callus formation and 45% greater tensile strength of the newly formed bone in the cortical osteotomy gap. Histological analysis indicated that the effect of dynamization occurred mainly after the 5th week. RELEVANCE: From these results we conclude that dynamic fixation of diaphyseal gaps is advantageous in comparison to stable external fixation.

  12. A control theoretic model of the forearm.

    PubMed

    Rehbinder, H; Martin, C

    2001-06-01

    In this paper, a control theoretic model of the forearm is developed and analyzed, and a computational method for predicting muscle activations necessary to generate specified motions is described. A detailed geometric model of the forearm kinematics, including the carrying angle and models of how the biceps and the supinator tendons wrap around the bones, is used. Also, including a dynamics model, the final model is a system of differential equations where the muscle activations play the role of control signals. Due to the large number of muscles, the problem of finding muscle activations is redundant, and this problem is solved by an optimization procedure. The computed muscle activations for ballistic movements clearly recaptures the triphasic ABC (Activation-Braking-Clamping) pattern. It is also transparent, from the muscle activation patterns, how the muscles cooperate and counteract in order to accomplish desired motions. A comparison with previously reported experimental data is included and the model predictions can be seen to be partially in agreement with the experimental data.

  13. [Intramuscular hemangioma of the forearm: seven cases].

    PubMed

    Fnini, S; Messoudi, A; Benjeddi, Y; Elandaloussi, Y; Hassoun, J; Garche, A; Ouarab, M; Largab, A

    2013-06-01

    The authors reexamined the files of seven patients dealt with for intramuscular hemangioma of forearm. It concerns five women and two men, between 16 and 39 years old. The average time of consultation was 13 months. The clinical signs were dominated by the development of a generally painless soft mass over the anterior compartment of the forearm and/or the elbow. Two patients presented nervous lesions signs of the ulnar or median nerves. The feeder pedicle was the ulnar artery in five cases and radial artery in two cases. The excision was incomplete in two cases because of the invasion of the ulnar nerve by the hemangioma. With four years average follow-up, the five patients having undergone a complete excision do not present a recurrence and the hand function is excellent. The authors insist on the interest of a preoperative diagnosis with the IRM, which permits to envisage surgical difficulties due to the proximity of vascular and nervous pedicles.

  14. Extracorporeal irradiated tumor bone: A reconstruction option in diaphyseal Ewing’s sarcomas

    PubMed Central

    Puri, Ajay; Gulia, Ashish; Agarwal, MG; Jambhekar, NA; Laskar, S

    2010-01-01

    Background: Limb salvage in extremity tumors is now established as an oncologically safe option without compromising long-term survival. En bloc resection followed by extracorporeal radiation and reimplantation is a biological reconstruction option in diaphyseal Ewing’s sarcomas. We analyzed the results of 12 cases of diaphyseal Ewing’s sarcomas treated using this modality. Materials and Methods: Between March 2006 and March 2008, 12 patients with Ewing’s sarcoma underwent enbloc resection and reconstruction, with reimplantation of the sterilized tumor bone, after extracorporeal irradiation. There were eight males and four females, with a mean age of 14 years (range 2 to 22 years). The femur was the most common bone involved (n=8) followed by the tibia and the humerus (two cases each). All these patients were non-metastatic at presentation and received chemotherapy as per the existing hospital protocol. The mean length of the bone resected was 20 cm (range 11 to 25 cm). The specimen was irradiated with 50 Gy prior to reimplantation and stabilized with the host bone, using suitable internal fixation. Standard biplanar radiographs were assessed for evidence of union on the follow-up visits. The functional status was assessed using the Musculoskeletal Tumor Society Scoring system at the time of the last follow up. The mean follow up duration was 29 months (range 12 to 57 months). Results: Two patients (17%) had early infection with graft removal, hence are excluded from any analysis of union, however they are included when analysing complications such as infection. Rest 10 cases were analyzed for bony union at the osteotomy sites. Sixteen (84%) of the 19 osteotomy sites united primarily, without any intervention. Implant failure and non-union was seen at three diaphyseal osteotomy sites. The average time for union of all osteotomy sites was 7.2 months (range 3 to 13 months).The average time for union of the metaphyseal osteotomy sites was 5.9 months (range 3 to

  15. Teaching Strategies for the Forearm Pass in Volleyball

    ERIC Educational Resources Information Center

    Casebolt, Kevin; Zhang, Peng; Brett, Christine

    2014-01-01

    This article shares teaching strategies for the forearm pass in the game of volleyball and identifies how they will help students improve their performance and development of forearm passing skills. The article also provides an assessment rubric to facilitate student understanding of the skill.

  16. Teaching Strategies for the Forearm Pass in Volleyball

    ERIC Educational Resources Information Center

    Casebolt, Kevin; Zhang, Peng; Brett, Christine

    2014-01-01

    This article shares teaching strategies for the forearm pass in the game of volleyball and identifies how they will help students improve their performance and development of forearm passing skills. The article also provides an assessment rubric to facilitate student understanding of the skill.

  17. Passive stiffness of coupled wrist and forearm rotations.

    PubMed

    Drake, Will B; Charles, Steven K

    2014-09-01

    Coordinated movement requires that the neuromuscular system account and compensate for movement dynamics. One particularly complex aspect of movement dynamics is the interaction that occurs between degrees of freedom (DOF), which may be caused by inertia, damping, and/or stiffness. During wrist rotations, the two DOF of the wrist (flexion-extension and radial-ulnar deviation, FE and RUD) are coupled through interaction torques arising from passive joint stiffness. One important unanswered question is whether the DOF of the forearm (pronation-supination, PS) is coupled to the two DOF of the wrist. Answering this question, and understanding the dynamics of wrist and forearm rotations in general, requires knowledge of the stiffness encountered during rotations involving all three DOF (PS, FE, and RUD). Here we present the first-ever measurement of the passive stiffness encountered during simultaneous wrist and forearm rotations. Using a wrist and forearm robot, we measured coupled wrist and forearm stiffness in 10 subjects and present it as a 3-by-3 stiffness matrix. This measurement of passive wrist and forearm stiffness will enable future studies investigating the dynamics of wrist and forearm rotations, exposing the dynamics for which the neuromuscular system must plan and compensate during movements involving the wrist and forearm.

  18. Fixation of diaphyseal fractures with a segmental defect: a biomechanical comparison of locked and conventional plating techniques.

    PubMed

    Fulkerson, Eric; Egol, Kenneth A; Kubiak, Erik N; Liporace, Frank; Kummer, Frederick J; Koval, Kenneth J

    2006-04-01

    Locking plates are an alternative to conventional compression plate fixation for diaphyseal fractures. The objective of this study was to compare the stability of various plating with locked screw constructs to conventional nonlocked screws for fixation of a comminuted diaphyseal fracture model using a uniform, synthetic ulna. Locked screw construct variables were the use of unicortical or bicortical screws, and increasing bone to plate distance. This biomechanical study compared various construct groups after cyclic axial loading and three-point bending. Results were analyzed via one-way analysis of variance. Displacements after cyclical axial loading and number of cycles to failure in cyclic bending were used to assess construct stability. The constructs fixed by plates with bicortical locked screws withstood significantly more cycles to failure than the other constructs (p < 0.001). Significantly less displacement occurred after axial loading with bicortical locked screws than with bicortical nonlocked screws. Increased distance of the plate from the bone surface, and use of unicortical locked screws led to early failure with cyclic loading for constructs with locked screws. These results support the use of plating with bicortical locked screws as an alternative to conventional plating for comminuted diaphyseal fractures in osteoporotic bone. Bicortical locked screws with minimal displacement from the bone surface provide the most stable construct in the tested synthetic comminuted diaphyseal fracture model. The results of this study suggest use of plates with unicortical screws for the described fracture is not recommended.

  19. Ulnar nerve entrapment neuropathy in the forearm.

    PubMed

    Holtzman, R N; Mark, M H; Patel, M R; Wiener, L M

    1984-07-01

    A 74-year-old male attorney developed rapidly progressive weakness of the fourth and fifth digits of the right hand with impairment of his grip and ability to perform cursive writing. Lancinating pain occurred spontaneously and was triggered by pressure along the ulnar border of the forearm about 5 cm proximal to the wrist crease. Nerve conduction studies revealed a complete electrical block to stimulation at a point 5 cm proximal to the wrist crease when recording from the abductor digiti minimi. Distal to this point, responses of normal amplitude and latency were recorded. Surgical exploration disclosed two fibrovascular bands coursing from the ulnar artery to the distal belly of the flexor carpi ulnaris, entrapping and grooving the ulnar nerve. Release of these bands resulted in reversal of the electrical block, complete relief of pain, and a full neurologic recovery during the ensuing six months.

  20. Expandable self-locking nail in the management of closed diaphyseal fractures of femur and tibia.

    PubMed

    Kapoor, Sudhir K; Kataria, Himanshu; Boruah, Tankeswar; Patra, Satya R; Chaudhry, Aashish; Kapoor, Saurabh

    2009-07-01

    Intramedullary fixation is the treatment of choice for closed diaphyseal fractures of femur and tibia. The axial and rotational stability of conventional interlocking nails depends primarily on locking screws. This method uses increased operating time and increased radiation exposure. An intramedullary implant that can minimize these disadvantages is obviously better. Expandable intramedullary nail does not rely on interlocking screws and achieves axial and rotational stability on hydraulic expansion of the nail. We analyzed 32 simple fractures of shaft of femur and tibia treated by self-locking expandable nail. Intramedullary fixation was done by using self-locking, expandable nail in 32 patients of closed diaphyseal fractures of tibia (n = 10) and femur (n = 22). The various modes of injury were road traffic accidents (n = 21), fall from height (n = 8), simple fall (n = 2), and pathological fracture (n = 1). Among femoral diaphyseal fractures 16 were males and six females, average age being 33 yrs (range, 18- 62 yrs). Seventeen patients had AO type A (A1 (n = 3), A2 (n = 4), A3 (n = 10)) and 5 patients had AO type B (B1 (n = 2), B2 (n = 2), B3 (n = 1)) fractures. Eight patients having tibial diaphyseal fractures were males and two were females; average age was 29.2 (range, 18- 55 yrs). Seven were AO type A (A1 (n = 2), A2 (n = 3), A3 (n = 2)) and three were AO type B (B1 (n = 1), B2 (n = 1), and B3 (n = 1)). We performed closed (n = 27) or open reduction (n = 5) and internal fixation with expandable nail to stabilize these fractures. The total radiation exposure during surgery was less as no locking screws were required. Early mobilisation and weight-bearing was started depending on fracture personality and evidences of healing. Absence of localised tenderness and pain on walking was considered clinical criteria for union, radiographic criteria of union being continuity in at least in three cortices in both AP and lateral views. Patients were followed for at

  1. Expandable self-locking nail in the management of closed diaphyseal fractures of femur and tibia

    PubMed Central

    Kapoor, Sudhir K; Kataria, Himanshu; Boruah, Tankeswar; Patra, Satya R; Chaudhry, Aashish; Kapoor, Saurabh

    2009-01-01

    Background: Intramedullary fixation is the treatment of choice for closed diaphyseal fractures of femur and tibia. The axial and rotational stability of conventional interlocking nails depends primarily on locking screws. This method uses increased operating time and increased radiation exposure. An intramedullary implant that can minimize these disadvantages is obviously better. Expandable intramedullary nail does not rely on interlocking screws and achieves axial and rotational stability on hydraulic expansion of the nail. We analyzed 32 simple fractures of shaft of femur and tibia treated by self-locking expandable nail. Materials and Methods: Intramedullary fixation was done by using self-locking, expandable nail in 32 patients of closed diaphyseal fractures of tibia (n = 10) and femur (n = 22). The various modes of injury were road traffic accidents (n = 21), fall from height (n = 8), simple fall (n = 2), and pathological fracture (n = 1). Among femoral diaphyseal fractures 16 were males and six females, average age being 33 yrs (range, 18- 62 yrs). Seventeen patients had AO type A (A1 (n = 3), A2 (n = 4), A3 (n = 10)) and 5 patients had AO type B (B1 (n = 2), B2 (n = 2), B3 (n = 1)) fractures. Eight patients having tibial diaphyseal fractures were males and two were females; average age was 29.2 (range, 18- 55 yrs). Seven were AO type A (A1 (n = 2), A2 (n = 3), A3 (n = 2)) and three were AO type B (B1 (n = 1), B2 (n = 1), and B3 (n = 1)). We performed closed (n = 27) or open reduction (n = 5) and internal fixation with expandable nail to stabilize these fractures. The total radiation exposure during surgery was less as no locking screws were required. Early mobilisation and weight-bearing was started depending on fracture personality and evidences of healing. Absence of localised tenderness and pain on walking was considered clinical criteria for union, radiographic criteria of union being continuity in at least in three cortices in both AP and lateral views

  2. Locking flexible nails for diaphyseal humeral fractures in the multiply injured patient: a preliminary study.

    PubMed

    Matityahu, Amir; Eglseder, W Andrew

    2011-09-01

    Multiply injured patients are sometimes treated with standard intramedullary nails for diaphyseal humeral fractures. We evaluated the use of the Synthes titanium locked flexible nail in 43 multiply injured patients (average injury severity score, 35.2) assessing time to union, nonunion rate, shoulder and elbow pain, and range of motion. Twenty-seven patients underwent antegrade insertion, and 16 underwent retrograde insertion. An increase in union rate was noted with antegrade (93%) versus retrograde (69%) insertion, without statistically significant difference in shoulder and elbow pain or range of motion. We recommend the locking flexible humeral nail with antegrade insertion for multiply injured patients with large soft-tissue damage or severe comminution that renders plate fixation difficult.

  3. Computerized fluoroscopy with zero-dose image updates for minimally invasive femoral diaphyseal fracture reduction

    NASA Astrophysics Data System (ADS)

    Zheng, Guoyan; Dong, Xiao

    2006-03-01

    In this paper, a computerized fluoroscopy with zero-dose image updates for femoral diaphyseal fracture reduction is proposed. It is achieved with a two-step procedure. Starting from a few (normally 2) calibrated fluoroscopic image, the first step, data preparation, automatically estimates the size and the pose of the diaphyseal fragments through three-dimensional morphable object fitting using a parametric cylinder model. The projection boundary of each estimated cylinder, a quadrilateral, is then fed to a region information based active contour model to extract the fragment contours from the input fluoroscopic images. After that, each point on the contour is interpolated relative to the four vertices of the corresponding quadrilateral, which resulted in four interpolation coefficients per point. The second step, image updates, repositions the fragment projection on each acquired image during bony manipulation using a computerized method. It starts with interpolation of the new position of each point on the fragment contour using the interpolation coefficients calculated in the first step and the new position of the corresponding quadrilateral. The position of the quadrilateral is updated in real time according to the positional changes of the associated bone fragments, as determined by the navigation system during fracture reduction. The newly calculated image coordinates of the fragment contour are then fed to a OpenGL® based texture warping pipeline to achieve a real-time image updates. The presented method provides a realistic augmented reality for the surgeon. Its application may result in great reduction of the X-ray radiation to the patient and to the surgical team.

  4. Biomechanical investigation of titanium elastic nail prebending for treating diaphyseal long bone fractures.

    PubMed

    Chen, Yen-Nien; Lee, Pei-Yuan; Chang, Chih-Wei; Ho, Yi-Hung; Peng, Yao-Te; Chang, Chih-Han; Li, Chun-Ting

    2016-12-02

    This study numerically investigated the deformation of titanium elastic nails prebent at various degrees during implantation into the intramedullary canal of fractured bones and the mechanism by which this prebending influenced the stability of the fractured bone. Three degrees of prebending the implanted portions of the nails were used: equal to, two times, and three times the diameter of the intramedullary canal. Furthermore, a simulated diaphyseal fracture with a 5-mm gap was created in the middle shaft portion of the bone fixed with two elastic nails in a double C-type configuration. End caps were simulated using a constraint equation. To confirm that the simulation process is able to present the mechanical response of the nail inside the intramedullary, an experiment was conducted by using sawbone for validation. The results indicated that increasing the degrees of nail prebending facilitated straightening the nails against the inner aspect of canal after implantation, with increase in stability under torsion. Furthermore, reducing nail prebending caused a larger portion of the nails to move closer to the loading site and center of bone after implantation; the use of end caps prevented the nail tips from collapsing and increased axial stability. End cap use was critical for preventing the nail tips from collapsing and for increasing the stability of the nails prebent at a degree equal to the diameter of the canal with insufficient frictional force between the nail and canal. Therefore, titanium elastic nail prebending in a double C-type configuration with a degree three times the diameter of the canal represents a superior solution for treating transverse fractures without a gap, whereas that with a degree equal to the diameter of the intramedullary canal and combined with end cap use represents an advanced solution for treating comminuted fractures in a diaphyseal long bone fracture.

  5. Intravascular extra-digital glomus tumor of the forearm

    PubMed Central

    Muneer, Mohammed; Alkhafaji, Ali; El-Menyar, Ayman; Al-Hetmi, Talal; Al-Basti, Habib; Al-Thani, Hassan

    2016-01-01

    Intravascular glomus tumor in the forearm is very rare and usually presents with persistent pain and focal tenderness. The diagnosis of this condition can be easily missed or delayed. There is no successful treatment so far other than surgical excision in most of cases. We presented a 45-year-old female presented with intravascular glomus tumor in her left forearm. The swelling was excised and the post-operative course was uneventful. Intravascular glomus tumor of the forearm is extremely rare and the persistent pain and tenderness are very suspicious. Diagnostic imaging may not be indicated in every case. PMID:27421300

  6. Tilt of the radius from forearm rotational axis reliably predicts rotational improvement after corrective osteotomy for malunited forearm fractures.

    PubMed

    Tatebe, Masahiro; Shinohara, Takaaki; Okui, Nobuyuki; Yamamoto, Michiro; Kurimoto, Shigeru; Hirata, Hitoshi

    2012-02-01

    Forearm rotation occurs around an axis connecting the center of the radial head and the fovea of the distal ulna. The purpose of the present study was to demonstrate the usefulness of the difference between forearm and proximal radial axis in the treatment of malunited forearm fractures. We reviewed the results of eight corrective osteotomies for malunited fractures of the forearm without dislocations of the wrist or elbow. Subjects were 6 men and 2 women (mean age, 15 years; range, 10-21 years). Corrective osteotomy was performed at the fracture site. Preoperatively and at final follow-up, the are of forearm rotation was recorded and anteroposterior and lateral X-rays were taken. Proximal radius tilt was defined as the angle between the rotational axis of the forearm and the axis of the proximal radius. Corrective osteotomy improved proximal radius tilt in all cases. Three patients were considered to have malrotation. Postoperative rotational are correlated with proximal radial tilt (r = -0.83). No significant difference in rotational arc was evident between malunited cases and the remaining cases. To improve forearm rotation, corrective osteotomy should be planned to minimize proximal radius tilt.

  7. The Concomitant Presence of Two Anomalous Muscles in the Forearm

    PubMed Central

    Karalezli, Nazım; Ogun, Cemile Oztin

    2007-01-01

    This article describes the concomitant presence of two anomalous forearm muscles in a 20-year-old man, discovered accidentally during an operation for a forearm injury. The first one was similar to a reverse palmaris longus muscle except for its direction to the Guyon’s canal. The second one originated from the radial antebrachial fascia, superficial to all other forearm muscles in the lower half of the forearm, then diverged medially and extended into the Guyon’s canal and was innervated by the ulnar nerve. The patient had no symptoms related to overcrowding of the Guyon’s canal before the injury. A hand surgeon should be well informed about the anatomic variations of the hand to be comfortable during surgical practice. PMID:18780071

  8. Function of the sensate free forearm flap after partial glossectomy.

    PubMed

    Biglioli, Federico; Liviero, Fabio; Frigerio, Alice; Rezzonico, Angela; Brusati, Roberto

    2006-09-01

    To compare functional recovery of sensitive free forearm flaps with non-sensitive free forearm flaps, following reconstruction for partial glossectomy. Sixteen patients underwent partial glossectomy for oncological reasons, of whom: nine patients underwent repair with non-sensitive free forearm flaps (group A) and seven with sensitive free flaps (group B). All patients underwent the following tests: (1) tactile sensitivity evaluation, localization of stimulus, sharp/blunt definition, discrimination between two points (static and dynamic), thermal sensitivity to heat/cold; (2) speech evaluation by means of the modified Fanzago test; (3) subjective evaluation concerning the degree of satisfaction of the following functions: swallowing, feeding and talking. The sensitivity and logopaedic evaluation tests and the subjective evaluation charts highlight an overall better functional recovery of the sensitive repair than the non-sensitive ones. In patients who have undergone partial glossectomy repair with free forearm neurofasciocutaneous flaps allow good recovery of oral functions and, therefore, a good quality of life.

  9. Forearm posture and mobility in quadrupedal dinosaurs.

    PubMed

    VanBuren, Collin S; Bonnan, Matthew

    2013-01-01

    Quadrupedality evolved four independent times in dinosaurs; however, the constraints associated with these transitions in limb anatomy and function remain poorly understood, in particular the evolution of forearm posture and rotational ability (i.e., active pronation and supination). Results of previous qualitative studies are inconsistent, likely due to an inability to quantitatively assess the likelihood of their conclusions. We attempt to quantify antebrachial posture and mobility using the radius bone because its morphology is distinct between extant sprawled taxa with a limited active pronation ability and parasagittal taxa that have an enhanced ability to actively pronate the manus. We used a sliding semi-landmark, outline-based geometric morphometric approach of the proximal radial head and a measurement of the angle of curvature of the radius in a sample of 189 mammals, 49 dinosaurs, 35 squamates, 16 birds, and 5 crocodilians. Our results of radial head morphology showed that quadrupedal ceratopsians, bipedal non-hadrosaurid ornithopods, and theropods had limited pronation/supination ability, and sauropodomorphs have unique radial head morphology that likely allowed limited rotational ability. However, the curvature of the radius showed that no dinosaurian clade had the ability to cross the radius about the ulna, suggesting parallel antebrachial elements for all quadrupedal dinosaurs. We conclude that the bipedal origins of all quadrupedal dinosaur clades could have allowed for greater disparity in forelimb posture than previously appreciated, and future studies on dinosaur posture should not limit their classifications to the overly simplistic extant dichotomy.

  10. Forearm Posture and Mobility in Quadrupedal Dinosaurs

    PubMed Central

    VanBuren, Collin S.; Bonnan, Matthew

    2013-01-01

    Quadrupedality evolved four independent times in dinosaurs; however, the constraints associated with these transitions in limb anatomy and function remain poorly understood, in particular the evolution of forearm posture and rotational ability (i.e., active pronation and supination). Results of previous qualitative studies are inconsistent, likely due to an inability to quantitatively assess the likelihood of their conclusions. We attempt to quantify antebrachial posture and mobility using the radius bone because its morphology is distinct between extant sprawled taxa with a limited active pronation ability and parasagittal taxa that have an enhanced ability to actively pronate the manus. We used a sliding semi-landmark, outline-based geometric morphometric approach of the proximal radial head and a measurement of the angle of curvature of the radius in a sample of 189 mammals, 49 dinosaurs, 35 squamates, 16 birds, and 5 crocodilians. Our results of radial head morphology showed that quadrupedal ceratopsians, bipedal non-hadrosaurid ornithopods, and theropods had limited pronation/supination ability, and sauropodomorphs have unique radial head morphology that likely allowed limited rotational ability. However, the curvature of the radius showed that no dinosaurian clade had the ability to cross the radius about the ulna, suggesting parallel antebrachial elements for all quadrupedal dinosaurs. We conclude that the bipedal origins of all quadrupedal dinosaur clades could have allowed for greater disparity in forelimb posture than previously appreciated, and future studies on dinosaur posture should not limit their classifications to the overly simplistic extant dichotomy. PMID:24058633

  11. Testing Tactile Masking between the Forearms.

    PubMed

    D'Amour, Sarah; Harris, Laurence R

    2016-02-10

    Masking, in which one stimulus affects the detection of another, is a classic technique that has been used in visual, auditory, and tactile research, usually using stimuli that are close together to reveal local interactions. Masking effects have also been demonstrated in which a tactile stimulus alters the perception of a touch at a distant location. Such effects can provide insight into how components of the body's representations in the brain may be linked. Occasional reports have indicated that touches on one hand or forearm can affect tactile sensitivity at corresponding contralateral locations. To explore the matching of corresponding points across the body, we can measure the spatial tuning and effect of posture on contralateral masking. Careful controls are required to rule out direct effects of the remote stimulus, for example by mechanical transmission, and also attention effects in which thresholds may be altered by the participant's attention being drawn away from the stimulus of interest. The use of this technique is beneficial as a behavioural measure for exploring which parts of the body are functionally connected and whether the two sides of the body interact in a somatotopic representation. This manuscript describes a behavioural protocol that can be used for studying contralateral tactile masking.

  12. Epidemiology of pediatric forearm fractures in Washington, DC.

    PubMed

    Ryan, Leticia Manning; Teach, Stephen J; Searcy, Kimberle; Singer, Steven A; Wood, Rachel; Wright, Joseph L; Chamberlain, James M

    2010-10-01

    Pediatric forearm fractures result in substantial morbidity and costs. Despite the success of public health efforts in the prevention of other injuries, the incidence of pediatric forearm fractures is increasing. Our objective is to characterize the epidemiology of forearm fractures in Washington, DC, children evaluated in an urban pediatric emergency department (ED). This retrospective study includes Washington, DC, children, aged 0 years to 17 years, treated for an isolated forearm fracture in the Children's National Medical Center ED from 2003 to 2006. Patients with bone mineralization disorders and repeat ED visits for the same fracture event were excluded. Chart review was done to obtain demographic and clinical data. Descriptive epidemiologic and bivariate analyses were conducted. This preliminary analysis included 929 patients. The majority of patients are male (64%) and African American (80%). The mean age (± standard deviation) is 8.4 years (±3.9). Weight-for-age percentile was ≥95% in 24.1% of cases. Most forearm fractures occurred during the spring season. The most common mechanism of injury was fall-related (83%) whereas direct trauma caused 10% of fractures. "Fall from monkey bars" was the specific mechanism of injury in 17% of all cases. The majority of forearm fractures (58%) resulted from minor trauma. Falls from monkey bars and minor trauma are implicated in the majority of childhood forearm fractures. The prevention strategies should target playground safety. Further research is needed to evaluate factors, including obesity and bone health, which may contribute to forearm fracture risk associated with minor trauma.

  13. In vivo three-dimensional elbow biomechanics during forearm rotation.

    PubMed

    Omori, Shinsuke; Miyake, Junichi; Oka, Kunihiro; Tanaka, Hiroyuki; Yoshikawa, Hideki; Murase, Tsuyoshi

    2016-01-01

    It is unclear how elbow kinematics changes during forearm rotation. This study investigated in vivo 3-dimensional elbow kinematics during forearm rotation. We studied 12 normal elbows using in vivo 3-dimensional computed tomography data in maximum forearm supination, neutral, and maximum pronation with the elbows in extension. We measured the motion of the radius and ulna relative to the humerus using a markerless bone registration technique and the contact area of the radiocapitellar joint, proximal radioulnar joint, and ulnohumeral joint using a proximity mapping method. When the forearm rotated from the supinated position to the pronated position, the radius showed significant varus rotation, internal rotation, and extension relative to the humerus. The center of the radial head significantly translated anteriorly, proximally, and laterally. The ulna significantly rotated in valgus, and the deepest point on the sagittal ridge of the trochlear notch translated medially with forearm pronation. The contact area of the radiocapitellar joint was largest in pronation. The contact area of the proximal radioulnar joint was largest in supination. The contact area of the ulnohumeral joint showed no significant change during forearm rotation. In pronation, because of the proximal migration of the radial head, the radiocapitellar joint was most congruent compared with other positions. The proximal radioulnar joint was most congruent in supination. The ulnohumeral joint congruency was not affected by forearm rotation. This study provides useful information for understanding 3-dimensional elbow motion and joint osseous stability related to forearm rotation. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. Posterolateral elbow dislocation with ipsilateral radial and ulnar diaphyseal fractures: a case report.

    PubMed

    Kose, O; Durakbasa, M O; Islam, N C

    2008-04-01

    Elbow dislocation associated with both ipsilateral radial and ulnar shaft fractures is a rare pattern of injury, although it is common for elbow dislocation and forearm fractures to occur separately. We report a case of an 80-year-old woman who had a posterolateral elbow dislocation and ipsilateral radial and ulnar shaft fractures and underwent closed reduction and plate fixation. She had an excellent outcome after 22 months of follow-up.

  15. Acquired Solitary Glomangiomyoma on the Forearm: A Rare Case Report

    PubMed Central

    Deger, Hakki; Tayfur, Mahir; Balcioglu, Mecdi Gurhan; Kadioglu, Emine

    2016-01-01

    Glomus tumours are benign lesions which are frequently seen on hand (particularly subungual region). In this report a 52-year-old male patient with glomangiomyoma on the left forearm has been presented. With a preliminary diagnosis of haemangioma, a subcutaneous well-circumscribed nodular lesion of the patient was excised. On histomorphological examination glomus cells, vascular structures and spindle-shaped smooth muscle cells were seen around it. Immunohistochemistry of smooth muscle cells and glomus cells showed positivity for smooth muscle actin. By means of these findings, the patient was diagnosed with glomangiomyoma. Glomus tumours are rare in the forearm (In the literatüre there are two cases). Moreover, glomangiomyomas are the least common histomorphological type of glomus tumour and are generally seen in the lower extremity. In the literature, a few cases of glomangioma and solitary glomus tumour has been described on the forearm histologically and only a few glomangiomyoma cases on forearm location. We have presented the glomangiomyoma on the forearm as a rarely-seen case. Early diagnosis of the glomangiomyoma on the forearm is of importance for the prevention of morbidity. PMID:27630858

  16. The "weight" of words on the forearms during relaxation.

    PubMed

    Santarpia, A; Blanchet, A; Mininni, G; Kwiatkowski, F; Lindeman, L; Lambert, J F

    2009-06-01

    In this paper we examined the influence of repetition of weight-related sentences on the involuntary pressure forces of the forearms, when in a relaxed state. These forces were involuntary oscillations, exerted by muscle movements of the breathing-cycle and muscle movements of the arm on force sensors. We constructed a linguistic bio-mechanical system (Ablasmi), where in each arm of a padded relaxation chair contained special sensors that were specifically designed to detect the pressure forces of each forearm while participants listened to the specific recorded weight-related sentences. In this experiment we used some classic sentences, such as "your right/left arm is heavy," inspired by Autogenic Training (Schultz in Le training autogene. Paris, PUF, 1974) and some sentences, such as "your right/left arm is made of lead," inspired by Grossmann's relaxation technique. We observed that when the recorded sentences were directed to the right arm there was a significant increase of involuntary pressure forces on the right forearm. Additionally, we observed the same effect on the left forearm for the sentences directed to the left forearm. Thus, we believe we have provided experimental evidence of a definite linguistic effect of weight-related sentences on the involuntary pressure forces of the forearms. The implications of these findings are discussed.

  17. Tibioperoneal diaphyseal toxopachyosteosis or Weismann-Netter-Stuhl syndrome: difficulties encountered in classifying this syndrome and differentiation from rickets.

    PubMed

    Nores, J M; Monsegu, M H; de Masfrand, V; Oberlin, F; Denormandie, P; Remy, J M

    1997-01-01

    Using two new cases and 70 case reports in the literature as a starting point, the authors focus on the Weismann-Netter-Stuhl syndrome. Weismann-Netter and Stuhl reported the first cases of tibioperoneal diaphyseal toxopachyosteosis in 1954. This syndrome is defined as an anomaly of the diaphyseal part of both tibiae and fibulae with posterior cortical thickening and anterior-posterior bowing. This anomaly is usually bilateral and symmetrical, and patients are therefore short in stature. The thickening of the fibula is true "tibialisation" and "is the main feature and the only feature confirming diagnosis". Routine laboratory investigations showed no abnormalities in the two new cases. The authors specify the limits encountered in classifying this anomaly and discuss the degree to which this anomaly is an entity unto itself when compared with rickets sequelae.

  18. Long-term anabolic effects of prostaglandin-E2 on tibial diaphyseal bone in male rats

    NASA Technical Reports Server (NTRS)

    Jee, Webster S. S.; Ke, Hua Zhu; Li, Xiao Jian

    1991-01-01

    The effects of long-term prostaglandin E2 (PGE2) on tibial diaphyseal bone were studied in 7-month-old male Sprague-Dawley rats given daily subcutaneous injections of 0, 1, 3 and 6 mg PGE2/kg/day for 60, 120 and 180 days. The tibial shaft was measured by single photon absorptiometry and dynamic histomorphometric analyses were performed on double-fluorescent labeled undecalcified tibial diaphyseal bone samples. Exogenous PGE2 administration produced the following transient changes in a dose-response manner between zero and 60 days: (1) increased bone width and mineral density; (2) increased total tissue and total bone areas; (3) decreased marrow area; (4) increased periosteal and corticoendosteal lamellar bone formation; (5) activated corticoendosteal lamellar and woven trabecular bone formation; and (6) activated intracortical bone remodeling. A new steady-state of increased tibial diaphyseal bone mass and elevated bone activities were observed from day 60 onward. The elevated bone mass level attained after 60 days of PGE2 treatment was maintained at 120 and 180 days. These observations indicate that the powerful anabolic effects of PGE2 will increase both periosteal and corticoendosteal bone mass and sustain the transient increase in bone mass with continuous daily administration of PGE2.

  19. Risk Factors for Subtrochanteric and Diaphyseal Fractures: The Study of Osteoporotic Fractures

    PubMed Central

    Napoli, Nicola; Schwartz, Ann V.; Palermo, Lisa; Jin, Jenny J.; Wustrack, Rosanna; Cauley, Jane A.; Ensrud, Kristine E.; Kelly, Michael

    2013-01-01

    Context: Patients on long-term bisphosphonate therapy may have an increased incidence of low-energy subtrochanteric and diaphyseal (SD) femoral fractures. However, the incidence and risk factors associated with these fractures have not been well defined. Objective: The objective of the study was to determine the incidence of and risk factors for low-energy SD fractures in the Study of Osteoporotic Fractures (SOF). Design: Low-energy SD fractures were identified from a review of radiographic reports obtained between 1986 and 2010 in women in the SOF. Among the SD fractures, pathological, periprosthetic, and traumatic fractures were excluded. We assessed risk factors for SD fractures as well as risk factors for femoral neck (FN) and intertrochanteric (IT) hip fractures using both age-adjusted and multivariate time-dependent proportional hazards models. During this follow-up, only a small minority had ever used bisphosphonates. Results: Forty-five women sustained low-energy subtrochanteric/diaphyseal femoral fractures over a total follow-up of 140 000 person-years. The incidence of SD fracture was 3.2 per 10 000 person-years compared with a total hip fracture incidence of 110 per 10 000 person-years. A total of about 12% of women reported bisphosphonate use at 1 or more visits. In multivariate analyses, age, total hip bone mineral density (BMD), bisphosphonate use, and history of diabetes emerged as independent risk factors for SD fractures. Risk factors for FN and IT fractures included age, BMD, and history of falls or prior fractures. Bisphosphonate use was protective against FN fractures, whereas there was an increased risk of SD fractures (hazard ratio 2.58, P = .049) with bisphosphonate use after adjustment for other risk factors for fracture. Conclusions: In SOF, low-energy SD fractures were rare occurrences, far outnumbered by FN and IT fractures. Typical risk factors were associated with FN and IT fractures, whereas only age, total hip BMD, and history of

  20. Radiographic factors and effect of fifth metatarsal Jones and diaphyseal stress fractures on participation in the NFL.

    PubMed

    Carreira, Dominic S; Sandilands, Scott M

    2013-04-01

    Jones fracture and proximal diaphyseal stress fracture of the fifth metatarsal have been associated with prolonged healing times and nonunions. We hypothesized that the Jones fracture and proximal diaphyseal stress fracture have a high incidence in elite collegiate football players and that they lead to a decrease in participation in the NFL. Also, we hypothesized that these fractures are associated with a cavovarus foot alignment. The database collected by a single NFL team during the 2004 to 2009 NFL Combines was reviewed to identify players with Jones and proximal diaphyseal fifth metatarsal fractures. A total of 74 fifth metatarsal fractures were identified in 68 players. Subsequent participation data also were collected through the NFL.com website and included games played and years played. Digital plain radiographs and additional imaging studies also were reviewed to determine the extent of healing, types of fixation utilized, and foot alignment. The locations of fractures in the proximal fifth metatarsal were 45 (61%) in the Jones area, 15 (20%) in the proximal diaphyseal area, and 14 (19%) of indeterminate location. The number of patients treated with intramedullary fixation was 55/74 (74%). Of 74 proximal fifth metatarsal fractures, 9 (12.2%) were nonunions at the time of the NFL Combine medical examinations. With the numbers available, the average number of games played in the NFL was not significantly different in the fifth metatarsal fracture group, 16.9, compared to the control group, 24.9 (P > .05). The average number of games started was 7.4 in the fracture group versus 12.1 in the control group (P > .05). No significant differences were noted in the number of years played in the NFL. Except for talonavicular angle measurements, all measurements of coronal plane alignment demonstrated significant differences across groups, but no differences were noted in sagittal plane alignment. No statistically significant difference was noted in participation in

  1. Hip spica versus Rush pins for management of femoral diaphyseal fractures in children

    PubMed Central

    Ruhullah, Mohammad; Singh, Hare Ram; Shah, Sanjay; Shrestha, Dipak

    2014-01-01

    Background: Femoral fractures are common in children between 2 and 12 years of age and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. We compared primary hip spica with closed reduction and fixation with retrogradely passed crossed Rush pins for diaphyseal femur fracture in children. The hypothesis was that Rush pin might provide better treatment with good clinical results in comparison with primary hip spica. Materials and Methods: Fifty children with femoral fractures were evaluated; 25 of them underwent conservative treatment using immediate hip spica (group A) and 25 were treated with crossed retrograde Rush pins (group B). The patients ages ranged from 3 to 13 years (mean of 9 years). Results: Mean duration of fracture union was 15 weeks in group A and 12 weeks in group B. Mean duration of weight bearing 14 weeks in group and 7 weeks in group B. Mean hospital stay was 4 days in group A and 8 days in group B. Mean followup period in group A was 16 months and group B was 17 months. Complications such as angulation, shortening, infection were compared. Conclusions: Closed reduction and internal fixation with crossed Rush pins was superior in terms of early weight bearing and restoration of normal anatomy. PMID:25298556

  2. Changes in long bone diaphyseal strength with horticultural intensification in west-central Illinois.

    PubMed

    Bridges, P S; Blitz, J H; Solano, M C

    2000-06-01

    This study examines changes in long bone diaphyseal strength in west-central Illinois from the Middle Woodland through the Mississippian periods. Significant differences occur between the Middle Woodland and the Late Woodland periods, at the time when use of native seed crops intensifies. In females, both humeral and femoral strength increases, which may be related to their role in growing and processing these crops. In males, right arm strength declines, which may be tied in part to the replacement of the atlatl by the bow. Fewer significant changes occur between the earlier and later Late Woodland periods, at the time when maize is introduced as a dietary staple, possibly because maize is at first grown as only one of a series of other starchy seeds. Finally, in the Mississippian period, when maize use intensifies, female left arm strength declines. This may be because maize is easier to process than native seeds, or it may reflect innovations in processing technology in the Mississippian period. External dimensions and shape indices, in part, reflect the trends seen in biomechanical strength. Comparisons are made to similar studies in other regions. Copyright 2000 Wiley-Liss, Inc.

  3. Computer-aided parachute guiding system for closed reduction of diaphyseal fractures.

    PubMed

    Du, Dajiang; Liu, Zhen; Omori, Shinsuke; Kurita, Masahiro; Tomita, Tetsuya; Sugamoto, Kazuomi; Yoshikawa, Hideki; Murase, Tsuyoshi

    2014-09-01

    Closed reduction is of great benefit for fracture healing. However, achieving this without sacrificing the reduction accuracy and exposing the surgeon and patient to excessive radiation is difficult. A novel parachute guiding system (ParaEx System) was developed for closed reduction of fractures based on computed tomography data. The system included two counter guides with stainless tubular markers that could be attached to the unilateral external fixator. Comminuted tibial diaphyseal fracture models were used to validate the ParaEx System. The mean errors (and standard deviations) of residual rotational and translational deformity were 0.67° ± 0.45°, 0.92° ± 1.00°, and 0.64° ± 0.50° in rotation and 1.30 ± 1.10 mm, 1.13 ± 0.70 mm, and 0.94 ± 0.92 mm in translation about the X, Y, and Z axes of the local coordinate axes, respectively. The ParaEx System was useful for accurate closed reduction of fractures at low cost. Copyright © 2013 John Wiley & Sons, Ltd.

  4. Habitual throwing and swimming correspond with upper limb diaphyseal strength and shape in modern human athletes.

    PubMed

    Shaw, Colin N; Stock, Jay T

    2009-09-01

    Variation in upper limb long bone cross-sectional properties may reflect a phenotypically plastic response to habitual loading patterns. Structural differences between limb bones have often been used to infer past behavior from hominin remains; however, few studies have examined direct relationships between behavioral differences and bone structure in humans. To help address this, cross-sectional images (50% length) of the humeri and ulnae of university varsity-level swimmers, cricketers, and controls were captured using peripheral quantitative computed tomography. High levels of humeral robusticity were found in the dominant arms of cricketers, and bilaterally among swimmers, whereas the most gracile humeri were found in both arms of controls, and the nondominant arms of cricketers. In addition, the dominant humeri of cricketers were more circular than controls. The highest levels of ulnar robusticity were also found in the dominant arm of cricketers, and bilaterally amongst swimmers. Bilateral asymmetry in humeral rigidity among cricketers was greater than swimmers and controls, while asymmetry for ulnar rigidity was greater in cricketers than controls. The results suggest that more mechanically loaded upper limb elements--unilaterally or bilaterally--are strengthened relative to less mechanically loaded elements, and that differences in mechanical loading may have a more significant effect on proximal compared to distal limb segments. The more circular humerus in the dominant arm in cricketers may be an adaptation to torsional strain associated with throwing activities. The reported correspondence between habitual activity patterns and upper limb diaphyseal properties may inform future behavioral interpretations involving hominin skeletal remains.

  5. An RNA-seq Protocol to Identify mRNA Expression Changes in Mouse Diaphyseal Bone: Applications in Mice with Bone Property Altering Lrp5 Mutations

    PubMed Central

    Ayturk, Ugur M.; Jacobsen, Christina M.; Christodoulou, Danos C.; Gorham, Joshua; Seidman, Jonathan G.; Seidman, Christine E.; Robling, Alexander G.; Warman, Matthew L.

    2013-01-01

    Loss-of-function and certain missense mutations in the Wnt co-receptor LRP5 significantly decrease or increase bone mass, respectively. These human skeletal phenotypes have been recapitulated in mice harboring Lrp5 knockout and knockin mutations. We hypothesized that measuring mRNA expression in diaphyseal bone from mice with Lrp5 wild-type (Lrp5+/+), knockout (Lrp5−/−), and high bone mass (HBM)-causing (Lrp5p.A214V/+) alleles could identify genes and pathways that regulate or are regulated by LRP5 activity. We performed RNA-seq on pairs of tibial diaphyseal bones from four 16-week-old mice with each of the aforementioned genotypes. We then evaluated different methods for controlling for contaminating non-skeletal tissue (i.e., blood, bone marrow, and skeletal muscle) in our data. These methods included pre-digestion of diaphyseal bone with collagenase and separate transcriptional profiling of blood, skeletal muscle and bone marrow. We found that collagenase digestion reduced contamination, but also altered gene expression in the remaining cells. In contrast, in silico filtering of the diaphyseal bone RNA-seq data for highly expressed blood, skeletal muscle, and bone marrow transcripts significantly increased the correlation between RNA-seq data from an animal’s right and left tibiae and from animals with the same Lrp5 genotype. We conclude that reliable and reproducible RNA-seq data can be obtained from mouse diaphyseal bone and that lack of LRP5 has a more pronounced effect on gene expression than the HBM-causing LRP5 missense mutation. We identified 84 differentially expressed protein-coding transcripts between LRP5 “sufficient” (i.e., Lrp5+/+ and Lrp5p.A214V/+) and “insufficient” (Lrp5−/−) diaphyseal bone, and far fewer differentially expressed genes between Lrp5p.A214V/+ and Lrp5+/+ diaphyseal bone. PMID:23553928

  6. Atypical Chronic Ankle Instability in a Pediatric Population Secondary to Distal Fibula Avulsion Fracture Nonunion.

    PubMed

    El Ashry, Saad R; El Gamal, Tarek A; Platt, Simon R

    Chronic ankle instability is a disabling condition, often occurring as a result of traumatic ankle injury. A paucity of published data is available documenting chronic ankle instability in the pediatric population. Much of the data has been confined to the adult population. We present 2 cases of chronic ankle instability, 1 in a 12-year-old and 1 in a 9-year-old patient. Unlike the typical adult etiology, the cause of instability was a dysfunctional lateral ligamentous complex as a consequence of bony avulsion of the tip of the fibula. Both patients had sustained a twisting injury to the ankle. The fractures failed to unite. The nonunion resulted in dysfunction of the anterior talofibular ligament with consequent chronic ankle instability. At the initial clinical assessment, magnetic resonance imaging was requested for both patients. In patient 1 (12 years old), the fracture was fixed with 2 headless screws and was immobilized in a plaster cast for 6 weeks. In patient 2 (9 years old), because of the small size of the avulsed fragment, fixation was not possible. A modified Gould-Broström procedure was undertaken, facilitating repair of the avulsed fragment using anchor sutures. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Low-Intensity Pulsed Ultrasound Treatment for Scaphoid Fracture Nonunions in Adolescents

    PubMed Central

    Carlson, Erik J.; Save, Ameya V.; Slade, Joseph F.; Dodds, Seth D.

    2015-01-01

    Background Treatment of scaphoid nonunion is challenging, leading clinicians to pursue innovation in surgical technique and adjunctive therapies to improve union rates. Purpose The purpose of this study was to investigate the use of low-intensity pulsed ultrasound as an adjunctive treatment modality following surgical treatment of scaphoid nonunion in adolescent patients, for whom this therapy has not yet been FDA-approved. Patients and Methods We performed a retrospective review of adolescent patients with scaphoid nonunion treated surgically followed by adjunctive low-intensity pulsed ultrasound therapy. All patients underwent 20 minutes of daily ultrasound therapy postoperatively until there was evidence of bony healing, based on both clinical and radiographic criteria. Final healing was confirmed by > 50% bone bridging on CT scan. Results Thirteen of fourteen (93%) patients healed at a mean interval of 113 days (range 61–217 days). There were no surgical or postoperative complications. One patient developed heterotopic bone formation about the scaphoid. Conclusions Our study suggests that low-intensity pulsed ultrasound therapy can safely be utilized as an adjunctive modality in adolescents to augment scaphoid healing following surgical intervention. Level of Evidence Level IV, Case series PMID:25945296

  8. Tips and tricks in creation of forearm arteriovenous fistulae.

    PubMed

    Bourquelot, Pierre; Pirozzi, Nicola

    2014-01-01

    Forearm arteriovenous fistula (AVF) is a direct anastomosis between the radial artery and the cephalic vein or the ulnar artery and the basilic vein, which are small-caliber vessels. The surgical technique must be precise to avoid postoperative stenosis of the anastomosis which may result in early thrombosis or nonmaturation. In our experience, microsurgery and preventive hemostasis are two major contributions to creation of forearm AVF. Using these techniques, construction of a radial-cephalic fistula was possible in 78% of children in our hospital, with 60% secondary patency rates at 4 years. In a personal unpublished series, 69% of the first arteriovenous angioaccess of adult patients were forearm fistulae, with 63% and 91% primary and secondary 1-year patency rates, respectively. Finally, 68% primary patency and 96% secondary patency rates at 1 year were reported by Pirozzi et al. in adults with an internal diameter of <1.6 mm in the radial artery.

  9. Case report: accessory head of the deep forearm flexors

    PubMed Central

    JONES, M.; ABRAHAMS, P. H.; SAÑUDO, J. R.

    1997-01-01

    In 1813 Gantzer described 2 accessory muscles in the human forearm which bear his name (Wood, 1868; Macalister, 1875) and these have subsequently been reported with variable attachments (Wood, 1868; Macalister, 1875; Turner, 1879; Schäfer & Thane, 1894; Le Double, 1897; Dykes & Anson, 1944; Mangini, 1960; Malhotra et al. 1982; Kida, 1988; Tountas & Bergman, 1993). The accessory heads of the deep flexors of the forearm (Gantzer's muscles) have been described as 2 different small bellies which insert either into FPL or FDP. There are no previous reports which have mentioned the existence of an accessory muscle which inserts into both of the 2 deep flexors of the forearm as in the case presented here. PMID:9306208

  10. Osteocutaneous radial forearm free flap in subtotal nasal reconstruction

    PubMed Central

    Moore, Alexander Michael; Montgomery, Jenny; McMahon, Jeremy; Sheikh, Saghir

    2014-01-01

    A 66-year-old man presented with a large squamous cell carcinoma of the right nasal vestibule. He underwent partial rhinectomy and medial maxillectomy followed by staged reconstruction. Reconstruction of a full-thickness nasal defect requires repair of three distinct layers: the skin–soft tissue envelope, subsurface framework and intranasal lining. We report the first use in the UK of an osteocutaneous radial forearm free flap in the reconstruction of a subtotal nasal deficit. The skin of the radial forearm free flap was tubed to recreate the nasal lining and the radial bone reconstructed the dorsal contour of the nose. A full-thickness paramedian forehead flap supplied external coverage. The osteocutaneous radial forearm free flap and forehead flap is a viable option for large nasal defects requiring reconstruction of framework, nasal lining and external covering. PMID:25427933

  11. Finding the Center of Volume of the Forearm

    NASA Astrophysics Data System (ADS)

    Klein, Stacy S.; Roselli, Robert J.

    2008-04-01

    A typical first-year physics course teaches students about the center of mass using both regular and irregularly shaped objects. Students often suspend an object in each of two dimensions from a string with the intersection determining the center of mass of the object. While these methods can be effective, they are not particularly exciting or motivating. Wouldn't it be more interesting to find the center of mass of a body part, such as the forearm? Through a series of simple measurements and assumptions, students can generate a first-order approximation of the center of volume and center of mass of their forearm. Comparisons can be made between the muscular forearm of the football player in the class with the scrawniest arm in the room, creating a deeper understanding of center of mass and how it relates to the human body.

  12. Posterior interosseous reverse forearm flap: experience with 80 consecutive cases.

    PubMed

    Angrigiani, C; Grilli, D; Dominikow, D; Zancolli, E A

    1993-08-01

    The results of an anatomic investigation performed in 40 fresh cadaver specimens and 80 consecutive clinical cases of the posterior interosseous reverse forearm flap are reported. It was observed that there is a choke anastomosis between the recurrent dorsal branch of the anterior interosseous artery and the posterior interosseous artery at the level of the middle third of the posterior forearm. Ink injections through a catheter placed in the distal part of the anterior interosseous artery stained the distal and middle thirds of the posterior forearm, but the proximal third remained unstained; this secondary territory cannot be captured through the choke anastomosis between the anterior interosseous artery and the posterior interosseous artery. Intravital fluorescein injection into the distal arterior interosseous artery revealed (under ultraviolet light) that the distal third of the posterior forearm is irrigated by direct flow through the recurrent branch of the arterior interosseous artery (the traditionally called distal anastomosis of the interosseous arteries). Therefore, we can assume that the blood flow is not reversed when the so-called posterior interosseous reverse forearm flap is raised. From this point of view, this flap could be renamed as the recurrent dorsal anterior interosseous direct flap; however, the classical name is maintained for practical purposes. From the venous standpoint, the cutaneous area included in this flap belongs to an oscillating type of venous territory and is connected to the deep system through an interconnecting venous perforator that accompanies a medial cutaneous arterial branch located at 1 to 2 cm distal to the middle point of the forearm.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Trauma-induced changes in diaphyseal cross-sectional geometry in two elites from Copan, Honduras.

    PubMed

    Nystrom, Kenneth C; Buikstra, Jane E

    2005-12-01

    This research utilized biplanar radiographs to estimate cross-sectional biomechanical properties for the skeletal remains of two elite individuals from the Early Classic period (ca. AD 400-600) of Copan, Honduras: K'inich Yax K'uk' Mo' (Hunal Burial 95-2), founder of the Early Classic Dynasty at Copan, and the primary female interment (Burial 37-8) from the Motmot tomb. Both individuals survived severe blunt-force insults to the right forearm. Gross skeletal examination and evaluation of the radiographs for K'inich Yax K'uk' Mo' suggest that these traumas resulted from, at least in part, disuse atrophy of the affected forearm skeletal elements. Gross and radiologic evaluation of the Motmot remains countered the possibility that she suffered from a metabolic bone disease, and confirmed the presence of a well-healed parry fracture of the right ulna. The degree of asymmetry in cross-sectional biomechanical properties reported here for K'inich Yax K'uk' Mo' is likely the secondary result of the described blunt-force trauma. The results obtained for the principal Motmot interment are not as dramatic, but suggest subtle changes to humeral cross-sectional geometry subsequent to trauma.

  14. Archery-related injuries of the hand, forearm, and elbow.

    PubMed

    Rayan, G M

    1992-10-01

    The five patients reported herein had various archery-related injuries of the upper extremities. Acute injuries included arrow laceration of a digital nerve and artery, contusion of forearm skin and subcutaneous tissue, and compression neuropathy of digital nerves from the bowstring. Chronic injuries included bilateral medial epicondylitis and median nerve compression at the wrist, de Quervain's tenosynovitis, and median nerve compression at the elbow. Essential measures for archery safety include use of archery protective gear, use of a light-weight bow, conditioning of the forearm flexor muscles, and modifications in drawing the bowstring.

  15. [Expanded pedicled forearm flap for reconstruction of multiple finger amputations].

    PubMed

    Alvarez Jorge, A; Martelo Villar, F

    2000-05-01

    Soft-tissue injuries of the hand frequently require flap coverage to preserve structures damaged at the time of injury or to facilitate later reconstruction. The radial forearm flap makes local tissue readily available and offers a simple method of reconstruction. Secondary augmentation of the skin flap by means of tissue expansion appears to be a useful alternative to improve the possibilities of reconstruction. This case report describes a primary reconstruction of a hand with multiple finger amputations using both techniques: Forearm flap and tissue expansion.

  16. Dual intersection syndrome of the forearm: a case report

    PubMed Central

    Zhari, Bouchra; Edderai, Meryem; Boumdine, Hassan; Amil, Touriya; En-nouali, Hassan

    2015-01-01

    The intersection syndrome, described since the 19th century, is an uncommon disorder associated with rubbing at the crossing point between the first dorsal compartment muscles and the radial wrist extensor muscles. Imaging modalities used to diagnosis this syndrome includes ultrasonography and magnetic resonance imaging. We reported a case of a 60-year-old man presented to our formation with painful swelling on the dorsum of the wrist and forearm. An MRI and an ultrasound were performed, and objectified a dual cross syndrome of the forearm. PMID:26587172

  17. Trends in subtrochanteric, diaphyseal, and distal femur fractures, 1984-2007.

    PubMed

    Ng, A C; Drake, M T; Clarke, B L; Sems, S A; Atkinson, E J; Achenbach, S J; Melton, L J

    2012-06-01

    The incidence of non-hip femur fractures increased between 1984 and 2007, with an increase in the rates for women after 1996. Recent reports have suggested that non-hip femur fractures may be decreasing over time, similar to proximal femur fractures. Incidence rates for non-hip femur fractures among Olmsted County, Minnesota, residents were assessed before and after 1995 when the oral bisphosphonate, alendronate, was approved in the USA. From 1984 to 2007, 727 non-hip femur fractures were observed in 690 Olmsted County residents (51% female [median age, 71.6 years] and 49% male [21.4 years]). Altogether, 20% of the fractures were subtrochanteric, 51% were diaphyseal, and 29% involved the distal femur. Causes included severe trauma in 51%, minimal to moderate trauma in 34%, and pathologic causes in 15%. The overall age- and sex-adjusted annual incidence of first non-hip femur fracture was 26.7 per 100,000 (25.0 per 100,000 for women and 26.6 per 100,000 for men). Incidence rates increased with age and were greater in women than men. Between 1984-1995 and 1996-2007, age-adjusted rates increased significantly for women (20.4 vs. 28.7 per 100,000; p = 0.002) but not for men (22.4 vs. 29.5 per 100,000; p = 0.202). The incidence of first non-hip femur fractures rose between 1984 and 2007, with an increase in the rates for women after 1995.

  18. Management of traumatic tibial diaphyseal bone defect by “induced-membrane technique”

    PubMed Central

    Gupta, Gaurav; Ahmad, Sohail; Mohd. Zahid; Khan, A H; Sherwani, M K A; Khan, Abdul Qayyum

    2016-01-01

    Background: Gap nonunion of long bones is a challenging problem, due to the limitation of conventional reconstructive techniques more so if associated with infection and soft tissue defect. Treatment options such as autograft with non-vascularized fibula and cancellous bone graft, vascularized bone graft, and bone transportation are highly demanding on the part of surgeons and hospital setups and have many drawbacks. This study aims to analyze the outcome of patients with wide diaphyseal bone gap treated with induced-membrane technique (Masquelet technique). Materials and Methods: This study included 9 patients (7 males and 2 females), all with tibial bone-gap. Eight of the 9 patients were infected and in 3 patients there was associated large soft tissue defect requiring flap cover. This technique is two-stage procedure. Stage I surgery included debridement, fracture stabilization, application of spacer between bone ends, and soft tissue reconstruction. Stage II surgery included removal of spacer with preservation of induced membrane formed at spacer surface and filling the bone-gap with morselized iliac crest bone-graft within the membrane sleeve. Average bone-gap of 5.2 cm was treated. The spacer was always found to be encapsulated by a thick glistening membrane which did not collapse after its removal. All patients were followed up for an average period of 21.5 months. Results: Serial Radiographs showed regular uptake of autograft and thus consolidation within themselves in the region of bone gap and also with host bone. Bone-union was documented in all patients and all patients are walking full weight-bearing without support. Conclusions: The study highlights that the technique provide effective and practical management for difficult gap nonunion. It does not require specialized equipment, investigations, and surgery. Thus, it provides a reasonable alternative to the developing infrastructures and is a reliable and reproducible technique. PMID:27293290

  19. Functional treatment of metacarpal diaphyseal fractures by buddy taping: A prospective single-center study.

    PubMed

    Jardin, Emmanuelle; Pechin, Caroline; Rey, Pierre-Bastien; Uhring, Julien; Obert, Laurent

    2016-02-01

    Metacarpal diaphyseal fractures are classically treated using a non-removable glove for 4 to 6 weeks. Here, we report the results of treatment by immediate active protected mobilization (buddy taping for four weeks) of minimally displaced M2 to M5 fractures. Fifty-four fractures (15 transverse or short oblique and 39 spiral or long oblique) in 51 patients were included during a one-year period; the average age of patients was 31 years. Clinical and radiographic assessments were carried out at day 15 and then months 1, 2 and 6 post-fracture. Thirty-one cases were reviewed at day 15, 27 at 1 month, and 22 at 2 months. The initial volar tilt was 26° on average for the short oblique or transverse fractures, and 11.5° for the long oblique or spiral fractures. Six fractures (11%) experienced 16.6° of secondary displacement on average. The fracture was healed in 37% of cases at 1 month, and in 100% of cases at 2 months in the patients who were reviewed clinically. Reduction in the QuickDASH and VAS for pain was evidence of fast functional recovery. The range of motion was comparable to that of the contralateral side in 90% cases after 2 months. Grip and pinch strength was 33% less than the contralateral side at 2 months. Although secondary displacement occurs in some cases, the functional results of this simple and practical treatment method are good after 2 months, as there is little pain, stiffness, strength loss and no cases of nonunion. Copyright © 2016 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  20. The locomotion of Babakotia radofilai inferred from epiphyseal and diaphyseal morphology of the humerus and femur.

    PubMed

    Marchi, Damiano; Ruff, Christopher B; Capobianco, Alessio; Rafferty, Katherine L; Habib, Michael B; Patel, Biren A

    2016-09-01

    Palaeopropithecids, or "sloth lemurs," are a diverse clade of large-bodied Malagasy subfossil primates characterized by their inferred suspensory positional behavior. The most recently discovered genus of the palaeopropithecids is Babakotia, and it has been described as more arboreal than Mesopropithecus, but less than Palaeopropithecus. In this article, the within-bone and between-bones articular and cross-sectional diaphyseal proportions of the humerus and femur of Babakotia were compared to extant lemurs, Mesopropithecus and Palaeopropithecus in order to further understand its arboreal adaptations. Additionally, a sample of apes and sloths (Choloepus and Bradypus) are included as functional outgroups composed of suspensory adapted primates and non-primates. Results show that Babakotia and Mesopropithecus both have high humeral/femoral shaft strength proportions, similar to extant great apes and sloths and indicative of forelimb suspensory behavior, with Babakotia more extreme in this regard. All three subfossil taxa have relatively large femoral heads, also associated with suspension in modern taxa. However, Babakotia and Mesopropithecus (but not Palaeopropithecus) have relatively small femoral head surface area to shaft strength proportions suggesting that hind-limb positioning in these taxa during climbing and other behaviors was different than in extant great apes, involving less mobility. Knee and humeral articular dimensions relative to shaft strengths are small in Babakotia and Mesopropithecus, similar to those found in modern sloths and divergent from those in extant great apes and lemurs, suggesting more sloth-like use of these joints during locomotion. Mesopropithecus and Babakotia are more similar to Choloepus in humerofemoral head and length proportions while Palaeopropithecus is more similar to Bradypus. These results provide further evidence of the suspensory adaptations of Babakotia and further highlight similarities to both extant suspensory

  1. Intramedullary nailing of humeral diaphyseal fractures. Is distal locking really necessary?

    PubMed Central

    Tyllianakis, Minos; Tsoumpos, Pantelis; Anagnostou, Kostas; Konstantopoulou, Anna; Panagopoulos, Andreas

    2013-01-01

    Purpose: Distal interlocking is regarded as an inherent part of the antegrade humeral nailing technique, but it exposes both the patient and surgeon to radiation, is time consuming, and has a potential risk of damaging neurovascular structures. We have presented our technique of diaphyseal humeral nailing without any distal interlocking in this paper. Materials and Methods: We have presented a series of 64 consecutive patients (33 male and 31 female, mean age: 41.5 years) with humeral shaft fractures treated with antegrade rigid intramedullary nailing without distal interlocking following a strict intra and postoperative protocol. According to the AO classification, there were 36 type A fractures, 22 type B, and 6 type C. Nails were inserted unreamed or by using limited proximal reaming and they were fitted as snuggly as possible into the medullary canal. After impaction of the nail into the fossa, we carefully tested rotational stability of fixation by checking any potential external rotation when the arm was slightly turned externally and left to the gravity forces. We were ready to add distal screws, but that was not required in these cases. Follow-up assessment included fracture union, complications and failures, and the final clinical outcome at minimum 2-year follow-up using the parameters of the constant score. Results: All fractures, except two, united between the 4th and 5th postoperative month. In one case, nail was exchanged with plate, and, in another, a larger nail was used at a second surgery. Shoulder function according to constant score, at a minimum of 2-year follow-up, was excellent or very good in 93.7% of the patients. Conclusions: Provided that some technical issues are followed, the method reduces intraoperative time and radiation exposure and avoids potential damage to neurovascular structures. PMID:23960365

  2. 78 FR 36308 - Proposed Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-17

    ... AFFAIRS Proposed Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire... Disability Benefits Questionnaire)'' in any correspondence. During the comment period, comments may be viewed.... SUPPLEMENTARY INFORMATION: Title: Elbow and Forearm Conditions Disability Benefits Questionnaire, VA Form...

  3. Chronic exertional compartment syndrome of the forearm in adolescents.

    PubMed

    García-Mata, Serafín

    2013-12-01

    Chronic exertional compartment syndrome (CECS) is a well-known process, although rare in the forearm. The diagnosis is based on history, clinical examination, and compartment pressure readings. My objective is to present the largest series of CECS of the forearm in adolescents and describe my experience in its management and evolution. I reviewed 5 patients, 4 male (competing in motorcycling or motocross) and 1 female (CECS in both the legs and forearms), aged between 15 and 18 years. Volar and dorsal compartments were affected in 3 patients and isolated volar in 2 cases. The clinical diagnosis was objectively confirmed by measuring ICP with a low-pressure digital transducer (Stryker). Open fasciotomy was carried out in 4 patients. They resumed their athletic activities 6 weeks after surgery without complications, increasing their athletic performance level in line with their preoperative status. All these patients remained asymptomatic, recovering their previous competitive levels. The results were objectively classified as excellent in all 4 cases. After a mean follow-up of 6 years, the condition has not relapsed in any of the patients. Two of the patients agreed to a new ICP measurement 1 year after the surgery, showing normal values. CECS in the forearm in adolescents is a rare condition that occurs after puberty. A high index of suspicion is necessary to diagnose it. It is based on symptoms and ICP measurements. Most patients are competing motorcyclists. Surgical treatment, involving isolated decompression of the superficial volar compartment, is safe and effective (restoring normal ICP).

  4. High Resolution Diffusion Tensor Imaging of Human Nerves in Forearm

    PubMed Central

    Zhou, Yuxiang; Narayana, Ponnada A; Kumaravel, Manickam; Athar, Parveen; Patel, Vipulkumar S; Sheikh, Kazim A

    2013-01-01

    Purpose To implement high resolution diffusion tensor imaging (DTI) for visualization and quantification of peripheral nerves in human forearm. Materials and Methods This HIPAA-compliant study was approved by our Institutional Review Board and written informed consent was obtained from all the study participants. Images were acquired with T1-and T2-weighted turbo spin echo with/without fat saturation, short tau inversion recovery (STIR). In addition, high spatial resolution (1.0 × 1.0 × 3.0 mm3) DTI sequence was optimized for clearly visualizing ulnar, superficial radial and median nerves in the forearm. Maps of the DTI derived indices, FA, mean diffusivity (MD), longitudinal diffusivity (λ//) and radial diffusivity (λ⊥) were generated. Results For the first time the three peripheral nerves, ulnar, superficial radial and median, were visualized unequivocally on high resolution DTI-derived maps. DTI delineated the forearm nerves more clearly than other sequences. Significant differences in the DTI-derived measures, FA, MD, λ// and λ⊥, were observed among the three nerves. A strong correlation between the nerve size derived from FA map and T2-weighted images was observed. Conclusions High spatial resolution DTI is superior in identifying and quantifying the median, ulnar and superficial radial nerves in human forearm. Consistent visualization of small nerves and nerve branches is possible with high spatial resolution DTI. These normative data could potentially help in identifying pathology in diseased nerves. PMID:24243801

  5. Grip strength and forearm circumference in a healthy population.

    PubMed

    Anakwe, R E; Huntley, J S; McEachan, J E

    2007-04-01

    Two hundred and fifty subjects were recruited. Age, sex, hand preference and anthropometric measurements were recorded for each subject. Grip strength was measured using a Jamar hydraulic dynamometer. Multiple regression analyses were performed. One hundred and seventy two subjects were men and 78 were women. Twenty-six subjects were left hand dominant. Hand grip strength was greatest for the 35 to 44 year old group for both sexes. Grip strength was consistently greater for men than women. Contralateral grip strength predicted maximum grip strength for both sexes. Forearm circumference predicted maximum hand grip strength for men. Although there was a large range of forearm circumferences in the population, there was little difference between sides for each subject (100% less than 2 cm). The demonstrated relationships between: (i) contralateral grip strengths and (ii) grip strength and forearm circumference lead us to suggest that for certain pathologies, a difference in forearm circumference greater than 2 cm may lend credence to a measurement of diminished grip strength.

  6. Forearm bone mass predicts mortality in chronic hemodialysis patients.

    PubMed

    Orlic, Lidija; Mikolasevic, Ivana; Crncevic-Orlic, Zeljka; Jakopcic, Ivan; Josipovic, Josipa; Pavlovic, Drasko

    2016-07-27

    We aim to determine the relationship between bone mineral density (BMD), measured by T- and Z-score, and mortality risk in hemodialysis (HD) patients. We also investigate which are the most suitable skeletal sites for predicting mortality rate. We analyzed the survival of 102 patients who had been treated with chronic HD according to BMD. Patients with a T-score ≤2.5 at the middle, ultradistal and proximal part of the forearm had a higher mortality risk than those with a T-score of -2.5 or higher. Furthermore, no statistically significant association was found between loss of bone mass at other measuring points-lumbar spine (anteroposterior orientation from L1-L4) and hip (neck, trochanter, intertrochanter, total and Ward's triangle)-and mortality risk. We were also interested in exploring the relationship between Z-score at different skeletal regions and mortality risk. We found that patients with a Z-score of -1 or lower at all three parts of the forearm had a greater mortality risk. It is also worth noting that the Z-score at all three parts of the forearm was a more apparent predictor of mortality, compared to the T-score at the same skeletal regions. This empirical analysis showed that BMD assessments should be obtained at the forearm, due to the good predictability of this skeletal site regarding mortality of HD patients. Moreover, data concerning bone density should be reported as Z-scores.

  7. Palatomaxillary reconstruction with titanium mesh and radial forearm flap.

    PubMed

    Sun, Guowen; Yang, Xudong; Tang, Enyi; Wen, Jianmin; Lu, Mingxing; Hu, Qingang

    2009-10-01

    The purpose of this study was to assess the treatment and prognosis of the palatomaxillary reconstruction with titanium mesh and the free radial forearm flap. This is a retrospective study of 19 patients with palatomaxillary defects who underwent immediate reconstruction using titanium mesh and a radial forearm flap during the 4-year period from 2004 to 2008. Intraoperatively, the titanium mesh was fixed to the residual bones for the reconstruction of hard-tissue defect after the tumor resection; then the free radial forearm flap was harvested to repair the soft-tissue defect, serving as the intraoral lining and titanium mesh covering. Postoperative esthetic appearance and function were followed-up. All of the patients achieved a satisfactory facial appearance. The speech assessment was good, and the oronasal reflux did not occur in all patients. Only 3 patients had titanium mesh exposure during the follow-up period. The free radial forearm flap with folded titanium mesh is a reliable option for reconstruction of palatomaxillary defects. It is highly effective for swallowing and speech rehabilitation as well as esthetic reconstruction.

  8. Distal forearm fractures in children. Complications and surgical indications.

    PubMed

    Dicke, T E; Nunley, J A

    1993-04-01

    Appropriate indications for operative management of pediatric distal forearm fractures include: 1. Compartment syndrome for fasciotomy. 2. Open fractures for irrigation and debridement. 3. Soft tissue/nerve entrapment. 4. Displaced intra-articular physeal fractures. 5. Displaced or angulated fractures when the patient is close to skeletal maturity. 6. Correction of physeal arrest with malalignment or malrotation. 7. Gross displacement with cosmetic deformity.

  9. Complications of pediatric distal radius and forearm fractures.

    PubMed

    Chia, Benjamin; Kozin, Scott H; Herman, Martin J; Safier, Shannon; Abzug, Joshua M

    2015-01-01

    Distal radius and forearm fractures represent a large percentage of pediatric fractures. The most common mechanism of injury is a fall onto an outstretched arm, which can lead to substantial rotational displacement. If this rotational displacement is not adequately addressed, there will be resultant loss of forearm motion and subsequent limitations in performing the activities of daily living. Good initial reductions and proper casting techniques are necessary when treating distal radius and forearm fractures nonsurgically; however, maintaining an acceptable reduction is not always possible. Atraumatic reduction of a displaced physeal fracture should occur within 7 days of the injury. If an impending malunion presents at 2 weeks or later after injury, observation is warranted because of concerns about physeal arrest with repeated attempts at manipulation, and it should be followed by a later assessment of functional limitations. Pediatric patients and their parents have higher expectations for recovery, which has contributed to an increase in the surgical management of pediatric distal radius and forearm fractures. In addition, surgical interventions, such as intramedullary nailing, have their own associated complications.

  10. Evidence-based Comprehensive Approach to Forearm Arterial Laceration.

    PubMed

    Thai, Janice N; Pacheco, Jose A; Margolis, David S; Swartz, Tianyi; Massey, Brandon Z; Guisto, John A; Smith, Jordan L; Sheppard, Joseph E

    2015-12-01

    Penetrating injury to the forearm may cause an isolated radial or ulnar artery injury, or a complex injury involving other structures including veins, tendons and nerves. The management of forearm laceration with arterial injury involves both operative and nonoperative strategies. An evolution in management has emerged especially at urban trauma centers, where the multidisciplinary resource of trauma and hand subspecialties may invoke controversy pertaining to the optimal management of such injuries. The objective of this review was to provide an evidence-based, systematic, operative and nonoperative approach to the management of isolated and complex forearm lacerations. A comprehensive search of MedLine, Cochrane Library, Embase and the National Guideline Clearinghouse did not yield evidence-based management guidelines for forearm arterial laceration injury. No professional or societal consensus guidelines or best practice guidelines exist to our knowledge. The optimal methods for achieving hemostasis are by a combination approach utilizing direct digital pressure, temporary tourniquet pressure, compressive dressings followed by wound closure. While surgical hemostasis may provide an expedited route for control of hemorrhage, this aggressive approach is often not needed (with a few exceptions) to achieve hemostasis for most forearm lacerations. Conservative methods mentioned above will attain the same result. Further, routine emergent or urgent operative exploration of forearm laceration injuries are not warranted and not cost-beneficial. It has been widely accepted with ample evidence in the literature that neither injury to forearm artery, nerve or tendon requires immediate surgical repair. Attention should be directed instead to control of bleeding, and perform a complete physical examination of the hand to document the presence or absence of other associated injuries. Critical ischemia will require expeditious surgical restoration of arterial perfusion. In a

  11. Evidence-based Comprehensive Approach to Forearm Arterial Laceration

    PubMed Central

    Thai, Janice N.; Pacheco, Jose A.; Margolis, David S.; Swartz, Tianyi; Massey, Brandon Z.; Guisto, John A.; Smith, Jordan L.; Sheppard, Joseph E.

    2015-01-01

    Introduction Penetrating injury to the forearm may cause an isolated radial or ulnar artery injury, or a complex injury involving other structures including veins, tendons and nerves. The management of forearm laceration with arterial injury involves both operative and nonoperative strategies. An evolution in management has emerged especially at urban trauma centers, where the multidisciplinary resource of trauma and hand subspecialties may invoke controversy pertaining to the optimal management of such injuries. The objective of this review was to provide an evidence-based, systematic, operative and nonoperative approach to the management of isolated and complex forearm lacerations. A comprehensive search of MedLine, Cochrane Library, Embase and the National Guideline Clearinghouse did not yield evidence-based management guidelines for forearm arterial laceration injury. No professional or societal consensus guidelines or best practice guidelines exist to our knowledge. Discussion The optimal methods for achieving hemostasis are by a combination approach utilizing direct digital pressure, temporary tourniquet pressure, compressive dressings followed by wound closure. While surgical hemostasis may provide an expedited route for control of hemorrhage, this aggressive approach is often not needed (with a few exceptions) to achieve hemostasis for most forearm lacerations. Conservative methods mentioned above will attain the same result. Further, routine emergent or urgent operative exploration of forearm laceration injuries are not warranted and not cost-beneficial. It has been widely accepted with ample evidence in the literature that neither injury to forearm artery, nerve or tendon requires immediate surgical repair. Attention should be directed instead to control of bleeding, and perform a complete physical examination of the hand to document the presence or absence of other associated injuries. Critical ischemia will require expeditious surgical restoration of

  12. Acute compartment syndrome of the forearm caused by calcific tendinitis of the distal biceps.

    PubMed

    Garayoa, Santiago Amillo; Romero-Muñoz, Luis M; Pons-Villanueva, Juan

    2010-12-01

    Acute compartment syndrome of the forearm requires immediate treatment to avoid damage of the soft tissues and a poor functional outcome for the forearm. Muscular and bone lesions are the main causes of acute compartment syndromes. We report a case of acute compartment syndrome of the forearm caused by a calcific tendinitis of the distal biceps.

  13. Forearm postural control during unloading: anticipatory changes in elbow stiffness.

    PubMed

    Biryukova, E V; Roschin, V Y; Frolov, A A; Ioffe, M E; Massion, J; Dufosse, M

    1999-01-01

    In this study, the equilibrium-point hypothesis of muscle-torque generation is used to evaluate the changes in central control parameters in the process of postural-maintenance learning. Muscle torque is described by a linear spring equation with modifiable stiffness, viscosity, and equilibrium angle. The stiffness is considered to be the estimation of the central command for antagonist-muscle coactivation and the equilibrium angle to be the estimation of the reciprocal command for a shift of invariant characteristics of the joint. In the experiments, a load applied to the forearm was released. The subjects were instructed to maintain their forearm in the initial horizontal position. Five sessions of approximately twenty trials each were carried out by eight subjects. During two "control" series, the load release was triggered by the experimenter. During three "learning" series, the load supported by one forearm was released by the subject's other hand. The elbow-joint angle, the angular acceleration, and the external load on the postural forearm were recorded. These recordings as well as anthropometric forearm characteristics were used to calculate the elbow-joint torque (which we called "experimental"). Linear regression analysis was performed to evaluate the equilibrium angle, joint stiffness, and viscosity at each trial. The "theoretical" torque was calculated using a linear spring equation with the found parameters. The good agreement observed between experimental and theoretical joint-torque time courses, apart from the very early period following unloading, argues in favor of the idea that the movement was mainly performed under a constant central command presetting the joint stiffness and the equilibrium angle. An overall increase in the stiffness occurred simultaneously with a decrease in the equilibrium angle during the "learning" series in all the subjects. This suggests that subjects learn to compensate for the disturbing effects of unloading by

  14. The First Korean Case of Camurati-Engelmann Disease (Progressive Diaphyseal Dysplasia) Confirmed by TGFB1 Gene Mutation Analysis

    PubMed Central

    Park, Seo-Jin; Yoon, Choon Sik; Park, Hui-Wan; Choi, Jong Rak; Chung, Jong Shin

    2009-01-01

    Camurati-Engelmann disease (CED) is an autosomal dominant progressive diaphyseal dysplasia caused by mutations in the transforming growth factor-β1 (TGFB1) gene. We report the first Korean family with an affected mother and son who were diagnosed with CED. The proband is a 19-yr-old male with a history of abnormal gait since the age of 2. He also suffered from proximal muscle weakness, pain in the extremities, and easy fatigability. Skeletal radiographs of the long bones revealed cortical, periosteal, and endosteal thickenings, predominantly affecting the diaphyses of the upper and lower extremities. No other bony abnormalities were noted in the skull and spine and no remarkable findings were seen on laboratory tests. The patient's mother had a long-standing history of mild limb pain. Under the impression of CED on radiographic studies, we performed mutation analysis. A heterozygous G to A transition at cDNA position +653 in exon 4 of the TGFB1 gene (R218H) was detected in the patient and his mother. PMID:19654961

  15. Corrective osteotomy in forearm fracture malunion improves functional outcome in adults.

    PubMed

    Chia, D S Y; Lim, Y J; Chew, W Y C

    2011-02-01

    Malunions of forearm fractures in adults can present with limitation of forearm rotation, or as distal radioulnar joint instability with functional impairment. This contrasts with paediatric patients in whom malunions of similar severities are often better tolerated. We did a retrospective review of six adult patients after corrective forearm osteotomy for symptomatic malunited forearm shaft fractures. The corrective operations were done between 7 and 168 months after initial injury, using oblique or wedge osteotomies. Median follow-up was 22.5 months. The patients recovered well, with statistically significant improvement in forearm rotation and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. No significant complications occurred.

  16. Motion discrimination of throwing a baseball using forearm electrical impedance

    NASA Astrophysics Data System (ADS)

    Nakamura, Takao; Kusuhara, Toshimasa; Yamamoto, Yoshitake

    2013-04-01

    The extroversion or hyperextension of elbow joint cause disorders of elbow joint in throwing a baseball. A method, which is easy handling and to measure motion objectively, can be useful for evaluation of throwing motion. We investigated a possibility of motion discrimination of throwing a baseball using electrical impedance method. The parameters of frequency characteristics (Cole-Cole arc) of forearm electrical impedance were measured during four types of throwing a baseball. Multiple discriminant analysis was used and the independent variables were change ratios of 11 parameters of forearm electrical impedance. As results of 120 data with four types of throwing motion in three subjects, hitting ratio was very high and 95.8%. We can expect to discriminate throwing a baseball using multiple discriminant analysis of impedance parameters.

  17. Chronic Tender Ulcers on the Calf and Both Forearms.

    PubMed

    Cameron, Michael C; Katayama, Mitsuya; Patel, Nishit S; Shenefelt, Philip D; Somboonwit, Charurut

    2017-01-01

    An elderly woman presented with a 3-month history of nonhealing, tender ulcers involving the right calf and both forearms. She denied any history of similar lesions or trauma. Two trials of oral antibiotics had led to no improvement. Her medical history was significant for rheumatoid arthritis treated with methotrexate, hydroxychloroquine, and prednisone. A review of clinical manifestations was otherwise negative for disease. Physical examination of the patient's right calf revealed two punched-out ulcers with central necrotic black eschars, underlying retiform purpuric pattern, and mild fibrinopurulent drainage (Figure 1). Similar lesions were present on her forearms (Figures 2 and 3). No other remarkable skin changes were noted. The differential diagnosis included polyarteritis nodosa, cutaneous necrosis secondary to antiphospholipid syndrome, cryoglobulinemic vasculitis, and an atypical presentation of pyoderma gangernosum.

  18. Ulnar dominant hand and forearm: an electrophysiologic approach.

    PubMed

    Abayev, Boris; Ha, Edward; Cruise, Cathy

    2005-09-01

    An ulnar-to-median anastomosis in the forearm is a rare condition, but may be present in any electromyographic case. A thorough approach to this condition is required to avoid misinterpretation of the electrodiagnostic report and confusion during the test. Prior to concluding that an anomaly is present, technical reason should be taken into consideration. The presence of volume-conducted potentials from various nearby muscles may confuse the electromyographer. Therefore, instead of using surface electrodes with unintended supramaximal intensity of stimulation, the needle electrodes may be used (in some cases) to localize specific muscles and to minimize volume-conducted potentials by not utilizing supramaximal stimulation intensity. The authors will discuss ulnar-to-median anastomosis in the forearm. This is the first attempt to put together all the information available in the literature about such an anastomosis.

  19. Basilic vein transposition in the forearm for secondary arteriovenous fistula.

    PubMed

    Glowinski, Jerzy; Glowinska, Irena; Malyszko, Jolanta; Gacko, Marek

    2014-04-01

    Radiocephalic (RC) fistulae remain the first choice access for hemodialysis. The antecubital fossa is recommended as the next site. However, for some patients a basilic vein can be used to create an arteriovenous (av) fistula. We report a series of patients where the forearm basilic vein served as an alternative conduit for secondary procedures. Over an 8-year period, 30 patients who had a failed RC fistula underwent a basilic vein transposition. The immediate results were satisfactory. All fistulas were successfully cannulated. Cumulative patency was 93% after 1 year, 78% after 2 years, and 55% after 3 years. No ischemic or infectious complications were noted during the study period. The use of the forearm basilic vein to create a native av fistula appears to be a good alternative to procedures in the antecubital fossa or upper arm, thus preserving more proximal veins for future use.

  20. Forearm Neurovascular Responses During Mental Stress and Vestibular Activation

    DTIC Science & Technology

    2005-02-01

    demonstrating that nitric oxide (7, 9, 10) and circulating epinephrine (13) contrib- ute to the forearm vasodilation during MS, but neural mecha- nisms remain... vestibular afferents , other visceral afferents , and anxiety signals from the central amygdaloid nucleus. Jacob et al. (11) present data that the autonomic...AA, Cannon RO III, and Panza JA. Role of nitric oxide in the vasodilator response to mental stress in normal subjects. Am J Cardiol 80: 1070–1074

  1. Carpal and Forearm Kinematics During a Simulated Hammering Task

    PubMed Central

    Leventhal, Evan L.; Moore, Douglas C.; Akelman, Edward; Wolfe, Scott W.; Crisco, Joseph J.

    2010-01-01

    Purpose Hammering is a functional task in which the wrist generally follows a path of motion from a position of combined radial deviation and extension to combined ulnar deviation and flexion, colloquially referred to as a dart thrower's motion (DTM). The purpose of this study was to measure wrist and forearm motion and scaphoid and lunate kinematics during a simulated hammering task. We hypothesized that the wrist follows an oblique path from radial extension to ulnar flexion and that there would be minimal radiocarpal motion during the hammering task. Methods 13 healthy volunteers consented to have their wrist and distal forearm imaged with computed tomography at five positions in a simulated hammering task. The kinematics of the carpus and distal radial ulnar joint were calculated using established markerless bone registration methods. The path of wrist motion was described relative to the sagittal plane. Forearm rotation and radioscaphoid and radiolunate motion were computed as a function wrist position. Results All volunteers performed the simulated hammering task using a path of wrist motion from radial extension to ulnar flexion that was oriented an average 41 ± 3° from the sagittal plane. These paths did not pass through the anatomic neutral wrist position; rather they passed through the neutral hammering position, which was offset by 36° ± 8° in extension. Rotations of the scaphoid and lunate were not minimal but averaged 40% and 41% respectively of total wrist motion. The range of forearm pronosupination during the task averaged 12 ± 8°. Conclusions The simulated hammering task was performed using a wrist motion that followed an oblique path, from radial extension to ulnar flexion. Scaphoid and lunate rotations were significantly reduced, but not minimized, when compared with rotations during pure wrist flexion/extension. This is likely due to the fact that an extended wrist position was maintained throughout the entire task studied. PMID:20610055

  2. Ischemic preconditioning of one forearm enhances static and dynamic apnea.

    PubMed

    Kjeld, Thomas; Rasmussen, Mads Reinholdt; Jattu, Timo; Nielsen, Henning Bay; Secher, Niels Henry

    2014-01-01

    Ischemic preconditioning enhances ergometer cycling and swimming performance. We evaluated whether ischemic preconditioning of one forearm (four times for 5 min) also affects static breath hold and underwater swimming, whereas the effect of similar preconditioning on ergometer rowing served as control because the warm-up for rowing regularly encompasses intense exercise and therefore reduced muscle oxygenation. Six divers performed a dry static breath hold, 11 divers swam underwater in an indoor pool, and 14 oarsmen rowed "1000 m" on an ergometer. Ischemic preconditioning reduced the forearm oxygen saturation from 65% ± 7% to 19% ± 7% (mean ± SD; P < 0.001), determined using spatially resolved near-infrared spectroscopy. During the breath hold (315 s, range = 280-375 s), forearm oxygenation decreased to 29% ± 10%; and in preparation for rowing, right thigh oxygenation decreased from 66% ± 7% to 33% ± 14% (P < 0.05). Ischemic preconditioning prolonged the breath hold from 279 ± 72 to 327 ± 39 s, and the underwater swimming distance from 110 ± 16 to 119 ± 14 m (P < 0.05) and also the rowing time was reduced (from 186.5 ± 3.6 to 185.7 ± 3.6 s; P < 0.05). We conclude that while the effect of ischemic preconditioning (of one forearm) on ergometer rowing was minimal, probably because of reduced muscle oxygenation during the warm-up, ischemic preconditioning does enhance both static and dynamic apnea, supporting that muscle ischemia is an important preparation for physical activity.

  3. Biomechanics of pronation and supination of the forearm.

    PubMed

    Kapandji, A

    2001-02-01

    Pronation-supination, the rotation of the forearm around its longitudinal axis, is an important motion because it allows the hand to be oriented, allowing one to take food and carry it to the mouth, perform personal hygiene, and live autonomously. The motion depends on the integrity of two bones, the radius and the ulna, as well as joints, ligaments, and muscles. In every pathological case, as described in this article, the anatomical features must be restored for normal function.

  4. Forearm muscle oxygenation decreases with low levels of voluntary contraction

    NASA Technical Reports Server (NTRS)

    Murthy, G.; Kahan, N. J.; Hargens, A. R.; Rempel, D. M.

    1997-01-01

    The purpose of our investigation was to determine if the near infrared spectroscopy technique was sensitive to changes in tissue oxygenation at low levels of isometric contraction in the extensor carpi radialis brevis muscle. Nine subjects were seated with the right arm abducted to 45 degrees, elbow flexed to 85 degrees, forearm pronated 45 degrees, and wrist and forearm supported on an armrest throughout the protocol. Altered tissue oxygenation was measured noninvasively with near infrared spectroscopy. The near infrared spectroscopy probe was placed over the extensor carpi radialis brevis of the subject's right forearm and secured with an elastic wrap. After 1 minute of baseline measurements taken with the muscle relaxed, four different loads were applied just proximal to the metacarpophalangeal joint such that the subjects isometrically contracted the extensor carpi radialis brevis at 5, 10, 15, and 50% of the maximum voluntary contraction for 1 minute each. A 3-minute recovery period followed each level of contraction. At the end of the protocol, with the probe still in place, a value for ischemic tissue oxygenation was obtained for each subject. This value was considered the physiological zero and hence 0% tissue oxygenation. Mean tissue oxygenation (+/-SE) decreased from resting baseline (100% tissue oxygenation) to 89 +/- 4, 81 +/- 8, 78 +/- 8, and 47 +/- 8% at 5, 10, 15, and 50% of the maximum voluntary contraction, respectively. Tissue oxygenation levels at 10, 15, and 50% of the maximum voluntary contraction were significantly lower (p < 0.05) than the baseline value. Our results indicate that tissue oxygenation significantly decreases during brief, low levels of static muscle contraction and that near infrared spectroscopy is a sensitive technique for detecting deoxygenation noninvasively at low levels of forearm muscle contraction. Our findings have important implications in occupational medicine because oxygen depletion induced by low levels of muscle

  5. Forearm muscle oxygenation decreases with low levels of voluntary contraction

    NASA Technical Reports Server (NTRS)

    Murthy, G.; Kahan, N. J.; Hargens, A. R.; Rempel, D. M.

    1997-01-01

    The purpose of our investigation was to determine if the near infrared spectroscopy technique was sensitive to changes in tissue oxygenation at low levels of isometric contraction in the extensor carpi radialis brevis muscle. Nine subjects were seated with the right arm abducted to 45 degrees, elbow flexed to 85 degrees, forearm pronated 45 degrees, and wrist and forearm supported on an armrest throughout the protocol. Altered tissue oxygenation was measured noninvasively with near infrared spectroscopy. The near infrared spectroscopy probe was placed over the extensor carpi radialis brevis of the subject's right forearm and secured with an elastic wrap. After 1 minute of baseline measurements taken with the muscle relaxed, four different loads were applied just proximal to the metacarpophalangeal joint such that the subjects isometrically contracted the extensor carpi radialis brevis at 5, 10, 15, and 50% of the maximum voluntary contraction for 1 minute each. A 3-minute recovery period followed each level of contraction. At the end of the protocol, with the probe still in place, a value for ischemic tissue oxygenation was obtained for each subject. This value was considered the physiological zero and hence 0% tissue oxygenation. Mean tissue oxygenation (+/-SE) decreased from resting baseline (100% tissue oxygenation) to 89 +/- 4, 81 +/- 8, 78 +/- 8, and 47 +/- 8% at 5, 10, 15, and 50% of the maximum voluntary contraction, respectively. Tissue oxygenation levels at 10, 15, and 50% of the maximum voluntary contraction were significantly lower (p < 0.05) than the baseline value. Our results indicate that tissue oxygenation significantly decreases during brief, low levels of static muscle contraction and that near infrared spectroscopy is a sensitive technique for detecting deoxygenation noninvasively at low levels of forearm muscle contraction. Our findings have important implications in occupational medicine because oxygen depletion induced by low levels of muscle

  6. Circadian rhythms and fractal fluctuations in forearm motion

    NASA Astrophysics Data System (ADS)

    Hu, Kun; Hilton, Michael F.

    2005-03-01

    Recent studies have shown that the circadian pacemaker --- an internal body clock located in the brain which is normally synchronized with the sleep/wake behavioral cycles --- influences key physiologic functions such as the body temperature, hormone secretion and heart rate. Surprisingly, no previous studies have investigated whether the circadian pacemaker impacts human motor activity --- a fundamental physiologic function. We investigate high-frequency actigraph recordings of forearm motion from a group of young and healthy subjects during a forced desynchrony protocol which allows to decouple the sleep/wake cycles from the endogenous circadian cycle while controlling scheduled behaviors. We investigate both static properties (mean value, standard deviation), dynamical characteristics (long-range correlations), and nonlinear features (magnitude and Fourier-phase correlations) in the fluctuations of forearm acceleration across different circadian phases. We demonstrate that while the static properties exhibit significant circadian rhythms with a broad peak in the afternoon, the dynamical and nonlinear characteristics remain invariant with circadian phase. This finding suggests an intrinsic multi-scale dynamic regulation of forearm motion the mechanism of which is not influenced by the circadian pacemaker, thus suggesting that increased cardiac risk in the early morning hours is not related to circadian-mediated influences on motor activity.

  7. Activation patterns in forearm muscles during archery shooting.

    PubMed

    Ertan, H; Kentel, B; Tümer, S T; Korkusuz, F

    2003-02-01

    A contraction and relaxation strategy with regard to forearm muscles during the release of the bowstring has often been observed during archery, but has not well been described. The purpose of this study was to analyze this strategy in archers with different levels of expertise; elite, beginner and non-archers. Electromyography (EMG) activity of the M. flexor digitorum superficialis and the M. extensor digitorum were recorded at a sampling frequency of 500 Hz, together with a pulse synchronized with the clicker snap, for twelve shots by each subject. Raw EMG records, 1-s before and after the clicker pulse, were rectified, integrated and normalized. The data was then averaged for successive shots of each subject and later for each group. All subjects including non-archers developed an active contraction of the M. extensor digitorum and a gradual relaxation of the M. flexor digitorum superficialis with the fall of the clicker. In elite archers release started about 100 ms after the fall of the clicker, whereas in beginners and non-archers release started after about 200 and 300 ms, respectively. Non-archers displayed a preparation phase involving extensive extensor activity before the release of the bowstring, which was not observed in elite and beginner archers. In conclusion, archers released the bowstring by active contraction of the forearm extensors, whereas a clear relaxation of the forearm flexors affecting the release movement was not observed.

  8. Non-contact wearable single forearm cardiac biopotential acquisition device

    NASA Astrophysics Data System (ADS)

    Gonçalves, Sérgio; Carneiro Martins, Raul

    2013-09-01

    In this work the authors propose a novel approach to obtain the electrocardiogram in the forearm using non-contact sensing. This new solution should be at same time portable, ergonomic and robust, enabling its use in different set of applications. A system of four electrodes was used in an adjustable sleeve to be wrapped in the forearm. No additional electrode references were used in other body parts. In order to increase the sensitivity of the system, an harmonium like approach was used in the design of the electrodes. The prototype was then compared with a similar system with a flat conformation. The developed prototype enabled the acquisition of an ECG signal in the forearm and the inclusion of the harmonium like electrode conformation resulted in a considerable increase of the sensitivity of the system. The acquired signal did not enable the identification of all characteristic cardiac waves. However, it was possible to identify clearly a signal pattern, characteristic of the QRS complex. The properties of the acquired signal restrict their use in rigorous electrocardiographic studies, allowing, however, its application in heart rate variability monitoring and biometric identification without the disadvantages usually associated with conventional electrodes. This makes it specially useful for man-machine interfaces and automated identification.

  9. Remote revascularization of abdominal wall transplants using the forearm.

    PubMed

    Giele, H; Bendon, C; Reddy, S; Ramcharan, R; Sinha, S; Friend, P; Vaidya, A

    2014-06-01

    Primary abdominal wall closure following small bowel transplantation is frequently impossible due to contraction of the abdominal domain. Although abdominal wall transplantation was reported 10 years ago this, technique has not been widely adopted, partly due to its complexity, but largely because of concerns that storing the abdominal allograft until the end of a prolonged intestinal transplant procedure would cause severe ischemia-reperfusion injury. We report six cases of combined small bowel and abdominal wall transplantation where the ischemic time was minimized by remotely revascularizing the abdominal wall on the forearm vessels, synchronous to the intestinal procedure. When the visceral transplant was complete, the abdominal wall was removed from the forearm and revascularized on the abdomen (n = 4), or used to close the abdomen while still vascularized on the forearm (n = 2). Primary abdominal wall closure was achieved in all. Mean cold ischemia was 305 min (300-330 min), and revascularization on the arm was 50 min (30-60 min). Three patients had proven abdominal wall rejection, all treated successfully. Immediate revascularization of the abdominal wall allograft substantially reduces cold ischemia without imposing constraints on the intestinal transplant. Reducing storage time may also have benefits with respect to ischemia-reperfusion-related graft immunogenicity.

  10. Measurement of angular wrist neutral zone and forearm muscle activity.

    PubMed

    Fagarasanu, Mircea; Kumar, Shrawan; Narayan, Yogesh

    2004-08-01

    To determine the forearm muscles activity in different wrist deviated positions and wrist neutral zone, and to assess the self-selected resting position without visual feedback. Wrist deviation occurs in almost all industrial and office jobs. This has been deemed hazardous for carpal tunnel syndrome. Proper resting wrist position is likely to decrease the hazard for carpal tunnel pressure. Twenty blindfolded subjects without history of hand/forearm musculoskeletal disorders participated in the study. The EMG of the forearm muscles (flexor carpi radialis, flexor carpi ulnaris, extensor carpi radialis and, extensor carpi ulnaris) in deviated and neutral wrist postures was recorded at a sampling rate of 1 kHz. Also, wrist neutral zone at rest was measured using a custom-made calibrated uniaxial electrogoniometer. One-way ANOVA with repeated measures was used in order to find the impact of wrist deviation on muscles activity. The participants positioned their wrist in rest at 7 degrees -9 degrees extension and 5 degrees -7 degrees ulnar deviation. Significantly higher EMG activity was recorded for each muscle in the wrist deviated postures when compared to neutral position (P < 0.001). Self selected wrist neutral posture decreased the muscle activity significantly. Placement of wrists in neutral zone is expected to reduce risk of injuries.

  11. Augmenting forearm crutches with wireless sensors for lower limb rehabilitation

    NASA Astrophysics Data System (ADS)

    Merrett, Geoff V.; Ettabib, Mohamed A.; Peters, Christian; Hallett, Georgina; White, Neil M.

    2010-12-01

    Forearm crutches are frequently used in the rehabilitation of an injury to the lower limb. The recovery rate is improved if the patient correctly applies a certain fraction of their body weight (specified by a clinician) through the axis of the crutch, referred to as partial weight bearing (PWB). Incorrect weight bearing has been shown to result in an extended recovery period or even cause further damage to the limb. There is currently no minimally invasive tool for long-term monitoring of a patient's PWB in a home environment. This paper describes the research and development of an instrumented forearm crutch that has been developed to wirelessly and autonomously monitor a patient's weight bearing over the full period of their recovery, including its potential use in a home environment. A pair of standard forearm crutches are augmented with low-cost off-the-shelf wireless sensor nodes and electronic components to provide indicative measurements of the applied weight, crutch tilt and hand position on the grip. Data are wirelessly transmitted between crutches and to a remote computer (where they are processed and visualized in LabVIEW), and the patient receives biofeedback by means of an audible signal when they put too much or too little weight through the crutch. The initial results obtained highlight the capability of the instrumented crutch to support physiotherapists and patients in monitoring usage.

  12. [Oropharyngeal reconstruction with radial forearm free flap: functional results].

    PubMed

    Bozec, A; Poissonnet, G; Converset, S; Lattes, L; Chamorey, E; Vallicionni, J; Demard, F; Dassonville, O

    2007-01-01

    The aim of this retrospective study is to evaluate functional results of oral and oropharyngeal reconstructions with radial forearm free flap. We present our experience with radial forearm free flap for reconstructing oral and oropharyngeal defect between 2000 and 2004. A total of 96 patients were included in this study. We analysed functional results (alimentation, elocution, mouth opening and cosmetic appearance) and researched the potentialy predictive factors of these results (age, comorbidity, preoperative irradiation...; Chi 2 test). The rate of free flap success was 97.9%. Good functional results (normal or quasi normal function) were obtained for alimentation, elocution, mouth opening and cosmetic appearance in respectively 92.6%, 64.9%, 81.9% and 84.1% of cases. Age (p = 0.05), preoperative irradiation (p = 0.005) and T stage (p = 0,02) had a negative effect on elocution, free flap failure on mouth opening (p = 0.03), preoperative irradiation (p = 0.05) and free flap failure (p = 0,02) on cosmetic appearance. Radial forearm free flap is considered as the flap of choice for oral and oropharyngeal reconstructions and allows excellent functional results.

  13. An Exoskeleton Robot for Human Forearm and Wrist Motion Assist

    NASA Astrophysics Data System (ADS)

    Ranathunga Arachchilage Ruwan Chandra Gopura; Kiguchi, Kazuo

    The exoskeleton robot is worn by the human operator as an orthotic device. Its joints and links correspond to those of the human body. The same system operated in different modes can be used for different fundamental applications; a human-amplifier, haptic interface, rehabilitation device and assistive device sharing a portion of the external load with the operator. We have been developing exoskeleton robots for assisting the motion of physically weak individuals such as elderly or slightly disabled in daily life. In this paper, we propose a three degree of freedom (3DOF) exoskeleton robot (W-EXOS) for the forearm pronation/ supination motion, wrist flexion/extension motion and ulnar/radial deviation. The paper describes the wrist anatomy toward the development of the exoskeleton robot, the hardware design of the exoskeleton robot and EMG-based control method. The skin surface electromyographic (EMG) signals of muscles in forearm of the exoskeletons' user and the hand force/forearm torque are used as input information for the controller. By applying the skin surface EMG signals as main input signals to the controller, automatic control of the robot can be realized without manipulating any other equipment. Fuzzy control method has been applied to realize the natural and flexible motion assist. Experiments have been performed to evaluate the proposed exoskeleton robot and its control method.

  14. The locked Grosse-Kempf intramedullary nail in the treatment of diaphyseal and metaphyseal fractures of the femur and tibia.

    PubMed

    Costa, P; Carretti, P; Giancecchi, F; Pignedoli, P; Rotini, R; Tartaglia, I

    1988-12-01

    The Gross-Kempf locked intramedullary nail widens the indications for the traditional Küntscher nail in the treatment of diaphyseal and metaphyseal fractures of the lower limbs. The study includes 87 patients with a total of 93 closed fractures treated between 1981 and 1987. Osteosynthesis was carried out in 85 closed fractures and in 8 Grade 1 or 2 open fractures. Possible assemblies in relation to the level and type of fracture and the protocol for weightbearing are illustrated, with emphasis on the fact that dynamization of static assemblies is not always essential. The high percentage of positive results (86%) and the relatively small incidence of complications confirm the validity of this method. The only drawback is the fairly high dose of radiation absorbed by the surgeon during the operation.

  15. Effectiveness of Serial Measurement of Differential Pressure in Closed Tibial Diaphyseal Fractures in Diagnosing Acute Compartment Syndrome using Whiteside's Technique.

    PubMed

    Ramprasath, D R; Thirunarayanan, V; David, J; Anbazhagan, S

    2016-03-01

    Acute Compartment Syndrome is a limb-threatening emergency and it occurs most commonly after fractures. The aim of our study is to find out the effectiveness of serial measurement of differential pressure in closed tibial diaphyseal fractures, in diagnosing acute compartment syndrome, using Whiteside's technique. A total of 52 cases in the age group of 15 to 55 years admitted with closed fractures were studied for serial compartment pressure as well as serial differential pressure. Eight patients had persistent compartment pressure > 40mmHg, out of which only two patients had persistent differential pressure < 30mmHg and these two patients underwent fasciotomy. Thus, by measuring the compartment pressure serially and calculating differential pressure serially, acute compartment syndrome can be diagnosed or ruled out with higher precision, so that unnecessary fasciotomies can be avoided.

  16. Intramedullary Allograft Fibula as a Reduction and Fixation Tool for Treatment of Complex Proximal Humerus Fractures with Diaphyseal Extension.

    PubMed

    Berkes, Marschall B; Little, Milton Tm; Lazaro, Lionel E; Cymerman, Rachel M; Pardee, Nadine C; Helfet, David L; Dines, Joshua S; Lorich, Dean G

    2013-05-15

    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 making the surgical procedure technically more manageable, and allows for early postoperative motion. In the first part of this study, we describe in detail the indications and surgical technique applied to these fractures. In the second part, we review the clinical and radiographic outcomes of these patients. Using this new technique, we have achieved an excellent union rate with minimal incidence of complications when treating these challenging fractures.

  17. Reduced diaphyseal strength associated with high intracortical vascular porosity within long bones of children with Osteogenesis Imperfecta

    PubMed Central

    Jameson, John; Smith, Peter; Harris, Gerald

    2015-01-01

    Osteogenesis Imperfecta is a genetic disorder resulting in bone fragility. The mechanisms behind this fragility are not well understood. In addition to characteristic bone mass deficiencies, research suggests that bone material properties are compromised in individuals with this disorder. However, little data exists regarding bone properties beyond the microstructural scale in individuals with this disorder. Specimens were obtained from long bone diaphyses of nine children with osteogenesis imperfecta during routine osteotomy procedures. Small rectangular beams, oriented longitudinally and transversely to the diaphyseal axis, were machined from these specimens and elastic modulus, yield strength, and maximum strength were measured in three-point bending. Intracortical vascular porosity, bone volume fraction, osteocyte lacuna density, and volumetric tissue mineral density were determined by synchrotron micro-computed tomography, and relationships among these mechanical properties and structural parameters were explored. Modulus and strength were on average 64–68% lower in the transverse vs. longitudinal beams (P<0.001, linear mixed model). Vascular porosity ranged between 3–42% of total bone volume. Longitudinal properties were associated negatively with porosity (P≤0.006, linear regressions). Mechanical properties, however, were not associated with osteocyte lacuna density or volumetric tissue mineral density (P≥0.167). Bone properties and structural parameters were not associated significantly with donor age (p≥0.225, linear mixed models). This study presents novel data regarding bone material strength in children with osteogenesis imperfecta. Results confirm that these properties are anisotropic. Elevated vascular porosity was observed in most specimens, and this parameter was associated with reduced bone material strength. These results offer insight towards understanding bone fragility and the role of intracortical porosity on the strength of bone

  18. Age estimation of immature human skeletal remains from the diaphyseal length of the long bones in the postnatal period.

    PubMed

    Cardoso, Hugo F V; Abrantes, Joana; Humphrey, Louise T

    2014-09-01

    Age at death in immature human skeletal remains has been estimated from the diaphyseal length of the long bones, but few studies have actually been designed specifically for the purpose of age estimation and those which have, show important caveats. This study uses regression and classical calibration to model the relationship between age and diaphyseal length of the six long bones, in a sample of 184 known sex and age individuals (72 females and 112 males), younger than 13 years of age, selected from Portuguese and English skeletal collections. Age estimation models based on classical calibration were obtained for each of the six long bones, and separately for each sex and for the sexes combined, and also for the entire sample and when it is subdivided into two subsamples at the age of 2 years. Comparisons between inverse and classical calibration show there is a systematic bias in age estimations obtained from inverse calibration. In the classical calibration models, the length of the femur provides the most accurate estimates of age. Age estimates are more accurate for the male subsample and for individuals under the age of 2 years. These results and a test of previously published methods caution against inverse calibration as a technique for developing age estimation methods even from the immature skeleton. Age estimation methods developed using cemetery collections of identified human skeletons should not be uncritically applied to present-day populations from the same region since many populations have experienced dramatic secular trends in growth and adult height over the last century.

  19. Reduced diaphyseal strength associated with high intracortical vascular porosity within long bones of children with osteogenesis imperfecta.

    PubMed

    Albert, Carolyne; Jameson, John; Smith, Peter; Harris, Gerald

    2014-09-01

    Osteogenesis imperfecta is a genetic disorder resulting in bone fragility. The mechanisms behind this fragility are not well understood. In addition to characteristic bone mass deficiencies, research suggests that bone material properties are compromised in individuals with this disorder. However, little data exists regarding bone properties beyond the microstructural scale in individuals with this disorder. Specimens were obtained from long bone diaphyses of nine children with osteogenesis imperfecta during routine osteotomy procedures. Small rectangular beams, oriented longitudinally and transversely to the diaphyseal axis, were machined from these specimens and elastic modulus, yield strength, and maximum strength were measured in three-point bending. Intracortical vascular porosity, bone volume fraction, osteocyte lacuna density, and volumetric tissue mineral density were determined by synchrotron micro-computed tomography, and relationships among these mechanical properties and structural parameters were explored. Modulus and strength were on average 64-68% lower in the transverse vs. longitudinal beams (P<0.001, linear mixed model). Vascular porosity ranged between 3 and 42% of total bone volume. Longitudinal properties were associated negatively with porosity (P≤0.006, linear regressions). Mechanical properties, however, were not associated with osteocyte lacuna density or volumetric tissue mineral density (P≥0.167). Bone properties and structural parameters were not associated significantly with donor age (P≥0.225, linear mixed models). This study presents novel data regarding bone material strength in children with osteogenesis imperfecta. Results confirm that these properties are anisotropic. Elevated vascular porosity was observed in most specimens, and this parameter was associated with reduced bone material strength. These results offer insight toward understanding bone fragility and the role of intracortical porosity on the strength of bone

  20. [Pronator teres syndrome is a rare but important cause of pain in the forearm].

    PubMed

    Rasmussen, Mathias Bæk; Deutch, Søren Rasmussen

    2016-11-14

    Pronator teres syndrome is a rare but clinically important condition which can cause pain in the forearm. It is a com-pression neuropathy due to compression of the median nerve proximal in the forearm. In this case report we de-scribe a 69-year-old male patient with pain in both forearms in more than ten years. After surgical decompression of the median nerve in both arms he experienced almost complete relief of his symptoms.

  1. Squared ligament of the elbow: anatomy and contribution to forearm stability.

    PubMed

    Otayek, Salma; Tayeb, Abd-el-Kader Ait; Assabah, Bouchra; Viard, Brice; Dayan, Romain; Lazure, Thierry; Soubeyrand, Marc

    2016-03-01

    The present study describes the macroscopic and microscopic features of the squared ligament of the elbow (SLE). In addition, the SLE biomechanical behavior and contribution to the forearm stability were also examined. Ten forearms from freshly frozen cadavers were used for this work. Each forearm was mounted in an experimental frame for quantification of longitudinal and transverse stability. Macroscopic features and biomechanical behavior were analyzed on dynamic videos obtained during forearm rotation. Then, the SLE was harvested from the 10 forearms for microscopic analysis on histological slices stained with hematoxylin-eosin-saffron. Two main SLE configurations were identified. One in which the SLE had three distinct bundles (anterior, middle, posterior) and another in which it was homogeneous. The anterior part of the SLE had a mean length of 11.2 mm (±2.4 mm) and a mean width of 1.2 mm (±0.2 mm) while the posterior part had a mean length of 9.9 mm (±2.2 mm) and a mean width of 1 mm (±0.2 mm). Microscopic examination showed that the SLE is composed of a thin layer of arranged collagen fibers. During forearm rotation, the SLE progressively tightens upon pronation and supination by wrapping around the radial neck. Tightening of the SLE during forearm rotation provides transverse and longitudinal stability to the forearm, mainly in maximal pronation and supination. The SLE is a true ligament and provides forearm stability when it is stretched in pronation and supination.

  2. Electromyographic analysis of forearm muscles in professional and amateur golfers.

    PubMed

    Farber, Adam J; Smith, J Steve; Kvitne, Ronald S; Mohr, Karen J; Shin, Steven S

    2009-02-01

    No fine-wire electromyography studies have been performed to compare the activity of forearm muscles in professional golfers versus amateur golfers. The fine-wire electromyographic activity of forearm muscles differs between professional and amateur golfers during the different phases of the golf swing. Controlled laboratory study. Ten male right-handed amateur golfers and 10 male right-handed professional golfers without history of elbow symptoms were tested with fine-wire electromyographic electrodes inserted into the flexor carpi radialis, pronator teres, flexor carpi ulnaris, and extensor carpi radialis brevis muscles of both forearms. Electromyographic data were synchronized with video data, and the muscle activity was expressed as a percentage of maximum manual muscle test activity for each phase of the golf swing. Compared with professional golfers, amateur golfers had more muscle activity in the pronator teres of the trail arm (right arm in a right-handed golfer) in the forward swing phase (120.9% maximum manual muscle test vs 57.4% maximum manual muscle test; P = .04) and a trend toward increased activity in the acceleration phase (104.8% maximum manual muscle test vs 53.1% maximum manual muscle test; P = .08). In contrast, professional golfers had more muscle activity in the pronator teres of the lead arm (left arm in a right-handed golfer) in the acceleration phase (88.1% maximum manual muscle test vs 36.3% maximum manual muscle test; P = .03) and a trend toward increased activity in the early follow-through phase (58.1% maximum manual muscle test vs 28.8% maximum manual muscle test; P = .06). Pronator teres muscle activity in the golf swing differs significantly between professional and amateur golfers. Exercises with an emphasis on stretching and strengthening of the pronator teres may be useful in treating and/or preventing medial epicondylitis in amateur golfers.

  3. MRI Correlation of Radial Head Fractures and Forearm Injuries.

    PubMed

    Awan, Hisham; Goitz, Robert

    2017-03-01

    Background: Radial head fractures can be associated with soft tissue injuries of the forearm and wrist. The Essex-Lopresti injury can lead to significant morbidity, especially if the diagnosis is not made acutely. Better identification of such injuries is needed to allow optimal surgical treatment and prevent long-term sequelae. We used magnetic resonance imaging (MRI) to correlate the degree of soft tissue injuries with radial head fractures. Methods: Sixteen pairs of forearms with an associated radial head fracture in 15 patients prospectively underwent an MRI within 2 weeks of their injury. MRI findings were correlated with fracture type, associated soft tissue injury, and presence of symptomatic wrist pain. Results: According to the modified Mason classification, there were 8 type I, 5 type II, and 3 type III radial head fractures. Wrist pain was reported in 8 of 16 extremities, and 2 had associated wrist pathology, including an acute scaphoid fracture in 1 patient and a preexisting stage II scapholunate advanced collapse (SLAC) wrist in another patient. The MRI findings included an elbow effusion in all 16 patients, edema in the proximal third of the radius in 15 extremities, which extended to the middle third in 3 extremities, edema of the interosseous membrane (IOM) in 5 extremities, and edema of the soft tissues including the supinator and/or pronator quadratus in 13 extremities. Conclusions: Eighty percent of patients with edema of the IOM had associated wrist pain. Soft tissue injuries of the forearm did not correlate with the severity of the radial head fracture.

  4. Forearm vascular responses to mental stress in healthy older adults.

    PubMed

    Heffernan, Matthew J; Patel, Hardikkumar M; Muller, Matthew D

    2013-12-01

    Forearm vascular conductance (FVC) increases in response to mental stress (verbal mental arithmetic) in young people. However, the effect of healthy aging and mental stress on FVC is unknown. In this study, we tested the hypothesis that FVC and cutaneous vascular conductance (CVC) would be attenuated in older adults compared to young adults. In 13 young (27 ± 1 year) and 11 older (62 ± 1 year) subjects, we quantified heart rate (HR), mean arterial pressure (MAP), FVC (Doppler ultrasound), and CVC (laser Doppler flowmetry) in response to a 3-min bout of mental stress in the supine posture. Changes from baseline were compared between groups and physiological variables were also correlated. Older adults had a blunted HR response to mental stress (Δ = 7 ± 2 vs. 14 ± 2 beats/min) but ΔMAP was comparable between groups (Δ = 11 ± 2 mmHg vs. 9 ± 1). During the third minute of mental stress, the %ΔFVC (-2 ± 5 vs. 31 ± 12%) and %ΔCVC (2 ± 6 vs. 31 ± 15%) were both impaired in older adults compared to young subjects. There was no relationship between ΔHR and %ΔCVC in either group, but there was a positive relationship between ΔHR and %ΔFVC in both young subjects (R = 0.610, P < 0.027) and older subjects (R = 0.615, P < 0.044), such that larger tachycardia was associated with higher forearm vasodilation. These data indicate that older adults have impaired forearm vasodilation in response to mental stress.

  5. Role of ulnar forearm free flap in oromandibular reconstruction.

    PubMed

    Gabr, E M; Kobayashi, M R; Salibian, A H; Armstrong, W B; Sundine, M; Calvert, J W; Evans, G R D

    2004-01-01

    The ulnar forearm flap is not frequently utilized for oromandibular reconstruction. This study evaluated the usefulness of the ulnar free flap for reconstruction. A retrospective study of 32 patients was conducted. The ulnar forearm flap was combined with an osseous flap in 24 patients. Nine females and 23 males with a mean age of 58.15 years comprised our study population. Squamous-cell carcinoma was the diagnosis in 93.75% of cases (56.25% T4), of which 20% were recurrent. Functional evaluation of swallowing was based on the University of Washington Questionnaire (UWQ). The mean hospital stay was 9.8 days. The external carotid (100%) was the recipient artery, and the internal jugular (74.07%) was the main recipient vein. Overall flap survival was 96.8%. One flap was lost due to unsalvageable venous thrombosis. Major local complications were seen in 9.4% of cases and included partial flap loss, hematoma, and an orocutaneous fistula. At the time of this study, 21 patients were available for functional evaluation. Speech was rated excellent and good in 33.3% of patients. Swallowing was found good in 28.6% of patients. Chewing was rated excellent and good in 47.6% of patients. Cosmetic acceptance was rated good in 71.4% of cases. The ulnar forearm is a useful free flap in oromandibular reconstruction. It is available when the radial artery is the dominant artery of the hand. Being more hidden, it may be more cosmetically accepted. It affords pliable soft tissue for lining and/or covering of oromandibular defects, and can be used as a second choice after other free-flap failures. Copyright 2004 Wiley-Liss, Inc.

  6. Wrist and forearm postures and motions during typing.

    PubMed

    Serina, E R; Tal, R; Rempel, D

    1999-07-01

    Awkward upper extremity postures and repetitive wrist motions have been identified by some studies as risk factors for upper extremity musculoskeletal disorders during keyboard work. However, accurate body postures and joint motions of typists typing on standardized workstations are not known. A laboratory study was conducted to continuously measure wrist and forearm postures and motions of 25 subjects while they typed for 10-15 min at a standard computer workstation adjusted to the subjects' anthropometry. Electrogoniometers continuously recorded wrist and forearm angles. Joint angular velocities and accelerations were calculated from the postural data. The results indicate that wrist and forearm postures during typing were sustained at non-neutral angles; mean wrist extension angle was 23.4 +/- 10.9 degrees on the left and 19.9 +/- 8.6 degrees on the right. Mean ulnar deviation was 14.7 +/- 10.1 degrees on the left and 18.6 +/- 5.8 degrees on the right. More than 73% of subjects typed with the left or right wrist in greater than 15 degrees extension and more than 20% typed with the left or right wrist in greater than 20 degrees ulnar deviation. Joint angles and motions while typing on an adjusted computer workstation were not predictable based on anthropometry or typing speed and varied widely between subjects. Wrist motions are rapid and are similar in magnitude to wrist motions of industrial workers performing jobs having a high risk for developing cumulative trauma disorders. The magnitude of the dynamic components suggests that wrist joint motions may need to be evaluated as a risk factor for musculoskeletal disorders during typing.

  7. Florid reactive periostitis of the forearm bones in a child.

    PubMed

    Mathew, S E; Madhuri, V; Alexander, M; Walter, N M; Gibikote, S V

    2011-03-01

    Florid reactive periostitis is a pronounced periosteal reaction, usually affecting the hands and feet, for which there is no obvious cause. It is rare in children and in long bones. We report an unusual case of florid reactive periostitis in a ten-year-old girl that involved both bones of the forearm. The lesion resolved over a period of one year, leaving a residual exostosis. She developed a physeal bar in the distal ulna in the region of the lesion at one-year follow-up. This was thought to be a complication of the biopsy procedure and was treated by resection and proximal ulnar lengthening.

  8. Electric pain control (EPC) of a painful forearm amputation stump.

    PubMed

    Györy, A N; Caine, D C

    1977-07-30

    Surgically and pharmaceutically uncontrollable pain in the forearm stump of a 28-year-old mine explosion victim of the Viet-Nam War, was successfully treated by electric pain control (EPC), which led to his full rehabilitation. The electrodes of the pain-control equipment were built into the prosthetic socket to enable treatment to be continued while the patient was working in his full-time occupation as a storeman. The theory underlying this form of treatment is briefly described and the method of manufacture of the modified prosthetic socket is provided, so that similar application of electric pain control can also be used in other patients.

  9. The Spanish experience with hand, forearm, and arm transplantation.

    PubMed

    Cavadas, Pedro C; Landin, Luis; Thione, Alessandro; Rodríguez-Pérez, Jose C; Garcia-Bello, Miguel A; Ibañez, Javier; Vera-Sempere, Francisco; Garcia-Cosmes, Pedro; Alfaro, Luis; Rodrigo, Jose D; Castro, Federico

    2011-11-01

    This article summarizes the findings from 3 recipients of hand allografts, including a description of the preparatory surgery and the transplant and secondary procedures to enhance the function of the hand, forearm, and arm allografts. The study focuses on the complications and disability reported by each patient, with a minimum follow-up of 2 years. The few complications were controlled successfully with medical treatment. Hand transplantation is a major reconstructive procedure that requires careful medical follow-up. The authors provide the first report of a significant improvement in disabilities of the upper limb as a result of hand allotransplantation.

  10. Metabolism of forearm tissues in man. Studies with glucagon.

    PubMed

    Pozefsky, T; Tancredi, R G; Moxley, R T; Dupre, J; Tobin, J D

    1976-02-01

    The role of glucagon in regulating peripheral tissue metabolism in man was assessed in the present studies. To do this, glucagon was infused for two hours into the brachial artery to produce a high but physiologic increment in the glucagon content of arterial blood supplying ipsilateral tissues. Metabolic effects on muscle and on subcutaneous adipose tissue plus skin were sought in seven overnight-fasting subjects and seven subjects starved briefly (60 hours). In the overnight-fasted group the infusion increased bassl glucagon concentration by 1,216 pg./ml. but was without effect on forearm tissue metabolism of glucose, lactate,glycerol, or amino acids. Starvation significantly reduced basal insulin (11.0 to 7.4 muU./ml.) and increased endogenous glucagon (116 to 134 pg./ml.). Basally, there was substantial ketone utilization and a decrease in glucose consumption by both muscle and subcutaneous adipose tissue plus skin. The glucagon infusion increased basal glucagon by 784 pg./ml. Muscle balances of glucose, lactate, acetoacetate, amino acids, and glycerol were unaffected. The metabolism of glucose, lactate, acetoacetate, glycerol, and free fatty acids by subcutaneous adipose tissue plus skin was also unchanged. It is concluded that physiologic increments of glucagon lasting two hours are without effect on forearm tissues in overnight-fasted and briefly starved man.

  11. Total Lip Reconstruction with Tendinofasciocutaneous Radial Forearm Flap

    PubMed Central

    Silberstein, Eldad; Krieger, Yuval; Shoham, Yaron; Arnon, Ofer; Sagi, Amiram; Bogdanov-Berezovsky, Alexander

    2014-01-01

    Introduction. Squamous cell carcinoma is a common tumour of lower lip. Small defects created by surgical resection may be readily reconstructed by linear closure or with local flaps. However, large tumours resection often results with microstomia and oral incompetence, drooling, and speech incomprehension. The goal of this study is to describe our experience with composite free radial forearm-palmaris longus tendon flap for total or near total lower lip reconstruction. Patients and Methods. This procedure was used in 5 patients with 80–100% lip defect resulting from Squamous cell carcinoma. Patients' age ranged from 46 to 82 years. They are three male patients and two female. In 3 cases chin skin was reconstructed as well and in one case a 5 cm segment of mandible was reconstructed using radius bone. In one case where palmaris longus was missing hemi-flexor carpi radialis tendon was used instead. All patients tolerated the procedure well. Results. All flaps totally survived. No patient suffered from drooling. All patients regained normal diet and normal speech. Cosmetic result was fair to good in all patients accept one. Conclusion. We conclude that tendino-fasciocutaneous radial forearm flap for total lower lip reconstruction is safe. Functional and aesthetic result approaches reconstructive goals. PMID:24672301

  12. Prehospital Dextrose Extravasation Causing Forearm Compartment Syndrome: A Case Report.

    PubMed

    Chinn, Matthew; Colella, M Riccardo

    2017-01-01

    A 57-year-old woman was found at home by paramedics to be hypoglycemic with altered mental status. She had multiple attempts at IV access and eventually a 22G IV was established and D50 was infused into her right forearm. Extravasation of the dextrose was noted after approximately 12 g of the medication was infused. She was given a dose of glucagon intramuscularly and her mental status improved. Shortly after her arrival to the emergency department, she was noted to have findings of compartment syndrome of her forearm at the site of the dextrose extravasation. She was evaluated by plastic surgery and taken to the operating room for emergent fasciotomy. She recovered well from the operation. D50 is well known to cause phlebitis and local skin necrosis as a complication. This case illustrates the danger of compartment syndrome after D50 extravasation. It is the first documented case of prehospital dextrose extravasation leading to compartment syndrome. There may be safer alternatives to D50 administration and providers must be acutely aware to monitor for D50 infusion complications.

  13. NIR time domain diffuse optical tomography experiments on human forearm

    NASA Astrophysics Data System (ADS)

    Zhao, Huijuan; Gao, Feng; Tanikawa, Yukari; Homma, Kazuhiro; Yamada, Yukio

    2003-07-01

    To date, the applications of near infrared (NIR) diffusion optical tomography (DOT) are mostly focused on the potential of imaging woman breast, human head hemodynamics and neonatal head. For the neonates, who are suffered from ischaemia or hemorrhages in brain, bedside monitoring of the cerebral perfusion situation, e.g., the blood oxygen saturation and blood volume, is necessary for avoiding permanent injure. NIR DOT is on the promising tools because it is noninvasive, smaller in size, and moveable. Prior to achieving the ultimate goal of imaging infant brain and woman breast using DOT, in this paper, the developed methodologies are justified by imaging in vivo human forearms. The absolute absorption- and scattering-coefficient images revealed the inner structure of the forearm and the bones were clearly distinguished from the muscle. The differential images showed the changes in oxy-hemoglobin, deoxy-hemoglobin and blood volume during the hand-gripping exercises, which are consistent with the physiological process reported on literatures.

  14. Identification and classification of tibioperoneal diaphyseal toxopachyosteosis (Weismann-Netter-Stuhl syndrome): based on two new cases and a review of the literature.

    PubMed

    Nor 3es, J M; Monsegu, M H; de Masfrand, V; Oberlin, F; Denormandie, P; Rémy, J M

    1997-01-01

    Using two new cases and 70 case reports in the literature as a starting point, the authors focus on the Weismann-Netter-Stuhl syndrome. Weismann-Netter and Stuhl reported the first cases of tibioperoneal diaphyseal toxopachyosteosis in 1954. This syndrome is defined as an anomaly of the diaphyseal part of both tibiae and fibulae with posterior cortical thickening and anterior-posterior bowing. This anomaly is usually bilateral and symmetrical and patients are short. The thickening of the fibula is true tibialisation and is the main feature and the only feature confirming diagnosis. Routine laboratory investigations showed no abnormalities. The authors specify the limits encountered in classifying this anomaly and discuss the degree to which this anomaly is an entity unto itself when compared with rickets sequelae.

  15. Risk Minimization and a Late Holocene Increase in Mobility at Roonka Flat, South Australia: An Analysis of Lower Limb Bone Diaphyseal Shape.

    PubMed

    Hill, Ethan C; Durband, Arthur C; Walshe, Keryn

    2016-09-01

    The strengthening of the El Niño Southern Oscillation (ENSO) in the mid-Holocene caused significant changes in climate, vegetation, and faunal assemblages in South Australia. The appearance of a light, flexible backed-artifact toolkit ∼4 kya has been interpreted as evidence for changes in foraging behavior in response to this event. Optimal foraging theory supports a risk minimization strategy for South Australian hunter-gatherers in which increased mobility was used to cope with effects of a dryer, unstable environment in the late Holocene. Whether this event caused changes in foraging mobility will be tested by examining lower limb external diaphyseal shape between pre-ENSO and post-ENSO skeletons from Roonka Flat, South Australia. Anteroposterior and mediolateral diameters were used to construct diaphyseal shape indices for Roonka Flat femora and tibiae. If populations living in South Australia became more mobile over time, then post-ENSO skeletons should exhibit higher shape indices. The pooled-sex post-ENSO sample has significantly higher femoral shape indices than the pre-ENSO sample. Males do not show significant diaphyseal shape differences over time, but females significantly increase. These data are consistent with the risk minimization model, indicating that South Australians became more mobile post-ENSO to better exploit a less productive environment by expanding their foraging radii. The temporal shift toward more elliptical diaphyses is more notable in females than males, which is consistent with Aboriginal ethnographies that show both sexes being intensely involved in hunting and capturing game animals. Am J Phys Anthropol 161:94-103, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  16. Primary shortening of the forearm and Sauvé-Kapandji for severely comminuted fractures of the distal forearm in elderly patients: a case report.

    PubMed

    Goorens, Chul Ki; Geurts, Ghislain; Goubau, Jean F

    2013-01-01

    We report a case of an elderly female who sustained a severely comminuted distal radial and ulnar fracture, treated by shortening of the forearm, combined with a primary Sauvé-Kapandji procedure and volar plating of the distal radius.

  17. Rupture of an anomalous tendon slip as a cause of forearm pain.

    PubMed

    O'Hara, J J; Stone, J H

    1995-12-01

    Rupture of an anomalous tendon slip between the FDS aponeurosis and FDP tendon to the ring finger was found in a young woman's forearm upon surgical exploration after months of forearm pain and disability. Excision of the anomalous slip resulted in quick and and complete recovery.

  18. Chronic Exertional Compartment Syndrome of the Forearm in an Elite Rower

    PubMed Central

    O'hEireamhoin, S.; Baker, J. F.; Neligan, M.

    2011-01-01

    We report a case of chronic exertional compartment syndrome (CECS) affecting the volar forearm compartment of an elite rower. CECS of the forearm is a less well recognised entity than lower limb CECS. We describe a typical history and detail a potential treatment. PMID:23198215

  19. [Chronic compartment syndrome of the flexor muscles in the forearm due to motocross].

    PubMed

    Jeschke, J; Baur, E M; Piza-Katzer, H

    2006-04-01

    A case of a mechanic and motorcyclist is reported who developed unilateral chronic exertional compartment syndrome of the flexor muscles in the forearm. After years of discomfort and medical check-ups, a subcutaneous fasciotomy of the superficial compartments of the flexor muscles in the forearm led to a complete relief of symptoms, which allowed the patient unrestricted activity.

  20. Deep soft-tissue leiomyoma of the forearm mimicking a primary bone tumor of the ulna

    PubMed Central

    Ramachandran, Rajoo; Rangaswami, Rajeswaran; Raja, Dorai Kumar; Shanmugasundaram, Gouthaman

    2015-01-01

    Leiomyomas of the soft tissues are rare in general, and extremely uncommon in the forearm. In general, leiomyomas are benign soft-tissue tumors that occur where smooth muscles are present. We present a case of soft-tissue leiomyoma of the forearm eroding the midshaft of the ulna, with emphasis on radiological diagnosis and histopathological correlation. PMID:27186256

  1. Utility of the Powerball in the invigoration of the musculature of the forearm.

    PubMed

    Balan, Sebastián Axel; Garcia-Elias, Marc

    2008-01-01

    In order to ascertain the utility of a 250 Hz NSD Powerball gyroscope in increasing the maximum grip force and muscular endurance of the forearm, ten adults without pathology in their upper limbs exercised one forearm with the device during a period of one month. We evaluated grip strength and forearm muscle endurance with a Jamar dynamometer both at the end of the month as well as after a resting period of one month. There was a tendency (not statistically significant p = 0.054), for the volunteers to increase their maximum grip strength. There was also highly significant increase in muscle endurance (p = 0.00001), a gain that remained slightly unchanged after the rest. Because the gyroscope generates random multidirectional forces to the forearm, the reactive muscle contraction is likely to stimulate more efficient neuromuscular contro of the wrist, a conclusion which our work appears to validate. The use of Powerball in forearm proprioception deficient patients is, therefore, justified.

  2. Limited forearm motion compensated by thoracohumeral kinematics when performing tasks requiring pronation and supination.

    PubMed

    Pereira, Barry P; Thambyah, Ashvin; Lee, Taeyong

    2012-05-01

    This study investigates the altered thoracohumeral kinematics when forearm rotation is restricted while performing five activities requiring pronation and supination. Two splints simulated both a fixed-supinated or fixed-neutral forearm in six healthy subjects; the three-dimensional coupled relationship among motion about the forearm, elbow, and shoulder were analyzed. In using a screwdriver, the normal range of forearm rotation of 77.6° (SD = 30.8°) was reduced in the fixed-supinated to 11.3° (SD = 2.9°) and fixed-neutral to 18.2° (SD = 6.2°). This restriction from the fixed-supinated and fixed-neutral forearms was compensated at the shoulder by a significant increase in the total range of (1) ad/abduction by 57.3° and 62.8° respectively (p < .001), (2) forward-reverse flexion (24.3° and 18.2° respectively; p < .05) and (3) internal-external rotation (37.1° and 44.2° respectively; p < .001). A similar result was demonstrated for the doorknob activity. The elbow did not significantly contribute to forearm rotation (p = .14), and is believed to be due to the elbow axis being orthogonal and oblique to the forearm axis. For open kinetic-chain activities, with a fixed-supinated forearm performing there was a significant coupled increase in ad/abduction (p < .05) and int/external rotation (p < .05) for the phone and feeding tasks, with the phone task also having a significantly increased forward shoulder flexion (p < .05). For the fixed-neutral forearm, significant compensatory movement was only seen in the feeding task with increased ad/abduction and internal-external shoulder rotation (p < .05) and the card inserting task with increased ad/abduction and forward-reverse shoulder flexion. Limited forearm function requires compensatory motion from adjacent joints to perform activities that require pronation and supination.

  3. Time resolved optical tomography of the human forearm

    NASA Astrophysics Data System (ADS)

    Hillman, Elizabeth M. C.; Hebden, Jeremy C.; Schweiger, Martin; Dehghani, Hamid; Schmidt, Florian E. W.; Delpy, David T.; Arridge, Simon R.

    2001-04-01

    A 32-channel time-resolved optical imaging instrument has been developed principally to study functional parameters of the new-born infant brain. As a prelude to studies on infants, the device and image reconstruction methodology have been evaluated on the adult human forearm. Cross-sectional images were generated using time-resolved measurements of transmitted light at two wavelengths. All data were acquired using a fully automated computer-controlled protocol. Images representing the internal scattering and absorbing properties of the arm are presented, as well as images that reveal physiological changes during a simple finger flexion exercise. The results presented in this paper represent the first simultaneous tomographic reconstruction of the internal scattering and absorbing properties of a clinical subject using purely temporal data, with additional co-registered difference images showing repeatable absorption changes at two wavelengths in response to exercise.

  4. Time resolved optical tomography of the human forearm.

    PubMed

    Hillman, E M; Hebden, J C; Schweiger, M; Dehghani, H; Schmidt, F E; Delpy, D T; Arridge, S R

    2001-04-01

    A 32-channel time-resolved optical imaging instrument has been developed principally to study functional parameters of the new-born infant brain. As a prelude to studies on infants, the device and image reconstruction methodology have been evaluated on the adult human forearm. Cross-sectional images were generated using time-resolved measurements of transmitted light at two wavelengths. All data were acquired using a fully automated computer-controlled protocol. Images representing the internal scattering and absorbing properties of the arm are presented, as well as images that reveal physiological changes during a simple finger flexion exercise. The results presented in this paper represent the first simultaneous tomographic reconstruction of the internal scattering and absorbing properties of a clinical subject using purely temporal data, with additional co-registered difference images showing repeatable absorption changes at two wavelengths in response to exercise.

  5. Dorsal forearm adipofascial turnover flap among the elderly.

    PubMed

    Silva, J Braga; Padoin, A V; Gazzalle, A; da Cunha, G L

    2011-06-01

    We have assessed the results of soft tissue cover on the back of the hand using an adipofascial turnover flap. From 2004 until 2007, 14 patients (mean age: 62 years) underwent reconstruction of extensive defects in the dorsum of the hand, using a forearm adipofascial turnover flap based on the perforators of the anterior interosseous artery covered with a split skin graft. The pivot point of the flap is typically 4-6 cm proximal to the level of the radial styloid process. In 93% of patients, the reconstruction healed without any problem. The adipofascial turnover flap is a useful and reliable method of reconstruction of the dorsum of the hand even in elderly patients.

  6. Mucormycosis infection following intravenous access in the forearm.

    PubMed

    Wollstein, Ronit; Palekar, Alka

    2010-01-01

    Mucormycosis is an opportunistic infection that is often fatal, requiring aggressive local control as well as systemic therapy. A rare case of a forearm infection originating in a traumatic intravenous access portal is described in the present study. The Mucor species infection prevented liver transplant, and the patient passed away. In the present case, it was decided to limit the resection to the skin and subcutaneous tissue based on a frozen section and the viability of the biopsied tissue. With consistently rising numbers of immunocompromised patients, awareness and familiarity with mucormycosis in the extremities is important. Knowing that a minimal traumatic event may precede the infection could assist in prevention and early diagnosis. Guidelines for pathological and clinical diagnosis and treatment need to be further clarified.

  7. Endoscopic Adipofascial Radial Forearm Flap Reconstruction of a Clival Defect

    PubMed Central

    2016-01-01

    Summary: Skull base surgical defects present unique challenges to anatomic and functional reconstruction. Fortunately, many endonasal skull base defects are successfully managed with a variety of local and regional reconstructive techniques. However, when prior surgery or radiotherapy eliminates the use of these local and regional reconstructive options, more elaborate free tissue transfer techniques are required. Managing endoscopic skull base defects of the anterior cranial fossa and clivus is further complicated by the limited access afforded for flap inset. The following case report describes durable reconstruction of a clival defect with an endoscopically-tunneled adipofascial radial forearm tissue transfer. The case highlights importance of a multidisciplinary surgical team approach with strong foundations in endonasal skull base and reconstructive surgery to achieve successful reconstruction of complex endonasal defects. PMID:27975017

  8. Iatrogenic pseudoaneurysm following reverse radial forearm free tissue transfer.

    PubMed

    Baynosa, Richard C; Echo, Anthony; Hovsepian, Raffi V; Zamboni, William A

    2007-08-01

    The appearance of a pseudoaneurysm in a free flap is an extremely rare complication in microsurgery. Yet, although uncommon, this occurrence still poses a dilemma as to the most effective mode of treatment. Treatment modalities consist of surgical exploration, embolization, and endovascular stenting. We present a case of arterial pedicle pseudoaneurysm following free tissue transfer of a radial forearm flap for a cranial defect. We describe our successful operative treatment of the pseudoaneurysm as well as review the literature regarding the applicability of the described treatments. We conclude that a critical evaluation of factors including the timing of arterial inflow loss, the necessity of the pedicle, the condition and quality of the recipient site, and the possibility of neovascularization can assist in determining the proper intervention and maximizing success.

  9. Prosthetic devices shaped as tubular chambers for the treatment of large diaphyseal defects by guided bone regeneration.

    PubMed

    Nicoli Aldini, N; Fini, M; Giavaresi, G; Guzzardella, G A; Giardino, R

    2005-01-01

    Guided tissue regeneration is based on the hypothesis that the different tissues have unequal abilities to penetrate a wounded area during the healing process. The use of a device acting as a chamber allows the growth of a particular tissue and prevents the ingrowth of other tissues which impair the healing process. At the same time the chamber protects and maintains in situ the intrinsic growth factors so that they may perform their specific activity. Guided tissue regeneration currently plays a well-recognized role mostly in dentistry and peripheral nerve surgery but interesting perspectives have also opened up in orthopedics. Considering the possibility of using guided bone regeneration in the repair of diaphyseal bone defects, this updated survey highlights some critical points and pathways related to the state-of-the-art of this promising procedure, focusing particularly on the properties of the material to make the tubular chamber, the use of osteopromotive factors and the most appropriate animal model to be used for the experimental evaluation.

  10. Surgical treatment of a proximal diaphyseal tibial deformity associated with partial caudal and cranial cruciate ligament deficiency and patella baja.

    PubMed

    Vincenti, S; Knell, S; Pozzi, A

    2017-04-01

    Caudal cruciate ligament injury can be a complication following tibial plateau leveling osteotomy (TPLO) (Slocum und Slocum, 1993) especially if the post-operative Tibial Plateau Angle (TPA) is less than 5 degree. We describe a case of negative TPA associated with partial cranial and caudal ligament rupture treated with a center of rotation of angulation (CORA) based cranial tibial opening wedge osteotomy and tibial tuberosity transposition. A 13 kg, mixed breed dog was presented for right pelvic limb lameness. Radiographically a bilateral patella baja and a malformed tibia tuberosity along with a bilateral TPA of -8 degree were detected. Arthroscopically a partial rupture of the cranial and caudal cruciate ligaments were found. A cranial tibial opening wedge osteotomy of 23 degree and a fibular ostectomy were performed. The osteotomy was fixed with a 8 holes ALPS 9 (KYON, Switzerland) and a 3-holes 2.0mm UniLock plate (Synthes, Switzerland). Then a proximal tibial tuberosity transposition of 10mm was performed and fixed with a pin and tension band construct. The postoperative TPA was 15 degree. The radiographic controls at 6, 10 weeks, 6 months and 1 year after surgery revealed an unchanged position of the implants and progressive healing of the osteotomies. At the 6 and 12 months recheck evaluation the dog had no evidence of lameness or stifle pain and radiographs revealed complete healing of the osteotomy site and no implant failure. The diaphyseal CORA based osteotomy allowed accurate correction of a proximal tibial deformity associated with negative TPA.

  11. Metabolic forearm vasodilation is enhanced following Bier block with phentolamine.

    PubMed

    Moradkhan, Raman; McQuillan, Patrick; Hogeman, Cynthia; Leuenberger, Andrea; Linton-Frazier, Latoya; Leuenberger, Urs A

    2007-10-01

    The extent to which sympathetic nerve activity restrains metabolic vasodilation in skeletal muscle remains unclear. We determined forearm blood flow (FBF; ultrasound/Doppler) and vascular conductance (FVC) responses to 10 min of ischemia [reactive hyperemic blood flow (RHBF)] and 10 min of systemic hypoxia (inspired O(2) fraction = 0.1) before and after regional sympathetic blockade with the alpha-receptor antagonist phentolamine via Bier block in healthy humans. In a control group, we performed sham Bier block with saline. Consistent with alpha- receptor inhibition, post-phentolamine, basal FVC (FBF/mean arterial pressure) increased (pre vs. post: 0.42 +/- 0.05 vs. 1.03 +/- 0.21 units; P < 0.01; n = 12) but did not change in the saline controls (pre vs. post: 0.56 +/- 0.14 vs. 0.53 +/- 0.08 units; P = not significant; n = 5). Post-phentolamine, total RHBF (over 3 min) increased substantially (pre vs. post: 628 +/- 75 vs. 826 +/- 92 ml/min; P < 0.01) but did not change in the controls (pre vs. post: 618 +/- 66 vs. 661 +/- 35 ml/min; P = not significant). In all conditions, compared with peak RHBF, peak skin reactive hyperemia was markedly delayed. Furthermore, post-phentolamine (pre vs. post: 0.43 +/- 0.06 vs. 1.16 +/- 0.17 units; P < 0.01; n = 8) but not post-saline (pre vs. post: 0.93 +/- 0.16 vs. 0.87 +/- 0.19 ml/min; P = not significant; n = 5), the FVC response to hypoxia (arterial O(2) saturation = 77 +/- 1%) was markedly enhanced. These data suggest that sympathetic vasoconstrictor nerve activity markedly restrains skeletal muscle vasodilation induced by local (forearm ischemia) and systemic (hypoxia) vasodilator stimuli.

  12. Biomechanics of Forearm Rotation: Force and Efficiency of Pronator Teres

    PubMed Central

    Ibáñez-Gimeno, Pere; Galtés, Ignasi; Jordana, Xavier; Malgosa, Assumpció; Manyosa, Joan

    2014-01-01

    Biomechanical models are useful to assess the effect of muscular forces on bone structure. Using skeletal remains, we analyze pronator teres rotational efficiency and its force components throughout the entire flexion-extension and pronation-supination ranges by means of a new biomechanical model and 3D imaging techniques, and we explore the relationship between these parameters and skeletal structure. The results show that maximal efficiency is the highest in full elbow flexion and is close to forearm neutral position for each elbow angle. The vertical component of pronator teres force is the highest among all components and is greater in pronation and elbow extension. The radial component becomes negative in pronation and reaches lower values as the elbow flexes. Both components could enhance radial curvature, especially in pronation. The model also enables to calculate efficiency and force components simulating changes in osteometric parameters. An increase of radial curvature improves efficiency and displaces the position where the radial component becomes negative towards the end of pronation. A more proximal location of pronator teres radial enthesis and a larger humeral medial epicondyle increase efficiency and displace the position where this component becomes negative towards forearm neutral position, which enhances radial curvature. Efficiency is also affected by medial epicondylar orientation and carrying angle. Moreover, reaching an object and bringing it close to the face in a close-to-neutral position improve efficiency and entail an equilibrium between the forces affecting the elbow joint stability. When the upper-limb skeleton is used in positions of low efficiency, implying unbalanced force components, it undergoes plastic changes, which improve these parameters. These findings are useful for studies on ergonomics and orthopaedics, and the model could also be applied to fossil primates in order to infer their locomotor form. Moreover, activity

  13. Biomechanics of forearm rotation: force and efficiency of pronator teres.

    PubMed

    Ibáñez-Gimeno, Pere; Galtés, Ignasi; Jordana, Xavier; Malgosa, Assumpció; Manyosa, Joan

    2014-01-01

    Biomechanical models are useful to assess the effect of muscular forces on bone structure. Using skeletal remains, we analyze pronator teres rotational efficiency and its force components throughout the entire flexion-extension and pronation-supination ranges by means of a new biomechanical model and 3D imaging techniques, and we explore the relationship between these parameters and skeletal structure. The results show that maximal efficiency is the highest in full elbow flexion and is close to forearm neutral position for each elbow angle. The vertical component of pronator teres force is the highest among all components and is greater in pronation and elbow extension. The radial component becomes negative in pronation and reaches lower values as the elbow flexes. Both components could enhance radial curvature, especially in pronation. The model also enables to calculate efficiency and force components simulating changes in osteometric parameters. An increase of radial curvature improves efficiency and displaces the position where the radial component becomes negative towards the end of pronation. A more proximal location of pronator teres radial enthesis and a larger humeral medial epicondyle increase efficiency and displace the position where this component becomes negative towards forearm neutral position, which enhances radial curvature. Efficiency is also affected by medial epicondylar orientation and carrying angle. Moreover, reaching an object and bringing it close to the face in a close-to-neutral position improve efficiency and entail an equilibrium between the forces affecting the elbow joint stability. When the upper-limb skeleton is used in positions of low efficiency, implying unbalanced force components, it undergoes plastic changes, which improve these parameters. These findings are useful for studies on ergonomics and orthopaedics, and the model could also be applied to fossil primates in order to infer their locomotor form. Moreover, activity

  14. Forearm Range of Motion in Australovenator wintonensis (Theropoda, Megaraptoridae)

    PubMed Central

    White, Matt A.; Bell, Phil R.; Cook, Alex G.; Barnes, David G.; Tischler, Travis R.; Bassam, Brant J.; Elliott, David A.

    2015-01-01

    The hypertrophied manual claws and modified manus of megaraptoran theropods represent an unusual morphological adaptation among carnivorous dinosaurs. The skeleton of Australovenator wintonensis from the Cenomanian of Australia is among the most complete of any megaraptorid. It presents the opportunity to examine the range of motion of its forearm and the function of its highly modified manus. This provides the basis for behavioural inferences, and comparison with other Gondwanan theropod groups. Digital models created from computed tomography scans of the holotype reveal a humerus range of motion that is much greater than Allosaurus, Acrocanthosaurus, Tyrannosaurus but similar to that of the dromaeosaurid Bambiraptor. During flexion, the radius was forced distally by the radial condyle of the humerus. This movement is here suggested as a mechanism that forced a medial movement of the wrist. The antebrachium possessed a range of motion that was close to dromaeosaurids; however, the unguals were capable of hyper-extension, in particular manual phalanx I-2, which is a primitive range of motion characteristic seen in allosaurids and Dilophosaurus. During flexion, digits I and II slightly converge and diverge when extended which is accentuated by hyperextension of the digits in particular the unguals. We envision that prey was dispatched by its hands and feet with manual phalanx I-2 playing a dominant role. The range of motion analysis neither confirms nor refutes current phylogenetic hypotheses with regards to the placement of Megaraptoridae; however, we note Australovenator possessed, not only a similar forearm range of motion to some maniraptorans and basal coelurosaurs, but also similarities with Tetanurans (Allosauroids and Dilophosaurus). PMID:26368529

  15. The passive stiffness of the wrist and forearm

    PubMed Central

    Charles, Steven K.; Zollo, Loredana; Guglielmelli, Eugenio; Hogan, Neville; Krebs, Hermano I.

    2012-01-01

    Because wrist rotation dynamics are dominated by stiffness (Charles SK, Hogan N. J Biomech 44: 614–621, 2011), understanding how humans plan and execute coordinated wrist rotations requires knowledge of the stiffness characteristics of the wrist joint. In the past, the passive stiffness of the wrist joint has been measured in 1 degree of freedom (DOF). Although these 1-DOF measurements inform us of the dynamics the neuromuscular system must overcome to rotate the wrist in pure flexion-extension (FE) or pure radial-ulnar deviation (RUD), the wrist rarely rotates in pure FE or RUD. Instead, understanding natural wrist rotations requires knowledge of wrist stiffness in combinations of FE and RUD. The purpose of this report is to present measurements of passive wrist stiffness throughout the space spanned by FE and RUD. Using a rehabilitation robot designed for the wrist and forearm, we measured the passive stiffness of the wrist joint in 10 subjects in FE, RUD, and combinations. For comparison, we measured the passive stiffness of the forearm (in pronation-supination), as well. Our measurements in pure FE and RUD agreed well with previous 1-DOF measurements. We have linearized the 2-DOF stiffness measurements and present them in the form of stiffness ellipses and as stiffness matrices useful for modeling wrist rotation dynamics. We found that passive wrist stiffness was anisotropic, with greater stiffness in RUD than in FE. We also found that passive wrist stiffness did not align with the anatomical axes of the wrist; the major and minor axes of the stiffness ellipse were rotated with respect to the FE and RUD axes by ∼20°. The direction of least stiffness was between ulnar flexion and radial extension, a direction used in many natural movements (known as the “dart-thrower's motion”), suggesting that the nervous system may take advantage of the direction of least stiffness for common wrist rotations. PMID:22649208

  16. Optical Myography: Detecting Finger Movements by Looking at the Forearm

    PubMed Central

    Nissler, Christian; Mouriki, Nikoleta; Castellini, Claudio

    2016-01-01

    One of the crucial problems found in the scientific community of assistive/rehabilitation robotics nowadays is that of automatically detecting what a disabled subject (for instance, a hand amputee) wants to do, exactly when she wants to do it, and strictly for the time she wants to do it. This problem, commonly called “intent detection,” has traditionally been tackled using surface electromyography, a technique which suffers from a number of drawbacks, including the changes in the signal induced by sweat and muscle fatigue. With the advent of realistic, physically plausible augmented- and virtual-reality environments for rehabilitation, this approach does not suffice anymore. In this paper, we explore a novel method to solve the problem, which we call Optical Myography (OMG). The idea is to visually inspect the human forearm (or stump) to reconstruct what fingers are moving and to what extent. In a psychophysical experiment involving ten intact subjects, we used visual fiducial markers (AprilTags) and a standard web camera to visualize the deformations of the surface of the forearm, which then were mapped to the intended finger motions. As ground truth, a visual stimulus was used, avoiding the need for finger sensors (force/position sensors, datagloves, etc.). Two machine-learning approaches, a linear and a non-linear one, were comparatively tested in settings of increasing realism. The results indicate an average error in the range of 0.05–0.22 (root mean square error normalized over the signal range), in line with similar results obtained with more mature techniques such as electromyography. If further successfully tested in the large, this approach could lead to vision-based intent detection of amputees, with the main application of letting such disabled persons dexterously and reliably interact in an augmented-/virtual-reality setup. PMID:27148039

  17. Optical Myography: Detecting Finger Movements by Looking at the Forearm.

    PubMed

    Nissler, Christian; Mouriki, Nikoleta; Castellini, Claudio

    2016-01-01

    One of the crucial problems found in the scientific community of assistive/rehabilitation robotics nowadays is that of automatically detecting what a disabled subject (for instance, a hand amputee) wants to do, exactly when she wants to do it, and strictly for the time she wants to do it. This problem, commonly called "intent detection," has traditionally been tackled using surface electromyography, a technique which suffers from a number of drawbacks, including the changes in the signal induced by sweat and muscle fatigue. With the advent of realistic, physically plausible augmented- and virtual-reality environments for rehabilitation, this approach does not suffice anymore. In this paper, we explore a novel method to solve the problem, which we call Optical Myography (OMG). The idea is to visually inspect the human forearm (or stump) to reconstruct what fingers are moving and to what extent. In a psychophysical experiment involving ten intact subjects, we used visual fiducial markers (AprilTags) and a standard web camera to visualize the deformations of the surface of the forearm, which then were mapped to the intended finger motions. As ground truth, a visual stimulus was used, avoiding the need for finger sensors (force/position sensors, datagloves, etc.). Two machine-learning approaches, a linear and a non-linear one, were comparatively tested in settings of increasing realism. The results indicate an average error in the range of 0.05-0.22 (root mean square error normalized over the signal range), in line with similar results obtained with more mature techniques such as electromyography. If further successfully tested in the large, this approach could lead to vision-based intent detection of amputees, with the main application of letting such disabled persons dexterously and reliably interact in an augmented-/virtual-reality setup.

  18. Elbow flexion and forearm supination strength in a healthy population.

    PubMed

    Kerschbaum, Maximilian; Maziak, Nina; Böhm, Elisabeth; Scheibel, Markus

    2017-09-01

    Despite the lack of representative data of a healthy population, many clinical trials concerning the measurement of postoperative elbow flexion or forearm supination strength use the contralateral side as a control. We hypothesized that there are no differences in elbow flexion and supination strength between the dominant and nondominant sides in healthy volunteers. The study was performed on a cross-sectional cohort of healthy subjects without any prior injuries or surgical interventions of the upper extremities. Isometric elbow flexion strength and supination strength were measured on both the dominant and nondominant sides. The results were analyzed for the entire group and subanalyzed for female vs. male, for different age groups, and according to handedness and regular practice of overhead sports. A total of 150 subjects (75 female and 75 male subjects; mean age, 44 ± 15 years [range, 18-72 years]) were included in this study. Within the entire collective, no significant differences concerning the elbow flexion strength between the dominant and nondominant sides could be detected, whereas the supination strength was 7% higher on the dominant side (P = .010). Women, right-hand-dominant subjects, and subjects who do not regularly practice overhead sports have a significant 8% higher supination strength on the dominant side compared with the nondominant side (P < .05). Left-hand-dominant subjects have an 8% higher elbow flexion strength on the nondominant right side (P < .05). Elbow flexion strength and forearm supination strength differ between the dominant and nondominant sides. The contralateral upper extremity cannot be used as a matched control without some adjustments. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Frequency and etiology of hand and forearm dermatoses among veterinarians.

    PubMed

    Tauscher, Amanda E; Belsito, Donald V

    2002-09-01

    Veterinarians are exposed to a range of skin irritants and allergens, yet few studies have addressed the occurrence of dermatoses among veterinarians. The goals of this study were to determine the frequency of noninfectious hand and forearm dermatoses among Kansas veterinarians, to estimate the role of occupational exposures in the aggravation of such dermatoses, to determine the frequency and nature of infectious dermatoses among veterinarians, and to investigate patterns of glove use. The secondary goals of this study were to collect information about the impact of skin disease on the lives and careers of veterinarians and to provide physicians with a practical approach to the treatment of veterinarians with dermatoses. A questionnaire was mailed to all members of the Kansas Veterinary Medical Association. The response rate was 60%. Twenty-four of respondents reported noninfectious, recurrent/persistent hand or forearm dermatoses; 66% were work related. Large animal veterinarians (P =.026) and atopics (P =.009) were more likely than their counterparts to attribute their dermatoses to work-related factors. Thirty-eight percent of respondents had contracted at least one infectious skin disease from an animal. Veterinarians who never or rarely use gloves during obstetric procedures were more likely to report work-related dermatoses (odds ratio, 4.25; 1.78 < OR < 10.07; P <.001) than those who use gloves. Veterinarians are affected frequently by infectious and noninfectious dermatoses. Improvement of barrier protection habits during obstetric procedures would likely reduce the frequency of occupational dermatoses among veterinarians. Copyright 2002, Elsevier Science (USA). All rights reserved.

  20. Forearm Range of Motion in Australovenator wintonensis (Theropoda, Megaraptoridae).

    PubMed

    White, Matt A; Bell, Phil R; Cook, Alex G; Barnes, David G; Tischler, Travis R; Bassam, Brant J; Elliott, David A

    2015-01-01

    The hypertrophied manual claws and modified manus of megaraptoran theropods represent an unusual morphological adaptation among carnivorous dinosaurs. The skeleton of Australovenator wintonensis from the Cenomanian of Australia is among the most complete of any megaraptorid. It presents the opportunity to examine the range of motion of its forearm and the function of its highly modified manus. This provides the basis for behavioural inferences, and comparison with other Gondwanan theropod groups. Digital models created from computed tomography scans of the holotype reveal a humerus range of motion that is much greater than Allosaurus, Acrocanthosaurus, Tyrannosaurus but similar to that of the dromaeosaurid Bambiraptor. During flexion, the radius was forced distally by the radial condyle of the humerus. This movement is here suggested as a mechanism that forced a medial movement of the wrist. The antebrachium possessed a range of motion that was close to dromaeosaurids; however, the unguals were capable of hyper-extension, in particular manual phalanx I-2, which is a primitive range of motion characteristic seen in allosaurids and Dilophosaurus. During flexion, digits I and II slightly converge and diverge when extended which is accentuated by hyperextension of the digits in particular the unguals. We envision that prey was dispatched by its hands and feet with manual phalanx I-2 playing a dominant role. The range of motion analysis neither confirms nor refutes current phylogenetic hypotheses with regards to the placement of Megaraptoridae; however, we note Australovenator possessed, not only a similar forearm range of motion to some maniraptorans and basal coelurosaurs, but also similarities with Tetanurans (Allosauroids and Dilophosaurus).

  1. Donor site morbidity of the fasciocutaneous radial forearm flap: what does the patient really bother?

    PubMed Central

    de Witt, Christien A.; Verdonck-de Leeuw, Irma M.; Quak, Jasper J.; Leemans, C. René

    2007-01-01

    The objective of this study was the evaluation of donor site morbidity in head and neck cancer patients after reconstruction using a free vascularized radial forearm flap with emphasis on subjective complaints. Fifty patients who underwent at least 6 months before a reconstruction using a free vascularized radial forearm flap were asked to fill out two questionnaires regarding cosmetics and sensibility and forearm disabilities. Furthermore, a function test including movement extensions (flexion–extension, ulnar–radial deviation and pronation–supination), strength (pinch and grip) and temperature (digiti I and V) of the donor and non-donor site were measured and compared. Thirty-five percent of the patients reported no complaints regarding cosmetics and sensibility and 75% mentioned no forearm disabilities. There was no difference in movement extensions, temperature and grip strength between donor and non-donor sites. The difference in pinch strength appeared to be significant (p < 0.001). The total score of the questionnaire on forearm disabilities correlated significantly with extension, pronation and grip strength of the donor arm. Donor site morbidity of the radial forearm flap measured by objective functional tests was limited but subjective self-ratings revealed complaints regarding cosmestics and sensibility and to a lesser extent regarding forearm disability. The present data may be used for solid patient counselling. PMID:17323087

  2. Prospective clinical evaluation of a novel anatomic cuff for forearm crutches in patients with osteoarthritis.

    PubMed

    Hügle, Thomas; Arnieri, Ansgar; Bünter, Margerita; Schären, Stefan; Mündermann, Annegret

    2017-03-14

    The use of forearm crutches has been associated with pain and neuropraxia along the ulnar bone. Whilst anatomic grips have improved comfort of crutch walking, to date anatomic forearm cuffs have not been clinically evaluated. The aim of this clinical pilot study was to determine if the use of forearm crutches with anatomic cuffs reduces pain and increases comfort and function in long-term users of forearm crutches during a 4-week period. Prospective study in ten patients suffering from end-stage osteoarthritis of the lower extremity. All participants were long-term users of conventional forearm crutches. Participants used forearm crutches with an anatomically shaped cuff for 4-weeks. General health was assessed using the SF-36, and the crutches were evaluated using a newly developed questionnaire focusing on symptoms along the forearm. Pain and paresthesia along the forearms decreased by 3.3 points (95% confidence interval difference (CI): [-5.0; -1.6], p = .004) and 3.5 points (95%CI: [-5.1; -1.9], p = .002), respectively, after using the crutches with the new anatomic cuff for 4 weeks. Comfort and sense of security of crutch use increased by 3.0 points (95%CI: [1.3; 4.7], p = .007) and 2.4 points (95%CI: [0.7; 4.1], p = .024). Cross-correlation analysis revealed correlations among items in the same item category and no correlations between items of different item categories of the new questionnaires. An anatomically shaped cuff increases comfort of forearm crutches. Further research should confirm long-term clinical improvement. This study was registered retrospectively in ISRCTN (TRN: ISRCTN 11135150 ) on 14/02/2017.

  3. Free radial forearm adiposo-fascial flap for inferior maxillectomy defect reconstruction

    PubMed Central

    Thankappan, Krishnakumar; Trivedi, Nirav P.; Sharma, Mohit; Kuriakose, Moni A.; Iyer, Subramania

    2009-01-01

    A free radial forearm fascial flap has been described for intraoral reconstruction. Adiposo-fascial flap harvesting involves few technical modifications from the conventional radial forearm fascio-cutaneous free flap harvesting. We report a case of inferior maxillectomy defect reconstruction in a 42-year-old male with a free radial forearm adiposo-fascial flap with good aesthetic and functional outcome with minimal primary and donor site morbidity. The technique of raising the flap and closing the donor site needs to be meticulous in order to achieve good cosmetic and functional outcome. PMID:19881028

  4. Diminished Baroreflex Control of Forearm Vascular Resistance Following Training

    NASA Technical Reports Server (NTRS)

    Mack, G. W.; Thompson, C. A.; Doerr, D. F.; Nadel, E. R.; Convertino, V. A.

    1991-01-01

    The stimulus-response characteristics of cardiopulmonary baroreflex control of forearm vascular resistance (FVR units in mm Hg x min x I00 ml/ml) were studied in 14 volunteers before and after 10 wk of endurance training. We assessed the relationship betaleen reflex stimulus (changes in central venous pressure, CVP) and response (FVR) during unloading of cardiopulmonary baroreceptors with lower body negative pressure (LBNP, 0 to - 2O mm Hg). Changes in CVP during LBNP were estimated from pressure changes in a large peripheral vein in the dependent arm of the subject in the right lateral decubitus position. Maximal oxygen uptake (VO(sub 2max)) and total blood volume increased with endurance training from 37.8 +/- 1.4 ml/min x kg and 63.6 +/- 2.1 ml/kg to 45.3 +/- 1.4 ml/ min x kg and 69.3 +/- 2.8 ml/kg respectively (P less than 0.05). Reflex forearm vasoconstriction occurred in response to a reduction in estimated CVP, and the absolute change in FVR per unit of CVP was reduced from -5.96 +/- 0.79 to -4.06 +/- 0.52 units x mm/ Hg (P less than 0.05) following exercise training but was unchanged from -6.10 to 0.57 to -6.22 +/- 0.94 units x mm/ Hg for the time control group (N = 7). Resting values for FVR were similar before and after exercise training; however, resting estimated CVP was elevated from 9.5 +/- 0.5 mm x Hg before training to 11.3 +/- 0.6 mm x Hg after training. The reduction in sensitivity of the cardiopulmonary baroreflex control of FVR was linearly related to the increase in blood volume (r = 0.65, P less than 0.05). suggesting that diminished cardiopulmonary baroreflex control of FVR in physically fit individuals is related, in part, to a training-induced blood volume expansion.

  5. Diminished Baroreflex Control of Forearm Vascular Resistance Following Training

    NASA Technical Reports Server (NTRS)

    Mack, G. W.; Thompson, C. A.; Doerr, D. F.; Nadel, E. R.; Convertino, V. A.

    1991-01-01

    The stimulus-response characteristics of cardiopulmonary baroreflex control of forearm vascular resistance (FVR units in mm Hg x min x I00 ml/ml) were studied in 14 volunteers before and after 10 wk of endurance training. We assessed the relationship betaleen reflex stimulus (changes in central venous pressure, CVP) and response (FVR) during unloading of cardiopulmonary baroreceptors with lower body negative pressure (LBNP, 0 to - 2O mm Hg). Changes in CVP during LBNP were estimated from pressure changes in a large peripheral vein in the dependent arm of the subject in the right lateral decubitus position. Maximal oxygen uptake (VO(sub 2max)) and total blood volume increased with endurance training from 37.8 +/- 1.4 ml/min x kg and 63.6 +/- 2.1 ml/kg to 45.3 +/- 1.4 ml/ min x kg and 69.3 +/- 2.8 ml/kg respectively (P less than 0.05). Reflex forearm vasoconstriction occurred in response to a reduction in estimated CVP, and the absolute change in FVR per unit of CVP was reduced from -5.96 +/- 0.79 to -4.06 +/- 0.52 units x mm/ Hg (P less than 0.05) following exercise training but was unchanged from -6.10 to 0.57 to -6.22 +/- 0.94 units x mm/ Hg for the time control group (N = 7). Resting values for FVR were similar before and after exercise training; however, resting estimated CVP was elevated from 9.5 +/- 0.5 mm x Hg before training to 11.3 +/- 0.6 mm x Hg after training. The reduction in sensitivity of the cardiopulmonary baroreflex control of FVR was linearly related to the increase in blood volume (r = 0.65, P less than 0.05). suggesting that diminished cardiopulmonary baroreflex control of FVR in physically fit individuals is related, in part, to a training-induced blood volume expansion.

  6. Sonographic identification of peripheral nerves in the forearm

    PubMed Central

    Jackson, Saundra A.; Derr, Charlotte; De Lucia, Anthony; Harris, Marvin; Closser, Zuheily; Miladinovic, Branko; Mhaskar, Rahul; Jorgensen, Theresa; Green, Lori

    2016-01-01

    Background: With the growing utilization of ultrasonography in emergency medicine combined with the concern over adequate pain management in the emergency department (ED), ultrasound guidance for peripheral nerve blockade in ED is an area of increasing interest. The medical literature has multiple reports supporting the use of ultrasound guidance in peripheral nerve blocks. However, to perform a peripheral nerve block, one must first be able to reliably identify the specific nerve before the procedure. Objective: The primary purpose of this study is to describe the number of supervised peripheral nerve examinations that are necessary for an emergency medicine physician to gain proficiency in accurately locating and identifying the median, radial, and ulnar nerves of the forearm via ultrasound. Methods: The proficiency outcome was defined as the number of attempts before a resident is able to correctly locate and identify the nerves on ten consecutive examinations. Didactic education was provided via a 1 h lecture on forearm anatomy, sonographic technique, and identification of the nerves. Participants also received two supervised hands-on examinations for each nerve. Count data are summarized using percentages or medians and range. Random effects negative binomial regression was used for modeling panel count data. Results: Complete data for the number of attempts, gender, and postgraduate year (PGY) training year were available for 38 residents. Nineteen males and 19 females performed examinations. The median PGY year in practice was 3 (range 1–3), with 10 (27%) in year 1, 8 (22%) in year 2, and 19 (51%) in year 3 or beyond. The median number (range) of required supervised attempts for radial, median, and ulnar nerves was 1 (0–12), 0 (0–10), and 0 (0–17), respectively. Conclusion: We can conclude that the maximum number of supervised attempts to achieve accurate nerve identification was 17 (ulnar), 12 (radial), and 10 (median) in our study. The only

  7. Sonographic identification of peripheral nerves in the forearm.

    PubMed

    Jackson, Saundra A; Derr, Charlotte; De Lucia, Anthony; Harris, Marvin; Closser, Zuheily; Miladinovic, Branko; Mhaskar, Rahul; Jorgensen, Theresa; Green, Lori

    2016-01-01

    With the growing utilization of ultrasonography in emergency medicine combined with the concern over adequate pain management in the emergency department (ED), ultrasound guidance for peripheral nerve blockade in ED is an area of increasing interest. The medical literature has multiple reports supporting the use of ultrasound guidance in peripheral nerve blocks. However, to perform a peripheral nerve block, one must first be able to reliably identify the specific nerve before the procedure. The primary purpose of this study is to describe the number of supervised peripheral nerve examinations that are necessary for an emergency medicine physician to gain proficiency in accurately locating and identifying the median, radial, and ulnar nerves of the forearm via ultrasound. The proficiency outcome was defined as the number of attempts before a resident is able to correctly locate and identify the nerves on ten consecutive examinations. Didactic education was provided via a 1 h lecture on forearm anatomy, sonographic technique, and identification of the nerves. Participants also received two supervised hands-on examinations for each nerve. Count data are summarized using percentages or medians and range. Random effects negative binomial regression was used for modeling panel count data. Complete data for the number of attempts, gender, and postgraduate year (PGY) training year were available for 38 residents. Nineteen males and 19 females performed examinations. The median PGY year in practice was 3 (range 1-3), with 10 (27%) in year 1, 8 (22%) in year 2, and 19 (51%) in year 3 or beyond. The median number (range) of required supervised attempts for radial, median, and ulnar nerves was 1 (0-12), 0 (0-10), and 0 (0-17), respectively. We can conclude that the maximum number of supervised attempts to achieve accurate nerve identification was 17 (ulnar), 12 (radial), and 10 (median) in our study. The only significant association was found between years in practice and

  8. Bipaddle radial forearm flap for head and neck reconstruction.

    PubMed

    Zhang, Yi Xin; Xi, Wenjing; Lazzeri, Davide; Zhou, Xiao; Li, Zan; Nicoli, Fabio; Zenn, Michael R; Torresetti, Matteo; Grassetti, Luca; Spinelli, Giuseppe

    2015-03-01

    Although the radial forearm free flap has become a workhorse flap in head and neck reconstruction, the skin grafting of the donor is the main drawback resulting in an unacceptable contour deformity and an unsightly appearance. Several technical modifications have been therefore applied to the radial forearm (RF) flap marking, elevation, and inset to overcome this major shortcoming. In this article, we report our clinical series with the bipaddle RF flap. The authors described their 11 cases of head and neck oncologic reconstruction with the bipaddle RF flap. The skin island is designed longer and narrower and split into 2 separate skin paddles each nourished by a proximal and a distal independent perforators raising from the radial artery so that the donor site could be closed directly. The narrow design of the skin paddle and the subsequent splitting in its 2 components applying the "perforator-pedicle propeller flap method" allow for the changing of the flap shape according to the shape of the recipient site defect. From 2007 to 2013, the bipaddle RF flap method was used in 11 patients to restore head and neck defects following cancer ablation. The mean age of the patients was 43 years, ranging from 31 to 50 years. The location of the defects was the tongue (n = 7) and the intraoral region (n = 4). The defect sizes varied from 4 × 5 cm to 5 × 6 cm, and the flap maximum width was 3 cm with mean area of 26.4 cm. The healing was uneventful in all patients with excellent cosmetic and functional results of both donor site and recipient site after 20 months of mean follow-up. The bipaddle RF free flap is a reliable and versatile option for the reconstruction of a wide range of soft tissue defects of head and neck region. This method allows for a customized resurfacing of the defect because of its large variability in shape and size. The harvesting site is closed primarily, and a second donor site for skin graft is avoided.Clinical Question, Level of Evidence

  9. EVALUATION OF PATIENTS UNDERGOING FIXATION OF DIAPHYSEAL HUMERAL FRACTURES USING THE MINIMALLY INVASIVE BRIDGE-PLATE TECHNIQUE

    PubMed Central

    Superti, Mauro José; Martynetz, Fábio; Falavinha, Ricardo Sprenger; Fávaro, Rodrigo Caldonazzo; Boas, Luis Felipe Villas; Filho, Salim Mussi; Martynetz, Juliano; Ribas, Bruno

    2015-01-01

    Objective: The aim was to describe the experience of our group in treating humeral shaft fractures using the bridge–plate technique via an anterior approach. Methods: Seventeen patients with acute diaphyseal humeral fractures with an indication for surgical treatment who were operated in 2006–2010 were evaluated. The AO and Gustilo & Anderson classifications were used. All the patients were operated using the anterior bridge-plate technique and completed a follow–up period of at least twelve months. Results: Sixteen men and one woman were treated. Their mean age was 31.8 years (18–52). Among the injury mechanisms found were: five motorcycle accidents, four car accidents, three fractures due to firearm projectiles, two falls to the ground and finally, with one case each, assault, crushing and being run over. Eight patients had open fractures: two grade I, one grade II, four grade IIIa and one grade IIIb, according to the Gustilo-Anderson classification. In relation to the AO classification, we found: one 12A1, three 12A2, four 12A3, one 12B1, four 12 B2, three 12B3 and one 12C2. The mean postoperative follow-up was 25 months (12–48). As complications, two patients had pain in the elbow and a ROM deficit and one had deep infection. The mean time taken to achieve consolidation was 17.5 weeks. There was no loss of reduction, pseudarthrosis or malunion in this series of patients. Conclusion: The authors believe that the technique described has low rates of complications and morbidity, with good initial results, although the series is limited by the small sample. PMID:27042639

  10. Establishing Biomechanical Mechanisms in Mouse Models: Practical Guidelines for Systematically Evaluating Phenotypic Changes in the Diaphyses of Long Bones

    PubMed Central

    Jepsen, Karl J; Silva, Matthew J; Vashishth, Deepak; Guo, X Edward; van der Meulen, Marjolein CH

    2016-01-01

    Mice are widely used in studies of skeletal biology, and assessment of their bones by mechanical testing is a critical step when evaluating the functional effects of an experimental perturbation. For example, a gene knockout may target a pathway important in bone formation and result in a “low bone mass” phenotype. But how well does the skeleton bear functional loads; eg, how much do bones deform during loading and how resistant are bones to fracture? By systematic evaluation of bone morphological, densitometric, and mechanical properties, investigators can establish the “biomechanical mechanisms” whereby an experimental perturbation alters whole-bone mechanical function. The goal of this review is to clarify these biomechanical mechanisms and to make recommendations for systematically evaluating phenotypic changes in mouse bones, with a focus on long-bone diaphyses and cortical bone. Further, minimum reportable standards for testing conditions and outcome variables are suggested that will improve the comparison of data across studies. Basic biomechanical principles are reviewed, followed by a description of the cross-sectional morphological properties that best inform the net cellular effects of a given experimental perturbation and are most relevant to biomechanical function. Although morphology is critical, whole-bone mechanical properties can only be determined accurately by a mechanical test. The functional importance of stiffness, maximum load, postyield displacement, and work-to-fracture are reviewed. Because bone and body size are often strongly related, strategies to adjust whole-bone properties for body mass are detailed. Finally, a comprehensive framework is presented using real data, and several examples from the literature are reviewed to illustrate how to synthesize morphological, tissue-level, and whole-bone mechanical properties of mouse long bones. PMID:25917136

  11. Decision-making in the treatment of diaphyseal clavicle fractures: is there agreement among surgeons? Results of a survey on surgeons' treatment preferences.

    PubMed

    Heuer, Hinrich J D; Boykin, Robert E; Petit, Charles J; Hardt, Juliane; Millett, Peter J

    2014-02-01

    Nonoperative treatment is standard for most diaphyseal clavicle fractures, but recent studies have demonstrated improved outcomes with operative treatment of displaced fractures. The objectives of this diagnostic study were to assess agreement of orthopaedic surgeons regarding their treatment preferences for diaphyseal clavicle fractures and to compare them with recent recommendations. Interobserver and intraobserver agreement in treatment decisions were hypothesized to be only slight. Anonymized case vignettes of 50 acute diaphyseal clavicle fractures including medical history, physical examination findings, and radiographs were independently reviewed by 32 orthopaedic surgeons from the United States. Four treatment options were offered and decisions were compared with current treatment recommendations. Interobserver agreement was calculated using Fleiss' kappa coefficient. Average intraobserver agreement for surgeons who completed a retest review (minimum interval of 8 weeks) was calculated. Thirty-two surgeons completed the first round of reviewing and 27 completed the retest (mean interval, 22 weeks). Interobserver agreement was overall fair (kappa = 0.36) and moderate (kappa = 0.56) when operative options were compared with nonoperative options. Median intraobserver agreement was 74% for the 4 treatment options offered and 84% in deciding on operative vs. nonoperative means. Concordance with recent recommendations for operative vs. nonoperative treatment was seen in 91% of decisions (median). Recent recommendations appear to have been adopted by a selected subgroup of U.S. orthopaedic surgeons, showing a surprisingly high median concordance of 91% in this study. However, only fair to moderate interobserver and intraobserver agreement was present, leaving potential for improvement. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  12. Healing of fracture nonunions treated with low-intensity pulsed ultrasound (LIPUS): A systematic review and meta-analysis.

    PubMed

    Leighton, Ross; Watson, J Tracy; Giannoudis, Peter; Papakostidis, Costas; Harrison, Andrew; Steen, R Grant

    2017-07-01

    Bone fractures fail to heal and form nonunions in roughly 5% of cases, with little expectation of spontaneous healing thereafter. We present a systematic review and meta-analysis of published papers that describe nonunions treated with low-intensity pulsed ultrasound (LIPUS). Articles in PubMed, Ovid MEDLINE, CINAHL, AMED, EMBASE, Cochrane Library, and Scopus databases were searched, using an approach recommended by the Methodological Index for Non-Randomized Studies (MINORS), with a Level of Evidence rating by two reviewers independently. Studies are included here if they reported fractures older than 3 months, presented new data with a sample N≥12, and reported fracture outcome (Heal/Fail). Thirteen eligible papers reporting LIPUS treatment of 1441 nonunions were evaluated. The pooled estimate of effect size for heal rate was 82% (95% CI: 77-87%), for any anatomical site and fracture age of at least 3 months, with statistical heterogeneity detected across all primary studies (Q=41.2 (df=12), p<0.001, Tau(2)=0.006, I(2)=71). With a stricter definition of nonunion as fracture age of at least 8 months duration, the pooled estimate of effect size was 84% (95% CI: 77%-91.6%; heterogeneity present: Q=21 (df=8), p<0.001, Tau(2)=0.007, I(2)=62). Hypertrophic nonunions benefitted more than biologically inactive atrophic nonunions. An interval without surgery of <6months prior to LIPUS was associated with a more favorable result. Stratification of nonunions by anatomical site revealed no statistically significant differences between upper and lower extremity long bone nonunions. LIPUS treatment can be an alternative to surgery for established nonunions. Given that no spontaneous healing of established nonunions is expected, and that it is challenging to test the efficacy of LIPUS for nonunion by randomized clinical trial, findings are compelling. LIPUS may be most useful in patients for whom surgery is high risk, including elderly patients at risk of delirium, or patients with dementia, extreme hypertension, extensive soft-tissue trauma, mechanical ventilation, metabolic acidosis, multiple organ failure, or coma. With an overall average success rate for LIPUS >80% this is comparable to the success of surgical treatment of non-infected nonunions. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  13. 78 FR 68907 - Agency Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-15

    ... AFFAIRS Agency Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire) Under OMB Review AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION... notice announces that the Veterans Benefits Administration (VBA), Department of Veterans Affairs, will...

  14. Carotid baroreceptor influence on forearm vascular resistance during low level lower body negative pressure

    NASA Technical Reports Server (NTRS)

    Thompson, Cynthia A.; Ludwig, David A.; Convertino, Victor A.

    1991-01-01

    The degree of forearm vasoconstriction induced by low levels of lower body negative pressure (LBNP) provides a measure of the responsiveness of the cardiopulmonary baroreflex. The validity of this measurement is based on the assumption that this vasoconstriction response is not influenced by unloading of carotid baroreceptors. To test the hypothesis that arterial baroreceptor unloading does not alter the degree of forearm vascular resistance during low levels of LBNP, 12 subjects were exposed to -15 and -20 mm Hg LBNP with and without additional artificial (+ 10 mm Hg neck pressure) unloading of the carotid baroreceptors. There was no measurable influence of carotid unloading on forearm vascular resistance at either level of LBNP. It is concluded that forearm vascular resistance measured during cardiopulmonary baroreceptor unloading is unaffected by carotid baroreceptor unloading within the magnitude encountered during low levels of LBNP.

  15. Measurement of the subcutaneous fat in the distal forearm by single photon absorptiometry

    SciTech Connect

    Hassager, C.; Borg, J.; Christiansen, C.

    1989-02-01

    The influence of subcutaneous fat on single photon (/sup 125/I) absorptiometry (SPA) measurement of bone mineral content of the distal forearm was investigated. A fat correction model was tested by measurements on eight lean subjects with different amounts of porcine fat around their forearm, and further validated from measurements on 128 females. In addition, it is shown that the fat content in the distal forearm can be measured by SPA with a short-term precision at 1.9% in an obese subject and that it correlates well with total body fat (r2 = .7) measured by dual photon absorptiometry, skinfold thickness (r2 = .5), and body mass index (r2 = .6). By using this method in a double-blind placebo-controlled trial, hormonal substitutional therapy significantly decreased the forearm fat content without affecting the body weight in postmenopausal osteoporotic women.

  16. Investigating the roles of core and local temperature on forearm skin blood flow.

    PubMed

    Mallette, Matthew M; Hodges, Gary J; McGarr, Gregory W; Gabriel, David A; Cheung, Stephen S

    2016-07-01

    We sought to isolate the contributions of core and local temperature on forearm skin blood flow (SkBF), and to examine the interaction between local- and reflexive-mechanisms of SkBF control. Forearm SkBF was assessed using laser-Doppler flowmetry in eight males and eight females during normothermia and hyperthermia (+1.2°C rectal temperature). Mean experimental forearm temperature was manipulated in four, 5min blocks between neutral (A: 33.0°C) and warm (B: 38.5°C) in an A-B-A-B fashion during normothermia, and B-A-B-A during hyperthermia. Mean control forearm skin temperature was maintained at ~33°C. Finally, local heating to 44°C was performed on both forearms to elicit maximal SkBF. Data are presented as a percentage of maximal cutaneous vascular conductance (CVC), calculated as laser-Doppler flux divided by mean arterial pressure. No sex differences were observed in any CVC measures (P>0.05). During normothermia, increasing experimental forearm temperature to 38.5°C elevated CVC by 42±8%max (d=3.1, P<0.001). Subsequently decreasing experimental forearm temperature back down to 33.0°C reduced CVC by 36±7%max (d=2.5, P<0.001). Finally, the second increase in experimental forearm temperature to 38.5°C increased CVC by 25±6%max (d=1.9, P<0.0001). During hyperthermia, decreasing experimental forearm temperature to 33.0°C reduced CVC by 6±1%max (d=0.5, P<0.001). Increasing experimental forearm temperature to 38.5°C increased CVC by 4±2%max (d=0.4, P<0.001). Finally, decreasing experimental forearm temperature to 33.0°C reduced CVC by 8±2%max (d=0.7, P<0.001). Compared to normothermia, CVC responses to local temperature changes during hyperthermia were almost abolished (normothermia: d=1.9-3.1; hyperthermia: d=0.4-0.7). These data indicate that local temperature drives SkBF during normothermia, while reflexive mechanisms regulate SkBF during hyperthermia.

  17. Neurological and vascular injury associated with supracondylar humerus fractures and ipsilateral forearm fractures in children.

    PubMed

    Muchow, Ryan D; Riccio, Anthony I; Garg, Sumeet; Ho, Christine A; Wimberly, Robert L

    2015-03-01

    Approximately 5% of supracondylar humerus fractures in children are associated with an ipsilateral forearm fracture, often referred to as a floating elbow when both injuries are displaced. Historically, these patients have higher complication rates than patients with an isolated supracondylar humerus fracture. The purpose of this study was to review the acute neurologic and vascular injuries in patients with ipsilateral, operative supracondylar humerus and forearm fractures and compare the findings with a cohort of isolated, operative supracondylar humerus fractures. We performed an IRB-approved, retrospective review of all pediatric patients with ipsilateral, operative supracondylar humerus and forearm fractures from a single institution and compared our findings to a cohort of isolated, operative supracondylar humerus fractures. A total of 150 patients with operative supracondylar humerus and ipsilateral forearm fractures were compared with 1228 patients with isolated, operative supracondylar humerus fractures. Twenty-two of the 150 (14.7%) floating elbow patients had documented pretreatment nerve palsies compared with 96/1228 (7.8%) of isolated injury patients (P=0.006). Eighteen of 22 nerve palsies were in patients with forearm fractures that required reduction. The overall incidence of nerve palsy was 18.9% (18/95) when a forearm fracture required reduction compared with only 7.3% (4/55) in a forearm fracture that was not reduced (P=0.05). We did not find a significant difference in the rate of pulseless extremities when comparing the ipsilateral (6/150 4%) and isolated (50/1228 4.1%) injury patients. No compartment syndromes were identified in any patient with an ipsilateral injury. The rate of acute neurologic injury in ipsilateral supracondylar humerus and forearm fractures is almost twice than that found in patients with isolated supracondylar humerus fractures. This rate increases further when the forearm fracture requires a manipulative reduction. The

  18. [Free radial forearm flap in head and neck: our experience].

    PubMed

    Tornero, Jordi; Cruz-Toro, Paula; Farré, Anna; Vega-Celiz, Jorge; Skufca, Javier; Nogués, Julio; Maños-Pujol, Manel

    2014-01-01

    Oncologic surgery leads to important defects and sequelae, as well as notable cosmetic and functional alterations. In this aspect reconstructive surgery has an essential role, allowing more radical excision and lower associated functional and cosmetic morbidities. The aim of this study was to present and evaluate the experience and results of the reconstructive microsurgery unit in our centre's ENT department. Retrospective study of procedures performed between 2006 and 2012. A total of 36 cases were reviewed. The primary tumour was found in the oropharynx (58%) in the majority of cases. In 5 cases the procedure was performed for reconstruction and fistula closure (4 pharyngostoma and 1 tracheoesophageal fistula). Failure from total necrosis was 16% (6/36). No associated mortality has been reported. The most common postoperative complications were wound dehiscence in 5 patients and pharyngostoma (fistula) in 5 cases. Prior radiotherapy significantly influenced the increase in the overall incidence of complications (P<05). Reconstructive surgery currently plays an important role in surgery for head and neck cancer. The radial forearm flap is a safe, reliable method for reconstruction of most defects in the ENT field. This type of intervention provides greater autonomy and safety in surgical oncology. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  19. Altered baroreflex control of forearm vascular resistance during simulated microgravity

    NASA Technical Reports Server (NTRS)

    Convertino, V. A.; Doerr, D. F.; Vernikos, J.

    1994-01-01

    Reflex peripheral vasoconstriction induced by activation of cardiopulmonary baroreceptors in response to reduced central venous pressure (CVP) is a basic mechanism for elevating systemic vascular resistance and defending arterial blood pressure during orthostatically-induced reductions in cardiac filling and output. The sensitivity of the cardiopulmonary baroreflex response [defined as the slope of the relationship between changes in forearm vascular resistance (FVR) and CVP] and the resultant vasoconstriction are closely and inversely associated with the amount of circulating blood volume. Thus, a high-gain FVR response will be elicited by a hypovolemic state. Exposure to microgravity during spaceflight results in reduced plasma volume. It is therefore reasonable to expect that the FVR response to cardiopulmonary baroreceptor unloading would be accentuated following adaptation to microgravity. Such data could provide better insight about the physiological mechanisms underlying alterations in blood pressure control following spaceflight. We therefore exposed eleven men to 6 degrees head-down bedrest for 7 days and measured specific hemodynamic responses to low levels of the lower body negative pressure to determine if there are alterations in cardiopulmonary baroreceptor stimulus-FVR reflex response relationship during prolonged exposure to an analog of microgravity.

  20. Functional Assessments in Patients Undergoing Radial Forearm Flap Following Hemiglossectomy.

    PubMed

    Li, Xiangru; Sun, Qiang; Guo, Shu

    2016-03-01

    Our goal was to evaluate the functional outcomes following radial forearm free-flap reconstruction with a focus on radiotherapy. A 2-year prospective study was performed. A total of 47 patients were enrolled finally. They were asked to complete the swallowing, chewing, speech domains of the University of Washington Quality of Life questionnaire preoperatively and at 2 years postoperatively. Swallowing capacity was apparently affected after surgery, but no patients reported there was chokes cough during eating, the mean score was 51.1 (SD: 21.3). Most patients (70.2%) presented their articulation was good enough for everyday life, and the mean score was 60.0 (SD: 21.1). As for chewing, only 7 (14.9%) patients complained there was negative effect, and the mean score was as high as 92.6 (SD: 18.0). Compared to patients with surgery only, patients with postoperative radiotherapy only had significantly worse swallowing and speech capacity. Compared with patients with postoperative radiotherapy only, patients with both preoperative and postoperative radiotherapy tended to have better swallowing and speech. No significant differences were found between chewing and radiotherapy. In most patients, the results of swallowing, speech, and chewing are favorable. Postoperative radiotherapy has an apparent impact on functional impairment, but preoperative tends to preserve the original tongue function.

  1. Microvascular radial forearm fasciocutaneous free flap in hard palate reconstruction.

    PubMed

    Duflo, S; Lief, F; Paris, J; Giovanni, A; Thibeault, S; Zanaret, M

    2005-09-01

    To report the reconstruction of palatal defects by microvascular radial forearm fasciocutaneous free flap (RFFF) and to report patient's quality of life outcomes after this procedure. During the period 1990-2002, 30 cases of palatal defects were reconstructed using RFFF in our institution. RFFF allowed restoration of a vestibular sulcus to maintain dental prostheses. Outcome measurements included post-operative assessment of speech, swallowing and diet evaluation 6 months, 1 year and 2 years after reconstruction. Quality of life outcomes were measured 1 and 2 years post-reconstruction. RFFF surgery was successful in 28 cases. Six months after resection 28 patients reported satisfactory speech and swallowing. Two years after surgery, 92% (n=26) of patients resumed a normal diet. All patients underwent dental evaluation and 68% (n=19) of patients required dental rehabilitation over a post-operative period of 3-18 months. Patients self assessed their quality of life on a scale of 0-2. First year post-operatively, 21 patients reported a good quality of life (score=2). After the second year, 26 patients reported a good quality of life and the remaining two patients reported an intermediate quality of life (score=1) because they did not resume a normal diet. RFFF for palatal reconstruction is a reliable technique and provides a definitive separation between oral and sinusonasal cavities. Furthermore, it improves quality of life by improving speech, swallowing and chewing. It should be considered an integral component of head and neck cancer therapy and rehabilitation.

  2. Comparative analysis of muscle architecture in primate arm and forearm.

    PubMed

    Kikuchi, Yasuhiro

    2010-04-01

    A comparative study of myological morphology, i.e. muscle mass (MM), muscle fascicle length and muscle physiological cross-sectional area (an indicator of the force capacity of muscles), was conducted in nine primate species: human (Homo sapiens), chimpanzee (Pan troglodytes), gibbon (Hylobates spp.), papio (Papio hamadryas), lutong (Trachypithecus francoisi), green monkey (Chlorocebus aethiops), macaque monkey (Macaca spp.), capuchin monkey (Cebus albifrons) and squirrel monkey (Saimiri sciureus). The MM distributions and the percentages in terms of functional categories were calculated as the ratios of the muscle masses. Moreover, individual normalized data were compared directly amongst species, independent of size differences. The results show that the different ratios of forearm-rotation muscles between chimpanzee and gibbons may be related to the differences in their main positional behaviour, i.e. knuckle-walking in chimpanzees and brachiation in gibbons, and the different frequencies of arm-raising locomotion between these two species. Moreover, monkeys have larger normalized MM values for the elbow extensor muscles than apes, which may be attributed to the fact that almost all monkeys engage in quadrupedal locomotion. The characteristics of the muscle internal parameters of ape and human are discussed in comparison with those of monkey.

  3. Altered baroreflex control of forearm vascular resistance during simulated microgravity

    NASA Technical Reports Server (NTRS)

    Convertino, V. A.; Doerr, D. F.; Vernikos, J.

    1994-01-01

    Reflex peripheral vasoconstriction induced by activation of cardiopulmonary baroreceptors in response to reduced central venous pressure (CVP) is a basic mechanism for elevating systemic vascular resistance and defending arterial blood pressure during orthostatically-induced reductions in cardiac filling and output. The sensitivity of the cardiopulmonary baroreflex response [defined as the slope of the relationship between changes in forearm vascular resistance (FVR) and CVP] and the resultant vasoconstriction are closely and inversely associated with the amount of circulating blood volume. Thus, a high-gain FVR response will be elicited by a hypovolemic state. Exposure to microgravity during spaceflight results in reduced plasma volume. It is therefore reasonable to expect that the FVR response to cardiopulmonary baroreceptor unloading would be accentuated following adaptation to microgravity. Such data could provide better insight about the physiological mechanisms underlying alterations in blood pressure control following spaceflight. We therefore exposed eleven men to 6 degrees head-down bedrest for 7 days and measured specific hemodynamic responses to low levels of the lower body negative pressure to determine if there are alterations in cardiopulmonary baroreceptor stimulus-FVR reflex response relationship during prolonged exposure to an analog of microgravity.

  4. Exchange nailing for nonunion of diaphyseal fractures of the tibia: our results and an analysis of the risk factors for failure.

    PubMed

    Tsang, S T J; Mills, L A; Frantzias, J; Baren, J P; Keating, J F; Simpson, A H R W

    2016-04-01

    The aim of this study was to identify risk factors for the failure of exchange nailing in nonunion of tibial diaphyseal fractures. A cohort of 102 tibial diaphyseal nonunions in 101 patients with a mean age of 36.9 years (15 to 74) were treated between January 1992 and December 2012 by exchange nailing. Of which 33 (32%) were initially open injuries. The median time from primary fixation to exchange nailing was 6.5 months (interquartile range (IQR) 4.3 to 9.8 months). The main outcome measures were union, number of secondary fixation procedures required to achieve union and time to union. Univariate analysis and multiple regression were used to identify risk factors for failure to achieve union. Multiple causes for the primary nonunion were found for 28 (27%) tibiae, with infection present in 32 (31%). Six patients were lost to follow-up. Further surgical procedures were required in 35 (36%) nonunions. Other fixation modalities were required in five fractures. A single nail exchange procedure achieved union in 60/96 (63%) of all nonunions. Only 11 out of 31 infected nonunions (35.4%) healed after one exchange nail procedure. Up to five repeated exchange nailings, with or without bone grafting, ultimately achieved union in 89 (93%) fractures. The median time to union after exchange nailing was 8.7 months (IQR 5.7 to 14.0 months). Univariate analysis confirmed that an oligotrophic/atrophic pattern of nonunion (p = 0.002), a bone gap of 5 mm or more (p = 0.04) and infection (p < 0.001), were predictive for failure of exchange nailing Multiple regression analysis found that infection was the strongest predictor of failure (p < 0.001). Exchange nailing is an effective treatment for aseptic tibial diaphyseal nonunion. However, in the presence of severe infection with a highly resistant organism, or extensive sclerosis of the bone, other fixation modalities, such as Ilizarov treatment, should be considered. Exchange nailing is an effective treatment for aseptic tibial

  5. Determination of antiseptic efficacy of rubs on the forearm and consequences for surgical hand disinfection.

    PubMed

    Hübner, N-O; Kellner, N B; Partecke, L I; Koburger, T; Heidecke, C-D; Kohlmann, T; Kramer, A

    2011-05-01

    While hands are acknowledged to be the most important source of pathogens from the skin of the surgical team, the transmission of pathogens from the forearms may also be relevant. Preoperative hand disinfection is recommended, but evidence-based standards for the forearms are lacking. As neither the European standard EN 12791 nor the American guidelines ASTM 1115 are applicable to the forearms, a new test method based on the European standard EN 12791 and the German Society for Hygiene and Microbiology (DGHM) method for testing for the efficacy of skin antiseptics was developed to address the forearms. The antiseptic efficacy of a commercially available alcohol-based hand rub [76.7% (w/w) ethanol] was assessed on the upper arm after 15s, 2.5 min, and 30 min, and on the lower arm after 2.5 min, 30 min, and 3 h. On the upper arm, application of the product followed the DGHM standard procedure. On the forearm, the product was applied by the participants themselves with the right hand over the left forearm and vice versa as performed during preoperative hand disinfection. Sampling and culture were performed according to the DGHM method for skin antisepsis on the upper arm. Twenty-two volunteers were investigated. The efficacy of the antiseptic treatment on the forearm was not significantly lower than on the upper arm for any of the areas tested (P > 0.05). Reduction factors for all tested areas and times were quite similar, with confidence intervals ranging between 1.43 and 2.31 log₁₀. We suggest that an application time of 10s may be sufficient for the treatment of the forearm as part of preoperative hand disinfection, provided that an appropriate product is used.

  6. Resistance exercise with different volumes: blood pressure response and forearm blood flow in the hypertensive elderly.

    PubMed

    Brito, Aline de Freitas; de Oliveira, Caio Victor Coutinho; Brasileiro-Santos, Maria do Socorro; Santos, Amilton da Cruz

    2014-01-01

    The purpose of this study was to evaluate the effect of two sessions of resistance exercise with different volumes on post-exercise hypotension, forearm blood flow, and forearm vascular resistance in hypertensive elderly subjects. The study was conducted with ten hypertensive elderly (65±3 years, 28.7±3 kg/m(2)) subjected to three experimental sessions, ie, a control session, exercise with a set (S1), and exercise with three sets (S3). For each session, the subjects were evaluated before and after intervention. In the pre-intervention period, blood pressure, forearm blood flow, and forearm vascular resistance were measured after 10 minutes of rest in the supine position. Thereafter, the subjects were taken to the gym to perform their exercise sessions or remained at rest during the same time period. Both S1 and S3 comprised a set of ten repetitions of ten exercises, with an interval of 90 seconds between exercises. Subsequently, the measurements were again performed at 10, 30, 50, 70, and 90 minutes of recovery (post-intervention) in the supine position. Post-exercise hypotension was greater in S3 than in S1 (systolic blood pressure, -26.5±4.2 mmHg versus -17.9±4.7 mmHg; diastolic blood pressure, -13.8±4.9 mmHg versus -7.7±5 mmHg, P<0.05). Similarly, forearm blood flow and forearm vascular resistance changed significantly in both sessions with an increase and decrease, respectively, that was more evident in S3 than in S1 (P<0.05). Resistance exercises with higher volume were more effective in causing post-exercise hypotension, being accompanied by an increase in forearm blood flow and a reduction of forearm vascular resistance.

  7. Within arm's reach: Measuring forearm length to assess growth patterns in captive bonobos and chimpanzees.

    PubMed

    Behringer, Verena; Stevens, Jeroen M G; Kivell, Tracy L; Neufuss, Johanna; Boesch, Christophe; Hohmann, Gottfried

    2016-09-01

    Bonobos and chimpanzees are known to differ in various morphological traits, a dichotomy that is sometimes used as an analogy for evolutionary splits during human evolution. The aim of our study was to measure the forearm length of immature and adult bonobos and adult chimpanzees to assess the extent of age-related changes of forearm length in bonobos and sex-dimorphism in bonobos and chimpanzees. As a proxy of somatic growth we measured forearm length of captive bonobos and chimpanzees ranging in age from 1 to 55 years. Measures were taken from subjects inserting their arms into a transparent Plexiglas® tube, a novel technique facilitating repeated measures of nonanesthetized apes in captivity. Measures from adult females (>12 years) showed that bonobos exceed chimpanzees in terms of forearm length and that sexual dimorphism in forearm length is pronounced in chimpanzees, but not in bonobos. Forearm length increased significantly with chronological age in bonobos. Validation tests revealed that the device generates useful data on morphometric dimensions. In most primates, sexual dimorphism in body size is male-biased and the differences in forearm length in chimpanzees follow this trend. Given that males of the two species did not differ in forearm length, the absence/presence of sexual dimorphism of this trait must be due to differences in somatic growth in females. Our novel method offers an alternative to obtain morphometric measures and facilitates longitudinal studies on somatic growth. Am J Phys Anthropol 161:37-43, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  8. Surgical trainees neuropraxia? An unusual case of compression of the lateral cutaneous nerve of the forearm.

    PubMed

    Seoighe, D M; Baker, J F; Mulhall, K J

    2010-09-01

    Compression of the lateral cutaneous nerve of the forearm is an uncommon diagnosis but has been associated with strenuous upper limb activity. We report the unique case of a 32-year-old male orthopaedic trainee who suffered this nerve palsy as a result of prolonged elbow extension and forearm pronation while the single assistant during a hip resurfacing procedure. Conservative measures were sufficient for sensory recovery to be clinically detectable after 12 weeks. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  9. Long-term results of forearm lengthening and deformity correction by the Ilizarov method.

    PubMed

    Orzechowski, Wiktor; Morasiewicz, Leszek; Krawczyk, Artur; Dragan, Szymon; Czapiński, Jacek

    2002-06-30

    Background. Shortening and deformity of the forearm is most frequently caused by congenital disorders or posttraumatic injury. Given its complex anatomy and biomechanics, the forearm is clearly the most difficult segment for lengthening and deformity correction.
    Material and methods. We analyzed 16 patients with shortening and deformity of the forearm, treated surgically, using the Ilizarov method in our Department from 1989 to 2001. in 9 cases 1-stage surgery was sufficient, while the remaining 7 patients underwent 2-5 stages of treatment. At total of 31 surgical operations were performed. The extent of forearm shortening ranged from 1,5 to 14,5 cm (5-70%). We development a new fixator based on Schanz half-pins.
    Results. The length of forearm lengthening per operative stage averaged 2,35 cm. the proportion of lengthening ranged from 6% to 48% with an average of 18,3%. The mean lengthening index was 48,15 days/cm. the per-patient rate of complications was 88% compared 45% per stage of treatment, mostly limited rotational mobility and abnormal consolidation of regenerated bone.
    Conclusions. Despite the high complication rate, the Ilizarov method is the method of choice for patients with forearm shortenings and deformities. Treatment is particularly indicated in patients with shortening caused by disproportionate length of the ulnar and forearm bones. Treatment should be managed so as cause the least possible damage to arm function, even at the cost of limited lengthening. Our new stabilizer based on Schanz half-pins makes it possible to preserve forearm rotation.

  10. Resistance exercise with different volumes: blood pressure response and forearm blood flow in the hypertensive elderly

    PubMed Central

    Brito, Aline de Freitas; de Oliveira, Caio Victor Coutinho; Brasileiro-Santos, Maria do Socorro; Santos, Amilton da Cruz

    2014-01-01

    Background The purpose of this study was to evaluate the effect of two sessions of resistance exercise with different volumes on post-exercise hypotension, forearm blood flow, and forearm vascular resistance in hypertensive elderly subjects. Methods The study was conducted with ten hypertensive elderly (65±3 years, 28.7±3 kg/m2) subjected to three experimental sessions, ie, a control session, exercise with a set (S1), and exercise with three sets (S3). For each session, the subjects were evaluated before and after intervention. In the pre-intervention period, blood pressure, forearm blood flow, and forearm vascular resistance were measured after 10 minutes of rest in the supine position. Thereafter, the subjects were taken to the gym to perform their exercise sessions or remained at rest during the same time period. Both S1 and S3 comprised a set of ten repetitions of ten exercises, with an interval of 90 seconds between exercises. Subsequently, the measurements were again performed at 10, 30, 50, 70, and 90 minutes of recovery (post-intervention) in the supine position. Results Post-exercise hypotension was greater in S3 than in S1 (systolic blood pressure, −26.5±4.2 mmHg versus −17.9±4.7 mmHg; diastolic blood pressure, −13.8±4.9 mmHg versus −7.7±5 mmHg, P<0.05). Similarly, forearm blood flow and forearm vascular resistance changed significantly in both sessions with an increase and decrease, respectively, that was more evident in S3 than in S1 (P<0.05). Conclusion Resistance exercises with higher volume were more effective in causing post-exercise hypotension, being accompanied by an increase in forearm blood flow and a reduction of forearm vascular resistance. PMID:25540580

  11. Texture-induced vibrations in the forearm during tactile exploration

    PubMed Central

    Delhaye, Benoit; Hayward, Vincent; Lefèvre, Philippe; Thonnard, Jean-Louis

    2012-01-01

    Humans can detect and discriminate between fine variations of surface roughness using active touch. It is hitherto believed that roughness perception is mediated mostly by cutaneous and subcutaneous afferents located in the fingertips. However, recent findings have shown that following abolishment of cutaneous afferences resulting from trauma or pharmacological intervention, the ability of subjects to discriminate between textures roughness was not significantly altered. These findings suggest that the somatosensory system is able to collect textural information from other sources than fingertip afference. It follows that signals resulting of the interaction of a finger with a rough surface must be transmitted to stimulate receptor populations in regions far away from the contact. This transmission was characterized by measuring in the wrist vibrations originating at the fingertip and thus propagating through the finger, the hand and the wrist during active exploration of textured surfaces. The spectral analysis of the vibrations taking place in the forearm tissues revealed regularities that were correlated with the scanned surface and the speed of exploration. In the case of periodic textures, the vibration signal contained a fundamental frequency component corresponding to the finger velocity divided by the spatial period of the stimulus. This regularity was found for a wide range of textural length scales and scanning velocities. For non-periodic textures, the spectrum of the vibration did not contain obvious features that would enable discrimination between the different stimuli. However, for both periodic and non-periodic stimuli, the intensity of the vibrations could be related to the microgeometry of the scanned surfaces. PMID:22783177

  12. Forearm lengthening by distraction osteogenesis in children: a report of 22 cases.

    PubMed

    Hill, R A; Ibrahim, T; Mann, H A; Siapkara, A

    2011-11-01

    We present our experience of forearm lengthening in children with various conditions performed by a single surgeon between 1995 and 2009. A total of 19 children with a mean age of 9.8 years (2.1 to 15.9) at the time of surgery had 22 forearm lengthenings using either an Ilizarov/spatial and Ilizarov circular frame or a monolateral external fixator. The patients were divided into two groups: group A, in whom the purpose of treatment was to restore the relationship between the radius and the ulna, and group B, in whom the objective was to gain forearm length. The mean follow-up after removal of the frame was 26 months (13 to 53). There were ten patients (11 forearms) in group A with a mean radioulnar discrepancy of 2.4 cm (1.5 to 3.3) and nine patients (11 forearms) in group B. In group A, the mean lengthening achieved was 2.7 cm (1.0 to 5.5), with a lengthening index of 11.1 weeks/cm. Equalisation or overcorrection of the discrepancy was achieved in seven of 11 forearms, but lengthening was only partially successful at preventing subluxation or dislocation of the radial head. In group B, the mean lengthening achieved was 3.8 cm (1.9 to 6.8), with a lengthening index of 7.25 weeks/cm. Common complications in both groups were pin-site infection and poor regenerate formation. Forearm lengthening by distraction osteogenesis is a worthwhile procedure in children that can improve cosmesis and function, particularly in patients with shortening of both radius and ulna.

  13. Is there still a place for cast wedging in pediatric forearm fractures?

    PubMed

    Samora, Julie Balch; Klingele, Kevin E; Beebe, Allan C; Kean, John R; Klamar, Jan; Beran, Matthew C; Willis, Leisel M; Yin, Han; Samora, Walter P

    2014-01-01

    Forearm fractures are common skeletal injuries in childhood and can usually be treated nonoperatively with closed reduction and casting. Trends toward increasing operative treatment of these fractures have emerged. We aim to demonstrate the safety and efficacy of cast wedging for treatment of pediatric forearm fractures. We performed a prospective chart review of patients with forearm fractures, including distal radius (DR) fractures, treated with cast wedging at a single large pediatric hospital from June 2011 to September 2012. Inclusion criteria specified open distal radial physis, closed injury, loss of acceptable reduction, and availability of clinical and radiographic data from injury to cast removal. Exclusion criteria included pathologic fractures, neurovascular injury, fracture dislocations, open fractures, and closed DR physis. Reductions were performed and patients followed according to standard protocol at our institution, including placement into long-arm casts, initial follow-up visit within 5 to 10 days postinjury, and weekly visits for 2 weeks thereafter. If alignment were deemed unacceptable within 3 weeks of injury, cast wedging was utilized. Radiographic measurements of alignment included both radius and ulna on the injury film, postreduction, prewedge, postwedge, and final films. Radiographic technique was standardized, with repeatability testing demonstrating a precision of ±2 degrees. Over 15 months, our hospital treated 2124 forearm or DR fractures with closed reduction and casting. There were 60 fractures treated either with percutaneous fixation (36) or open treatment (24). A total of 79 forearm or DR fractures were treated with cast wedging secondary to loss of reduction, of which 70 patients had complete clinical and radiographic data. Average age was 8.4 years (range, 3 to 14 y), with 25 females and 45 males. Significant improvement in angulation for both-bone forearm fracture from prewedge to final films was seen in 69 children, with

  14. Characterization of evoked tactile sensation in forearm amputees with transcutaneous electrical nerve stimulation

    NASA Astrophysics Data System (ADS)

    Chai, Guohong; Sui, Xiaohong; Li, Si; He, Longwen; Lan, Ning

    2015-12-01

    Objective. The goal of this study is to characterize the phenomenon of evoked tactile sensation (ETS) on the stump skin of forearm amputees using transcutaneous electrical nerve stimulation (TENS). Approach. We identified the projected finger map (PFM) of ETS on the stump skin in 11 forearm amputees, and compared perceptual attributes of the ETS in nine forearm amputees and eight able-bodied subjects using TENS. The profile of perceptual thresholds at the most sensitive points (MSPs) in each finger-projected area was obtained by modulating current amplitude, pulse width, and frequency of the biphasic, rectangular current stimulus. The long-term stability of the PFM and the perceptual threshold of the ETS were monitored in five forearm amputees for a period of 11 months. Main results. Five finger-specific projection areas can be independently identified on the stump skin of forearm amputees with a relatively long residual stump length. The shape of the PFM was progressively similar to that of the hand with more distal amputation. Similar sensory modalities of touch, pressure, buzz, vibration, and numb below pain sensation could be evoked both in the PFM of the stump skin of amputees and in the normal skin of able-bodied subjects. Sensory thresholds in the normal skin of able-bodied subjects were generally lower than those in the stump skin of forearm amputees, however, both were linearly modulated by current amplitude and pulse width. The variation of the MSPs in the PFM was confined to a small elliptical area with 95% confidence. The perceptual thresholds of thumb-projected areas were found to vary less than 0.99 × 10-2 mA cm-2. Significance. The stable PFM and sensory thresholds of ETS are desirable for a non-invasive neural interface that can feed back finger-specific tactile information from the prosthetic hand to forearm amputees.

  15. Cardiovascular responses to cold-water immersions of the forearm and face, and their relationship to apnoea.

    PubMed

    Andersson, J; Schagatay, E; Gislén, A; Holm, B

    2000-12-01

    Apnoea as well as cold stimulation of the face or the extremities elicits marked cardiovascular reflexes in humans. The purpose of this study was to investigate whether forearm immersion in cold water has any effect on the cardiovascular responses to face immersion and apnoea. We recorded cardiovascular responses to coldwater immersions of the forearm and face in 19 (part I) and 23 subjects (part II). The experimental protocol was divided in two parts, each part containing four tests: I1, forearm immersion during eupnoea; I2, face immersion during eupnoea; I3, forearm and face immersion during eupnoea; I4, face immersion during apnoea; II1, apnoea without immersion; II2, forearm immersion during apnoea; II3, face immersion during apnoea; and II4, forearm and face immersion during apnoea. The water temperature was 9-11 degrees C. Cold-water immersion of either the forearm or face was enough to elicit the most pronounced thermoregulatory vasoconstriction during both eupnoea and apnoea. During eupnoea, heart rate responses to forearm immersion (3% increase) and face immersion (9% decrease) were additive during concurrent stimulation (3% decrease). During apnoea, the heart rate responses were not affected by the forearm immersion. The oxygen-conserving diving response seems to dominate over thermoregulatory responses in the threat of asphyxia. During breathing, however, the diving response serves no purpose and does not set thermoregulatory adjustments aside.

  16. Three-dimensional CFD analysis of the hand and forearm in swimming.

    PubMed

    Marinho, Daniel A; Silva, Antonio J; Reis, Victor M; Barbosa, Tiago M; Vilas-Boas, Joao P; Alves, Francisco B; Machado, Leandro; Rouboa, Abel I

    2011-02-01

    The purpose of this study was to analyze the hydrodynamic characteristics of a realistic model of an elite swimmer hand/forearm using three-dimensional computational fluid dynamics techniques. A three-dimensional domain was designed to simulate the fluid flow around a swimmer hand and forearm model in different orientations (0°, 45°, and 90° for the three axes Ox, Oy and Oz). The hand/forearm model was obtained through computerized tomography scans. Steady-state analyses were performed using the commercial code Fluent. The drag coefficient presented higher values than the lift coefficient for all model orientations. The drag coefficient of the hand/forearm model increased with the angle of attack, with the maximum value of the force coefficient corresponding to an angle of attack of 90°. The drag coefficient obtained the highest value at an orientation of the hand plane in which the model was directly perpendicular to the direction of the flow. An important contribution of the lift coefficient was observed at an angle of attack of 45°, which could have an important role in the overall propulsive force production of the hand and forearm in swimming phases, when the angle of attack is near 45°.

  17. Computer simulation of forearm rotation in angular deformities: a new therapeutic approach.

    PubMed

    Kasten, P; Krefft, M; Hesselbach, J; Weinberg, A-M

    2002-11-01

    A new computer-assisted simulation of forearm rotation based on orthogonal radiographs of the forearm is introduced. A new computer program called STOOPS was developed based on a new kinematic model describing motion of the radius and ulna in regards to forearm rotation. The computer program allows simulation of angular deformities of the forearm and can predict subsequent rotational impairment. To validate the program, the authors compared the actual pronation of 21 patients with angular deformities with the predicted pronation by STOOPS. The mean difference between the simulated and clinically measured pronation was 5.6 degrees (S.D. 9.4 degrees ). There was no statistically significant difference between the measured and simulated values. Using the computer-assisted simulation may help predict impairment of pronation due to angular deformities. If clinical impairment differs from the computed one, other causes such as lesions to the interosseous membrane or the adjacent joints have to be excluded. If values are similar, correction of the angular deformities should result in improvement of forearm pronation.

  18. Self-tuning control of a two-link manipulator with a flexible forearm

    SciTech Connect

    Koivo, A.J.; Lee, K.S. )

    1992-08-01

    The control of the motion of a two-link manipulator with a flexible forearm is studied. The first link is rigid, and the second link has a flexible part as an extension of a rigid part. The motion of the manipulator takes place on a horizontal plane. The dynamics of the two-link manipulator with a flexible forearm are determined in Lagrange's formulation. The positions of specified points on the flexible forearm are obtained from the strain gauge measurements and the positions of the joint variables. The inputs are applied to the actuators of the revolute first joint and the prismatic link. For the controller design, a time series multivariate model of the autoregressive exogenous (ARX) type is used to describe the input/output relation. The discounted least squares method is used to estimate the parameters of the time series model. A self-tuning controller is so designed that the positions of the specified points on the flexible forearm track the given trajectory points. The controller operates on the Cartesian coordinates, which specify the positions of the chosen points on the flexible forearm. Simulation results as well as laboratory experiments on a Stanford/JPL arm controlled by a self-tuning controller are presented to illustrate the approach.

  19. Metacarpal Bone Plane Examination by Ultrasonography for the Diagnosis of Fetal Forearm and Hand Deformity

    PubMed Central

    Zhou, Leiping; Lv, Mingli; Zeng, Min; Zhou, Yun; Yang, Tian; Yang, Yu; Cao, Yunyun; Kong, Xiaoxiao; Niu, Jianmei

    2017-01-01

    We explored the value of the metacarpal bone plane in screening for serious fetal forearm and hand deformities, excluding simple polydactyly and dactylion deformity, by ultrasonographic examination. Observed the second to fifth metacarpal bone plane of fetuses in 20,139 pregnant women at a gestational age of 16 to 30 weeks in The International Peace Maternity & Child Health Hospital of China Welfare Institute (IPMCH). There was a total 138 cases of fetal forearm and/or hand deformity among the 20,139 pregnant women. Of these, 134 cases were diagnosed, 4 cases were not diagnosed, and 1 case was misdiagnosed. Among the 134 diagnosed cases, there were 19 cases of hand absence, 5 cases of cleft hand, 13 cases of ectrodactyly, 26 cases of radius absence, 9 cases of forearm and hand dysplasia, 55 cases of thanatophoric dysplasia, 6 cases of wrist joint dysplasia, and 1 case of forearm amputation deformity. The deformity rate was 0.76%, the diagnostic coincidence rate was 99.97%, the sensitivity was 97.10%, the specificity was 99.99%, and the false negative rate was 2.9%. As such, careful observation of the metacarpal bone plane can be used increase the diagnosis rate of fetal forearm and hand deformity. PMID:28169352

  20. Medical thermography (digital infrared thermal imaging - DITI) in paediatric forearm fractures - A pilot study.

    PubMed

    Ćurković, S; Antabak, A; Halužan, D; Luetić, T; Prlić, I; Šiško, J

    2015-11-01

    Trauma is the most common cause of hospitalisation in children, and forearm fractures comprise 35% of all paediatric fractures. One-third of forearm fractures are distal forearm fractures, which are the most common fractures in the paediatric population. This type of fracture represents an everyday problem for the paediatric surgeon. The three phases of fracture healing in paediatric trauma are associated with skin temperature changes that can be measured and then compared with standard plain radiographs of visible callus formation, and eventually these methods can be used in everyday practice. Thermographic assessment of temperature distribution within the examined tissues enables a quick, non-contact, non-invasive measurement of their temperature. Medical thermography is used as a screening method in other parts of medicine, but the use of this method in traumatology has still not been researched.

  1. Anticipatory and Reactive Response to Falls: Muscle Synergy Activation of Forearm Muscles.

    PubMed

    Couzens, Greg; Kerr, Graham

    2015-10-01

    We investigated the surface electromyogram response of six forearm muscles to falls onto the outstretched hand. The extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, abductor pollicis longus, flexor carpi radialis and flexor carpi ulnaris muscles were sampled from eight volunteers who underwent ten self-initiated falls. All muscles initiated prior to impact. Co-contraction is the most obvious surface electromyogram feature. The predominant response is in the radial deviators. The surface electromyogram timing we recorded would appear to be a complex anticipatory response to falling modified by the effect on the forearm muscles following impact. The mitigation of the force of impact is probably more importantly through shoulder abduction and extension and elbow flexion rather than action of the forearm muscles.

  2. Dislocation of the elbow with ipsilateral forearm fracture. Six particular cases.

    PubMed

    Madhar, M; Saidi, H; Fikry, T; Cermak, K; Moungondo, F; Schuind, F

    2013-10-01

    Elbow dislocation associated with ipsilateral radial shaft fracture is an infrequent injury (nine cases reported in the literature). We present six new cases observed between 2006 and 2012, with an average age of 31 years and a mean follow-up of 18 months. The forearm fracture and ipsilateral dislocation of the elbow were probably caused by forearm hypersupination with extension of the elbow. The dislocation was reduced by manipulation before open reduction and osteosynthesis of the forearm fracture. Four elbows were stable after reduction; two markedly unstable elbows necessitated temporary humero-ulnar external fixation; one case needed a ligamentoplasty several months later. Despite the complexity of the traumatic lesion, the clinical and radiological outcomes were acceptable.

  3. Photoacoustic imaging of the human forearm using 40 MHz linear-array transducer

    NASA Astrophysics Data System (ADS)

    Zafar, Haroon; Breathnach, Aedán.; Subhash, Hrebesh M.; Leahy, Martin J.

    2014-02-01

    In this work photoacoustic imaging (PAI) based on multi element linear-array transducer, combined with multichannel collecting system was used for in vivo imaging of microcirculation of the human forearm. The Vevo® 2100 LAZR PAT system (VISUALSONICS) was used for imaging which simultaneously collects high-resolution ultrasound and photoacoustic signals. 3D PA and high frequency ultrasound scans, measured 30.5 mm (length) x 14.1 mm (width) x 10 mm (depth) were acquired from the area of forearm skin using 40 MHz frequency transducer at 860 nm wavelength. 3D structural and functional (microcirculation) maps of the forearm skin were obtained. The multi element linear-array transducer based PAI has been found promising in terms of resolution, imaging depth and imaging speed for in vivo microcirculation imaging within human skin.

  4. Free myocutaneous flap transfer to treat congenital Volkmann's contracture of the forearm.

    PubMed

    Rubin, G; Palti, R; Gurevitz, S; Yaffe, B

    2015-07-01

    The purpose of this study is to report our experience with free functional muscle transfer procedures for the late sequelae of the rare condition of congenital Volkmann's ischaemic contracture of the forearm. Four children, with an average age of 9.5 years (range 1.5-17), were treated and were followed for a mean of 6 years (range 1-14). Two patients had dorsal forearm contractures, and two had both flexor and extensor forearm contractures. We carried out free functional muscle transfers to replace the flexor or extensor muscles. The functional result was assessed according to the classification system of Hovius and Ultee. All patients had wrist contractures and skeletal involvement with limb length discrepancy that influenced the outcome. All five transferred muscles survived and improved the function of the hand in three of the four patients. LEVEL OF EVIDENCE 4. © The Author(s) 2014.

  5. Auricle reconstruction with a radial forearm flap prelaminated with porous polyethylene (Medpor®) implant.

    PubMed

    Simsek, Tekin; Eroglu, Lutfi

    2012-11-01

    Severe auricular traumas with extensive involvement of the surrounding structures present with a serious defect necessitating free tissue transfers for reconstruction. In this case report, we present a case of whole left auricle reconstruction with a radial forearm flap prelaminated with porous polyethylene (Medpor®) implant in a 17-year-old female patient. First, a subdermal pouch was fashioned on the volar aspect of the left forearm along the projection of the radial artery and the Medpor implant was placed in this pouch. Four weeks later, the prelaminated radial forearm flap containing the Medpor implant was transferred to the recipient site. Resultant construct had a pliable skin cover, and the patient was pleased with the esthetic outcome even though revisions such as external auditory meatus widening, conchal cup deepening, and lobule defining were planned as further interventions. We believe that this method is a pertinent reconstructive option for extensive defects of the auricular region. Copyright © 2012 Wiley Periodicals, Inc.

  6. [A rare cause of compartment syndrome of the forearm and hand following snake bite injury].

    PubMed

    Schnecker, K

    1990-06-01

    With the intention to commit suicide a 25 year old patient was bitten by his own rattle snake. At the time of the admission the skin of the right forearm was dark, a hemorrhagic necrotizing colour, and the patient was in shock. He was immediately taken to the intensive care unit and the shock symptoms were treated there. Parasthesias in the area of the nervus medianus were also noticed. The treatment included an antiserum and the release of the tourniquet which caused a further increase of the swelling of the forearm. The lesion led to a hemorrhagic necrotizing inflammation. The surgical incision of the loge of Guyon, the carpal channel, the forearm and proximal of the lacertus fibrosus was persuaded. The circulation improved immediately and after three weeks the nerval function had recovered. The skin defect was covered 14 days after the first operation with meshgraft.

  7. Postural forearm changes induced by predictable in time or voluntary triggered unloading in man.

    PubMed

    Dufossé, M; Hugon, M; Massion, J

    1985-01-01

    Human subjects sitting in a chair were asked to maintain their right forearm in a horizontal position in half supination. The forearm was loaded with a constant weight of one kilogram. Vertical force at the wrist level, angular position of the elbow and EMG activity of biceps, brachio-radialis and triceps muscles were recorded. Unloading was tested under four different conditions, the first two having been used in a previous study (Hugon et al. 1982): Voluntary unloading by the subject's other hand. An "anticipatory" deactivation of the load bearing forearm flexors is observed preventing the elbow rotation of that arm. Unpredictable passive unloading. This results in an upward forearm rotation which provokes the classical "unloading reflex". Two new conditions were tested in the present paradigm: Imposed unloading predictable in time (tone signal preceding unloading by a fixed interval). Unloading being actively triggered when the subject presses a key. Under the two latter conditions, no anticipatory deactivation of the flexor supporting muscles preceding the onset of unloading as in situation A was observed. During the first 120 ms after the onset of unloading, the forearm rotation was the same as in situation B (unpredictable passive unloading). Thereafter, the rotation was smaller in some subjects, apparently due to an ameliorated reflex action. It is concluded that temporal information concerning the precise time of the unloading or the triggering of the load release by a voluntary movement (key press) was not by itself able to induce the anticipatory deactivation of the forearm flexors that was seen with a coordinated voluntary release of the load by the contralateral arm.

  8. Isokinetic profile of wrist and forearm strength in elite female junior tennis players

    PubMed Central

    Ellenbecker, T S; Roetert, E P; Riewald, S

    2006-01-01

    Background In tennis, injuries to the elbow and wrist occur secondary to the repetitive nature of play and are seen at increasingly young ages. Isokinetic testing can be used to determine muscular strength levels, but dominant/non‐dominant and agonist/antagonist relations are needed for meaningful interpretation of the results. Objectives To determine whether there are laterality differences in wrist extension/flexion (E/F) and forearm supination/pronation (S/P) strength in elite female tennis players. Methods 32 elite female tennis players (age 12 to 16 years) with no history of upper extremity injury underwent bilateral isokinetic testing using a Cybex 6000 dynamometer. Peak torque and single repetition work values for wrist E/F and forearm S/P were measured at speeds of 90°/s and 210°/s, with random determination of the starting extremity. Repeated measures analysis of variance was used to determine differences between extremities for peak torque and single repetition work values. Results Significantly greater (p<0.01) dominant arm wrist E/F and forearm pronation strength was measured at both testing speeds. Significantly less (p<0.01) dominant side forearm supination strength was measured at both testing speeds. Conclusions Greater dominant arm wrist E/F and forearm pronation strength is common and normal in young elite level female tennis players. These strength relations indicate sport specific muscular adaptations in the dominant tennis playing extremity. The results of this study can guide clinicians who work with young athletes from this population. Restoring greater dominant side wrist and forearm strength is indicated after an injury to the dominant upper extremity in such players. PMID:16632571

  9. Quantifying forearm muscle activity during wrist and finger movements by means of multi-channel electromyography.

    PubMed

    Gazzoni, Marco; Celadon, Nicolò; Mastrapasqua, Davide; Paleari, Marco; Margaria, Valentina; Ariano, Paolo

    2014-01-01

    The study of hand and finger movement is an important topic with applications in prosthetics, rehabilitation, and ergonomics. Surface electromyography (sEMG) is the gold standard for the analysis of muscle activation. Previous studies investigated the optimal electrode number and positioning on the forearm to obtain information representative of muscle activation and robust to movements. However, the sEMG spatial distribution on the forearm during hand and finger movements and its changes due to different hand positions has never been quantified. The aim of this work is to quantify 1) the spatial localization of surface EMG activity of distinct forearm muscles during dynamic free movements of wrist and single fingers and 2) the effect of hand position on sEMG activity distribution. The subjects performed cyclic dynamic tasks involving the wrist and the fingers. The wrist tasks and the hand opening/closing task were performed with the hand in prone and neutral positions. A sensorized glove was used for kinematics recording. sEMG signals were acquired from the forearm muscles using a grid of 112 electrodes integrated into a stretchable textile sleeve. The areas of sEMG activity have been identified by a segmentation technique after a data dimensionality reduction step based on Non Negative Matrix Factorization applied to the EMG envelopes. The results show that 1) it is possible to identify distinct areas of sEMG activity on the forearm for different fingers; 2) hand position influences sEMG activity level and spatial distribution. This work gives new quantitative information about sEMG activity distribution on the forearm in healthy subjects and provides a basis for future works on the identification of optimal electrode configuration for sEMG based control of prostheses, exoskeletons, or orthoses. An example of use of this information for the optimization of the detection system for the estimation of joint kinematics from sEMG is reported.

  10. Bedside Ultrasound vs X-Ray for the Diagnosis of Forearm Fractures in Children.

    PubMed

    Rowlands, Rachel; Rippey, James; Tie, Sing; Flynn, James

    2017-02-01

    Painful forearm injuries after a fall occur frequently in children. X-ray study is currently the gold standard investigation. Ultrasound (US) is a potential alternative that avoids exposure to ionizing radiation and may be less painful than x-ray study; and familiarity and skill with US is increasing among emergency physicians. The primary aim of this study was to determine if a cohort of physicians with little or no previous experience with US could, after a short training program, safely exclude forearm fractures in children. Secondary aims were to compare any pain or discomfort associated with clinical examination, US, and x-ray study and to determine the acceptability of US as a diagnostic tool to parents and patients. A prospective, nonrandomized, interventional diagnostic study was performed on children between the ages of 0 and 16 years who had a suspected fracture of the forearm. US scanning was performed by a group of physicians, most with little or no previous US experience. After the brief training program, a group of pediatric emergency physicians could diagnose forearm fractures in children with a sensitivity of 91.5% and a specificity of 87.6%. Pain associated with US was no better or worse than pain associated with x-ray study. Patients and parents preferred US over x-ray study as an investigation modality for suspected forearm fractures. A group of pediatric emergency physicians with limited previous experience could, after a short training program, diagnose forearm fractures in children. Pain associated with US was no better or worse than pain associated with x-ray study. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  11. Adrenergic and myogenic regulation of viscoelasticity in the vascular bed of the human forearm.

    PubMed

    Frances, M F; Goswami, R; Rachinsky, M; Craen, R; Kiviniemi, A M; Fleischhauer, A; Steinback, C D; Zamir, M; Shoemaker, J K

    2011-11-01

    This study tested the hypothesis that the compliance (C) and viscoelasticity (K) of the forearm vascular bed are controlled by myogenic and/or α-adrenergic receptor (αAR) activation. Heart rate (HR) and waveforms of brachial artery blood pressure (Finometer) and forearm blood flow (Doppler ultrasound) were measured in baseline conditions and during infusion of noradrenaline (NA; αAR agonist), with and without phentolamine (αAR antagonist; n = 10; 6 men and 4 women). These baseline and αAR-agonist-based measures were repeated when the arm was positioned above or below the heart to modify the myogenic stimulus. A lumped Windkessel model was used to quantify the values of forearm C and K in each set of conditions. Baseline forearm C was inversely, and K directly, related to the myogenic load (P < 0.001). Compared with saline infusion, C was increased, but K was unaffected, with phentolanine, but only in the 'above' position. Compliance was reduced (P < 0.001) and K increased (P = 0.06) with NA infusion (main effects of NA) across arm positions; phentolamine minimized these NA-induced changes in C and K for both arm positions. Examination of conditions with and without NA infusion at similar forearm intravascular pressures indicated that the NA-induced changes in C and K were due largely to the concurrent changes in blood pressure. Therefore, within the range of arm positions used, it was concluded that vascular stiffness and vessel wall viscoelastic properties are acutely affected by myogenic stimuli. Additionally, forearm vascular compliance is sensitive to baseline levels of αAR activation when transmural pressure is low.

  12. Quantifying Forearm Muscle Activity during Wrist and Finger Movements by Means of Multi-Channel Electromyography

    PubMed Central

    Gazzoni, Marco; Celadon, Nicolò; Mastrapasqua, Davide; Paleari, Marco; Margaria, Valentina; Ariano, Paolo

    2014-01-01

    The study of hand and finger movement is an important topic with applications in prosthetics, rehabilitation, and ergonomics. Surface electromyography (sEMG) is the gold standard for the analysis of muscle activation. Previous studies investigated the optimal electrode number and positioning on the forearm to obtain information representative of muscle activation and robust to movements. However, the sEMG spatial distribution on the forearm during hand and finger movements and its changes due to different hand positions has never been quantified. The aim of this work is to quantify 1) the spatial localization of surface EMG activity of distinct forearm muscles during dynamic free movements of wrist and single fingers and 2) the effect of hand position on sEMG activity distribution. The subjects performed cyclic dynamic tasks involving the wrist and the fingers. The wrist tasks and the hand opening/closing task were performed with the hand in prone and neutral positions. A sensorized glove was used for kinematics recording. sEMG signals were acquired from the forearm muscles using a grid of 112 electrodes integrated into a stretchable textile sleeve. The areas of sEMG activity have been identified by a segmentation technique after a data dimensionality reduction step based on Non Negative Matrix Factorization applied to the EMG envelopes. The results show that 1) it is possible to identify distinct areas of sEMG activity on the forearm for different fingers; 2) hand position influences sEMG activity level and spatial distribution. This work gives new quantitative information about sEMG activity distribution on the forearm in healthy subjects and provides a basis for future works on the identification of optimal electrode configuration for sEMG based control of prostheses, exoskeletons, or orthoses. An example of use of this information for the optimization of the detection system for the estimation of joint kinematics from sEMG is reported. PMID:25289669

  13. Inhibitory action of forearm flexor muscle afferents on corticospinal outputs to antagonist muscles in humans

    PubMed Central

    Bertolasi, Laura; Priori, Alberto; Tinazzi, Michele; Bertasi, Valeria; Rothwell, John C

    1998-01-01

    To find out whether muscle afferents influence the excitability of corticospinal projections to antagonist muscles, we studied sixteen healthy subjects and one patient with a focal brain lesion. Using transcranial magnetic and electrical brain stimulation we tested the excitability of corticomotoneuronal connections to right forearm muscles at rest after conditioning stimulation of the median nerve at the elbow. Somatosensory potentials evoked by median nerve stimulation were also recorded in each subject. Test stimuli delivered at 13–19 ms after median nerve stimulation significantly inhibited EMG responses elicited in forearm extensor muscles by transcranial magnetic stimulation, but did not inhibit responses to electrical stimulation. In contrast, magnetically and electrically elicited responses in forearm flexor muscles were suppressed to the same extent. The higher the intensity of the test shocks, the smaller was the amount of median nerve-elicited inhibition. Inhibition in extensor muscles was also smaller during tonic wrist extension, or if the induced electrical stimulating current in the brain flowed from posterior to anterior over the motor strip rather than vice versa. Test responses evoked by magnetic transcranial stimulation in the first dorsal interosseous and in brachioradialis muscles were not inhibited after median nerve stimulation at the elbow. Stimulation of digital nerves failed to inhibit motor potentials in extensor muscles. Test stimuli delivered at 15 and 17 ms after radial nerve stimulation significantly inhibited EMG responses elicited in forearm flexor muscles by magnetic transcranial stimulation. In the patient with a focal thalamic lesion, who had dystonic postures and an absent N20 component of the somatosensory-evoked potentials but normal strength, median nerve stimulation failed to inhibit magnetically evoked responses in forearm extensor muscles. We propose that activation of median nerve muscle afferents can suppress the

  14. The Association Between Weight Status and Pediatric Forearm Fractures Resulting From Ground-Level Falls.

    PubMed

    Manning Ryan, Leticia; Teach, Stephen J; Searcy, Kimberle; Singer, Steven A; Wood, Rachel; Wright, Joseph L; Hunting, Katherine L; Chamberlain, James M

    2015-12-01

    The purpose of our study was to evaluate the hypothesis that pediatric forearm fractures resulting from ground-level falls are associated with increased weight status (weight for age/sex percentile ≥ 95th) in comparison with those resulting from major trauma. This is a retrospective case-control study nested within a case series of 929 children, ages 0 to 17 years, with self-identified residence in Washington, DC, who were treated for isolated forearm fractures in an urban, academic pediatric emergency department between 2003 and 2006. Multivariable logistic regression was performed to test for the association of weight status with mechanism of injury while controlling for sex, age, race/ethnicity, bone fractured, and season. Of 929 forearm fractures, there were 226 (24.3%) with ground-level falls and 54 (5.8%) with major trauma. Compared with children with forearm fractures resulting from major trauma, ground-level fall cases were significantly older (10.4 [3.4] vs 7.4 [4.2] years, P < 0.05), had greater adjusted odds of having a weight for age/sex of 95th percentile or higher (odds ratio, 2.7; 95% confidence interval, 1.2-6.5), and had significantly more radius-only fractures (odds ratio, 2.3; 95% confidence interval, 1.2-4.7). These groups did not differ in sex, race/ethnicity, or injury season. Ground-level falls are a common mechanism of pediatric forearm fracture and are significantly associated with increased weight status and radius-only fractures. These results suggest the need for further investigation into obesity and bone health in pediatric patients with forearm fractures caused by ground-level falls.

  15. Recovery of nerve injury-induced alexia for Braille using forearm anaesthesia.

    PubMed

    Björkman, Anders; Rosén, Birgitta; Lundborg, Göran

    2008-04-16

    Nerve injuries in the upper extremity may severely affect hand function. Cutaneous forearm anaesthesia has been shown to improve hand sensation in nerve-injured patients. A blind man who lost his Braille reading capability after an axillary plexus injury was treated with temporary cutaneous forearm anaesthesia. After treatment sensory functions of the hand improved and the patient regained his Braille reading capability. The mechanism behind the improvement is likely unmasking of inhibited or silent neurons, but after repeated treatment sessions at increasing intervals the improvement has remained at 1-year follow-up, implying a structural change in the somatosensory cortex.

  16. Carotid-cardiac baroreflex influence on forearm vascular resistance during low level LBNP

    NASA Technical Reports Server (NTRS)

    Ludwig, David

    1990-01-01

    Twelve healthy males were tested at low levels of lower body negative pressure (LBNP) with and without artificial stimulation of the carotid-cardiac baroreceptors. The carotid-cardiac baroreceptors were stimulated by applying a pressure of 10 mmHg to the carotid artery via a pressurized neck chamber. During the procedure, forearm blood flow (FBF) and forearm vascular resistance (FVR) were measured using a Whitney mercury silastic strain gauge technique. FBF decreased while FVR increased with increased intensity of LBNP. Both FBF and FVR were unaffected by carotid-cardiac baroreceptor stimulation.

  17. Kinematic strategies for upper arm-forearm coordination in three dimensions.

    PubMed

    Medendorp, W P; Crawford, J D; Henriques, D Y; Van Gisbergen, J A; Gielen, C C

    2000-11-01

    This study addressed the question of how the three-dimensional (3-D) control strategy for the upper arm depends on what the forearm is doing. Subjects were instructed to point a laser-attached in line with the upper arm-toward various visual targets, such that two-dimensional (2-D) pointing directions of the upper arm were held constant across different tasks. For each such task, subjects maintained one of several static upper arm-forearm configurations, i. e., each with a set elbow angle and forearm orientation. Upper arm, forearm, and eye orientations were measured with the use of 3-D search coils. The results confirmed that Donders' law (a behavioral restriction of 3-D orientation vectors to a 2-D "surface") does not hold across all pointing tasks, i.e., for a given pointing target, upper arm torsion varied widely. However, for any one static elbow configuration, torsional variance was considerably reduced and was independent of previous arm position, resulting in a thin, Donders-like surface of orientation vectors. More importantly, the shape of this surface (which describes upper arm torsion as a function of its 2-D pointing direction) depended on both elbow angle and forearm orientation. For pointing with the arm fully extended or with the elbow flexed in the horizontal plane, a Listing's-law-like strategy was observed, minimizing shoulder rotations to and from center at the cost of position-dependent tilts in the forearm. In contrast, when the arm was bent in the vertical plane, the surface of best fit showed a Fick-like twist that increased continuously as a function of static elbow flexion, thereby reducing position-dependent tilts of the forearm with respect to gravity. In each case, the torsional variance from these surfaces remained constant, suggesting that Donders' law was obeyed equally well for each task condition. Further experiments established that these kinematic rules were independent of gaze direction and eye orientation, suggesting that

  18. Experimental and computational analysis of soft tissue stiffness in forearm using a manual indentation device.

    PubMed

    Iivarinen, Jarkko T; Korhonen, Rami K; Julkunen, Petro; Jurvelin, Jukka S

    2011-12-01

    A hand held stiffness meter can be used to measure indentation stiffness of human soft tissues, sensitively altered, e.g., by pathological tissue swelling. Under indentation load, the relative contribution of each soft tissue component (i.e., skin, adipose tissue and muscle) to the biomechanical response is not known. In the present study, we evaluated the biomechanical role of different soft tissues in relaxed, physically stressed and oedemic human forearm. Soft tissue stiffness of the forearms of nine healthy human subjects was measured under four different test protocols: (1) forearm at rest, (2) forearm under isometric flexor loading, (3) forearm under isometric extensor loading, and (4) forearm under venous occlusion. In (2) and (3) the loading forces were monitored using a dynamometer, and in (4) the soft tissue swelling was induced by venous occlusion using a pressure cuff. At the site of indentation, thickness of different tissue layers (skin, adipose tissue and muscle) was measured using B-mode ultrasound imaging. Layered, hyperelastic finite element (FE) model of the indentation measurement was created and the model response was matched with that of the stiffness meter to determine the elastic modulus for each tissue in the model. Optimized values of the elastic modulus for skin and adipose tissue at rest were 210 kPa and 1.9 kPa, respectively. Further, significance of the variations in stiffness of different tissues on the indentation response was tested. Experimentally, indentation stiffness of the forearm increased during isometric extensor and flexor loads as well as under venous occlusion by 53, 91 and 15%, respectively. The FE model could reproduce the experimental responses primarily by the increased modulus of skin; 112% (446 kPa), 210% (651 kPa) and 21% (254 kPa) under flexor and extensor loading as well as during venous occlusion, respectively. The indentation response was 9-16 times more sensitive to changes in the mechanical properties of skin

  19. [Combined Monteggia and Galeazzi lesions of the forearm : a rare injury].

    PubMed

    Letta, C; Schmied, M; Haller, A; Rindlisbacher, A

    2012-11-01

    Combined forearm fractures are identified according to their location as Galeazzi, Monteggia or Essex-Lopresti injuries. The feature common to these three forms is the combination of a forearm fracture with instability of the distal or proximal radio-ulnar joint. The combination of Galeazzi and Monteggia fractures in the same extremity is an exceedingly rare occurrence. It has been reported in eight cases including two pediatric patients worldwide. In this case report the rare occurrence of the combination of these injuries and the possibility of pitfalls in the operative treatment are presented.

  20. Forearm-finger skin temperature gradient as an index of cutaneous perfusion during steady-state exercise.

    PubMed

    Keramidas, Michail E; Geladas, Nickos D; Mekjavic, Igor B; Kounalakis, Stylianos N

    2013-09-01

    The purpose of this study was to examine whether the forearm-finger skin temperature gradient (T(forearm-finger)), an index of vasomotor tone during resting conditions, can also be used during steady-state exercise. Twelve healthy men performed three cycling trials at an intensity of ~60% of their maximal oxygen uptake for 75 min separated by at least 48 h. During exercise, forearm skin blood flow (BFF ) was measured with a laser-Doppler flowmeter, and finger skin blood flow (PPG) was recorded from the left index fingertip using a pulse plethysmogram. T(forearm-finger) of the left arm was calculated from the values derived by two thermistors placed on the radial side of the forearm and on the tip of the middle finger. During exercise, PPG and BFF increased (P<0.001), and T(forearm-finger) decreased (P<0.001) from their resting values, indicating a peripheral vasodilatation. There was a significant correlation between T(forearm-finger) and both PPG (r = -0.68; P<0.001) and BFF (r = -0.50; P<0.001). It is concluded that T(forearm-finger) is a valid qualitative index of cutaneous vasomotor tone during steady-state exercise.

  1. Titanium elastic nailing in pediatric femoral diaphyseal fractures in the age group of 5–16 years – A short term study

    PubMed Central

    Bhuyan, Basant Kumar; Mohan Singh, Suryansh

    2014-01-01

    Background Management of femoral diaphyseal fracture in the age group of 5–16 years is controversial. The purpose of this study is to demonstrate the effectiveness of intramedullary fixation of femoral shaft fractures by using titanium elastic nailing system (TENS). Materials and methods Between April 2011 and April 2014, 40 pediatric patients (31 boys, 9 girls) aged 5–16 years with diaphyseal femoral fractures were treated by retrograde TENS fixation. Fractures were classified according to system of Winquest and Hansen as Grade-I (n = 18), Grade-II (n = 10), Grade-III (n = 7) and compound fractures according to the Gustilo and Anderson's classification Grade-I (n = 3), Grade-II (n = 2). The final results were evaluated by using Flynn's criteria. Results The mean duration of follow-up was 21 months (range 3–39 months). All fractures were radiologically united with grade 3 callus formation at 8–10 weeks period (mean 9 weeks) and full weight bearing was possible in a mean time of 9.5 weeks. According to Flynn's criteria, excellent result was found in 33 patients (82.5%) and satisfactory in 7 patients (17.5%). Limb lengthening was noticed in 6 cases, varus mal-alignment was in 4 cases and rotational mal-alignment was seen in 3 cases. Peri-operative difficulties encountered were failure of closed reduction in 4 cases and cork screwing of nails in 2 cases. Conclusion TENS is a safe and effective method for the treatment of pediatric femoral shaft fractures, because it is minimally invasive, relatively easy to use and shows very good functional and cosmetic results. PMID:25983499

  2. Nonoperatively treated forearm shaft fractures in children show good long-term recovery

    PubMed Central

    Sinikumpu, Juha-Jaakko; Victorzon, Sarita; Antila, Eeva; Pokka, Tytti; Serlo, Willy

    2014-01-01

    Background and purpose — The incidence of forearm shaft fractures in children has increased and operative treatment has increased compared with nonoperative treatment in recent years. We analyzed the long-term results of nonoperative treatment. Patients and methods — We performed a population-based age- and sex-matched case-control study in Vaasa Central Hospital, concerning fractures treated in the period 1995–1999. There were 47 nonoperatively treated both-bone forearm shaft fractures, and the patients all participated in the study. 1 healthy control per case was randomly selected and evaluated for comparison. We analyzed clinical and radiographic outcomes of all fractures at a mean of 11 (9–14) years after the trauma. Results — The main outcome, pronosupination of the forearm, was not decreased in the long term. Grip strength was also equally as good as in the controls. Wrist mobility was similar in flexion (85°) and extension (83°) compared to the contralateral side. The patients were satisfied with the outcome, and pain-free. Radiographally, 4 cases had radio-carpal joint degeneration and 4 had a local bone deformity. Interpretation — The long-term outcome of nonoperatively treated both-bone forearm shaft fractures in children was excellent. PMID:25238437

  3. Design of a Model of Forearm Bone Fractures for Educational Purposes

    ERIC Educational Resources Information Center

    Jastaniah, Saddig; Hamdan, Abdulrahman; Alhadrami, Abdullah; Almatrafi, Talal; Arif, Ahmed; Almalki, Hassan

    2016-01-01

    This work explores a new approach to demonstrate possible forearm fractures in humans as an educating means for student radiographers. The Design of abnormal bones are not normally available as phantoms; the manufacturer usually produces normal human musculoskeletal models for educational purposes. Hence fractures and abnormalities are usually…

  4. Duration of Venodilation for Peripheral Intravenous Cannulation, as Induced by a Thermal Stimulus on the Forearm.

    PubMed

    Tokizawa, Yuki; Tsujimoto, Tomomi; Inoue, Tomoko

    2017-03-01

    Application of a thermal stimulus is a common procedure used to promote venodilation for peripheral intravenous cannulation (PIVC); however, the effects of thermal stimulation on the duration of venodilation and skin temperature of the forearm are unclear. To investigate the duration of venodilation induced by a thermal stimulus on the forearm. Healthy female adults ( N = 40) from Japan participated in this study from November to December 2013. A heat pack was warmed to 40°C ± 2°C and placed over the forearm for 15 min. Vein diameter was measured via ultrasound and skin temperature via temperature sensor at six time points: before application of the thermal stimulus and at 1-min intervals for 5 min upon removal of the thermal stimulus. The main outcomes were vein diameter, proportional change in vein diameter, and skin temperature. We calculated proportional change in vein diameter after application of the thermal stimulus using vein diameter before the thermal stimulus to represent 100%. Compared with vein diameter before thermal stimulus, the diameter at each time point after thermal stimulus was significantly increased ( p < .05) as were proportional change in vein diameter ( p < .05) and skin temperature. A thermal stimulus of 40°C ± 2°C on the forearm dilated veins significantly for PIVC, and the effect persisted for at least 5 min.

  5. Stress fractures of forearm bones in military recruits of rifle drill training.

    PubMed

    Kuo, Chun-Lin; Pan, Ru-Yu; Wu, Jia-Lin; Huang, Wen-Sheng; Wang, Shyu-Jye

    2009-10-01

    Stress fractures rarely occur in the forearms. These injuries usually occur in healthy young patients, which are usually neglected by patients or physicians. Early diagnosis and treatment are important to avoid late complications of these fractures. The purpose of this study was to analyze a case series of military recruits who participated in rifle drill training and presented with forearm stress fractures at our institution. We evaluated 216 military recruits of rifle drill training. Twelve patients were diagnosed with forearm stress fractures by typical history, physical examination, laboratory studies, serial radiographs, and bone scan examinations. Eighteen fractures were found in 12 patients. On initial radiographs, 11 had periosteal reactions, 4 had callus formation with complete fracture lines, and 3 were normal. All 18 fractures had increase radioactivity in the involved middle (15 of 18) or distal (2 of 18) ulnae and one middle radius (1 of 18). Stress fractures of the forearms in military rifle drill training usually occur in middle ulnae. Fifty percent of them were bilateral fractures. A high index of suspicion is the key to diagnosis. Early diagnosis with conservative treatment can achieve satisfactory results and avoid late complications of stress fractures.

  6. Local L-NG-monomethyl-arginine attenuates the vasodilator action of bradykinin in the human forearm.

    PubMed Central

    O'Kane, K P; Webb, D J; Collier, J G; Vallance, P J

    1994-01-01

    1. Studies in animals indicate that bradykinin relaxes blood vessels directly through an action on smooth muscle and indirectly through the release of endothelium-derived mediators. Its precise mechanism of action in the human arterial circulation is not yet known. 2. In this study the effects of a specific inhibitor of nitric oxide synthase, L-NG-monomethyl-arginine (L-NMMA) and noradrenaline on the vasodilator responses to bradykinin were examined in the forearm arterial bed of healthy volunteers. Noradrenaline was used as a control for vasoconstriction by L-NMMA; glyceryl trinitrate (GTN) as a control vasodilator acting independently of the NO synthase enzyme. 3. L-NMMA (4 mumol min-1; 5 min) alone reduced resting forearm blood flow by 44% (P < 0.01; n = 6) confirming that nitric oxide plays an important role in regulating vascular tone. 4. Bradykinin (10 and 100 pmol min-1; 3 min each dose) and GTN (2 and 5 nmol min-1; 3 min each dose) increased forearm blood flow in a dose-dependent manner (percentage changes 171 +/- 17% and 398 +/- 35%, and 176 +/- 21% and 268 +/- 42%, respectively; n = 6). 5. The response to bradykinin, but not that to GTN, was attenuated by L-NMMA compared with noradrenaline (P < 0.05; n = 6), suggesting that bradykinin-induced vasodilatation in the forearm is mediated, at least in part, by stimulating release of nitric oxide. PMID:7833219

  7. Effects of forearm bier block with bretylium on the hemodynamic and metabolic responses to handgrip

    NASA Technical Reports Server (NTRS)

    Lee, F.; Shoemaker, J. K.; McQuillan, P. M.; Kunselman, A. R.; Smith, M. B.; Yang, Q. X.; Smith, H.; Gray, K.; Sinoway, L. I.

    2000-01-01

    We tested the hypothesis that a reduction in sympathetic tone to exercising forearm muscle would increase blood flow, reduce muscle acidosis, and attenuate reflex responses. Subjects performed a progressive, four-stage rhythmic handgrip protocol before and after forearm bier block with bretylium as forearm blood flow (Doppler) and metabolic (venous effluent metabolite concentration and (31)P-NMR indexes) and autonomic reflex responses (heart rate, blood pressure, and sympathetic nerve traffic) were measured. Bretylium inhibits the release of norepinephrine at the neurovascular junction. Bier block increased blood flow as well as oxygen consumption in the exercising forearm (P < 0.03 and P < 0.02, respectively). However, despite this increase in flow, venous K(+) release and H(+) release were both increased during exercise (P < 0.002 for both indexes). Additionally, minimal muscle pH measured during the first minute of recovery with NMR was lower after bier block (6.41 +/- 0.08 vs. 6.20 +/- 0.06; P < 0.036, simple effects). Meanwhile, reflex effects were unaffected by the bretylium bier block. The results support the conclusion that sympathetic stimulation to muscle during exercise not only limits muscle blood flow but also appears to limit anaerobiosis and H(+) release, presumably through a preferential recruitment of oxidative fibers.

  8. The Effect of Movement Imagery Training on Learning Forearm Pass in Volleyball

    ERIC Educational Resources Information Center

    Ay, Khitam Mousa; Halaweh, Rami Saleh; Al-Taieb, Mohammad Abu

    2013-01-01

    This study investigates the effect of movement imagery on learning the forearm pass in volleyball. Twenty four mail students from Physical Education Factuly at Jordan University (19 ± 0.5) years of age. After Completed the Movement Imagery Questionnaire-Revised (MIQ-R; Hall & Martin, 1997) the subjects randomly divided into two groups,…

  9. An EMG-CT method using multiple surface electrodes in the forearm.

    PubMed

    Nakajima, Yasuhiro; Keeratihattayakorn, Saran; Yoshinari, Satoshi; Tadano, Shigeru

    2014-12-01

    Electromyography computed tomography (EMG-CT) method is proposed for visualizing the individual muscle activities in the human forearm. An EMG conduction model was formulated for reverse-estimation of muscle activities using EMG signals obtained with multi surface electrodes. The optimization process was calculated using sequential quadratic programming by comparing the estimated EMG values from the model with the measured values. The individual muscle activities in the deep region were estimated and used to produce an EMG tomographic image. For validation of the method, isometric contractions of finger muscles were examined for three subjects, applying a flexion load (4.9, 7.4 and 9.8 N) to the proximal interphalangeal joint of the middle finger. EMG signals in the forearm were recorded during the tasks using multiple surface electrodes, which were bound around the subject's forearm. The EMG-CT method illustrates the distribution of muscle activities within the forearm. The change in amplitude and area of activated muscles can be observed. The normalized muscle activities of all three subjects appear to increase monotonically with increases in the load. Kinesiologically, this method was able to estimate individual muscle activation values and could provide a novel tool for studying hand function and development of an examination for evaluating rehabilitation.

  10. A Magnetoencephalographic Study of Sensorimotor Activity Differences during Unilateral and Bilateral Forearm Movements

    ERIC Educational Resources Information Center

    Nakagawa, Kei

    2010-01-01

    This study compared activation of the sensorimotor area using magnetoencephalography after unilateral and bilateral movements. Thirteen healthy individuals and a patient with mild hemiplegia performed unilateral and bilateral forearm pronation movements. Among healthy participants, there were no significant differences in motor-evoked field during…

  11. Evaluation of Muscle Activities in Human Forearms under Exercises by Diffuse Optical Tomography

    NASA Astrophysics Data System (ADS)

    Tanikawa, Yukari; Gao, Feng; Miyakawa, Michio; Kiryu, Toru; Kizuka, Tomohiro; Endo, Yasuomi; Okawa, Shinpei; Yamada, Yukio

    During the forearm exercise, it is generally understood that the inner muscles work for the task, and the outer muscles work to fix the joints for the efficient work of the inner muscles. For evaluation of the exercise, quantitative measurement of inner muscle activities is necessary. Electromyograph (EMG) and oxygen monitoring using continuous-wave near-infrared spectroscopy (CW-NIRS) have been used for the evaluation because both of them are the modalities of safe, portable and noninvasive measurements of muscle activities. However, these modalities can show the qualitative changes in the muscle activities in the vicinity of the skin surface. Time-resolved diffuse optical tomography (TR-DOT) can quantitatively provide tomographic images of the changes in the oxygenation state of the whole muscles. In vivo experiments of TR-DOT were performed for human forearms under handgrip exercises, and DOT images of the changes in the oxygenation state of the forearms were reconstructed using the algorithm based on the modified generalized pulsed spectrum technique. The DOT images are compared with the MR-images, and it is shown that the activities of the inner muscles of the forearms were active during the handgrip excises.

  12. The Effect of Movement Imagery Training on Learning Forearm Pass in Volleyball

    ERIC Educational Resources Information Center

    Ay, Khitam Mousa; Halaweh, Rami Saleh; Al-Taieb, Mohammad Abu

    2013-01-01

    This study investigates the effect of movement imagery on learning the forearm pass in volleyball. Twenty four mail students from Physical Education Factuly at Jordan University (19 ± 0.5) years of age. After Completed the Movement Imagery Questionnaire-Revised (MIQ-R; Hall & Martin, 1997) the subjects randomly divided into two groups,…

  13. Effects of forearm bier block with bretylium on the hemodynamic and metabolic responses to handgrip

    NASA Technical Reports Server (NTRS)

    Lee, F.; Shoemaker, J. K.; McQuillan, P. M.; Kunselman, A. R.; Smith, M. B.; Yang, Q. X.; Smith, H.; Gray, K.; Sinoway, L. I.

    2000-01-01

    We tested the hypothesis that a reduction in sympathetic tone to exercising forearm muscle would increase blood flow, reduce muscle acidosis, and attenuate reflex responses. Subjects performed a progressive, four-stage rhythmic handgrip protocol before and after forearm bier block with bretylium as forearm blood flow (Doppler) and metabolic (venous effluent metabolite concentration and (31)P-NMR indexes) and autonomic reflex responses (heart rate, blood pressure, and sympathetic nerve traffic) were measured. Bretylium inhibits the release of norepinephrine at the neurovascular junction. Bier block increased blood flow as well as oxygen consumption in the exercising forearm (P < 0.03 and P < 0.02, respectively). However, despite this increase in flow, venous K(+) release and H(+) release were both increased during exercise (P < 0.002 for both indexes). Additionally, minimal muscle pH measured during the first minute of recovery with NMR was lower after bier block (6.41 +/- 0.08 vs. 6.20 +/- 0.06; P < 0.036, simple effects). Meanwhile, reflex effects were unaffected by the bretylium bier block. The results support the conclusion that sympathetic stimulation to muscle during exercise not only limits muscle blood flow but also appears to limit anaerobiosis and H(+) release, presumably through a preferential recruitment of oxidative fibers.

  14. Radial Forearm Osteocutaneous Free Flap for Reconstruction of Hard Palate With Alveolar Defect.

    PubMed

    Jeong, Euicheol C; Yoon, Sehoon; Jung, Young Ho

    2017-07-01

    The radial forearm free flap is beneficial for reconstruction of large palatal defect with oronasal fistula.A 51-year-old male patient who had anterior palate defect including alveolus after the radiation therapy of malignant cancer on the nasopharyngeal area undertook the radial forearm osteocutaneous free flap to close the oronasal fisula and restore the alveolar arch. The small radial bone segment was fixed in the alveolar defect and vascular anastomoses were performed with facial vessels in neck. The donor site was closed with split thickness skin graft. All suture wounds in the oral and nasal side had healed primarily with no complication within 1 month. The patient was able to swallow soluble foods in the 3 weeks postoperatively without the leakage phenomena in the nose and decreased hypernasality nature in his speech. Grafted bone union at alveolus was confirmed by follow-up computed tomography scan. There was no complication at left forearm donor site with intact musculoskeletal function.Radial forearm osteocutaneous free flap is a versatile option for its capability of reconstruction in complicated defect of soft and hard plate with alveolar defect.

  15. Hand motion recognition based on forearm deformation measured with a distance sensor array.

    PubMed

    Sung-Gwi Cho; Yoshikawa, Masahiro; Baba, Kohei; Ogawa, Kazunori; Takamatsu, Jun; Ogasawara, Tsukasa

    2016-08-01

    Studies of upper limb motion analysis using surface electromyogram (sEMG) signals measured from the forearm plays an important role in various applications, such as human interfaces for controlling robotic exoskeletons, prosthetic hands, and evaluation of body functions. Though the sEMG signals have a lot of information about the activities of the muscles, the signals do not have the activities of the deep layer muscles. We focused on forearm deformation, since hand motion brings the muscles, tendons, and skeletons under the skin. The reason why we focus is that we believe the forearm deformation delivers information about the activities of deep layer muscles. In this paper, we propose a hand motion recognition method based on the forearm deformation measured with a distance sensor array. The method uses the support vector machine. Our method achieved a mean accuracy of 92.6% for seven hand motions. Because the accuracy of the pronation and the supination are high, the distance sensor array has the potential to estimate the activities of deep layer muscles.

  16. Intra- and Intersession Reliability of Surface Electromyography on Muscles Actuating the Forearm During Maximum Voluntary Contractions.

    PubMed

    Gaudet, Guillaume; Raison, Maxime; Maso, Fabien Dal; Achiche, Sofiane; Begon, Mickael

    2016-12-01

    The aim of this study is to determine the intra- and intersession reliability of nonnormalized surface electromyography (sEMG) on the muscles actuating the forearm during maximum voluntary isometric contractions (MVIC). A subobjective of this study is to determine the intra- and intersession reliability of forearm MVIC force or torque, which is a prerequisite to assess sEMG reliability. Eighteen healthy adults participated at 4 different times: baseline, 1-h post, 6-h post, and 24-h post. They performed 3 MVIC trials of forearm flexion, extension, pronation, and supination. sEMG of the biceps brachii short head, brachialis, brachioradialis, triceps brachii long head, pronator teres, and pronator quadratus were measured. The intraclass correlation coefficient (ICC) on MVIC ranged from 0.36 to 0.99. Reliability was excellent for flexion, extension, and supination MVIC for both intra- and intersession. The ICC on sEMG ranged from 0.58 to 0.99. sEMG reliability was excellent for brachialis, brachioradialis, and pronator quadratus, and good to excellent for triceps brachii, biceps brachii, and pronator teres. This study shows that performing 3 MVICs is sufficient to obtain highly reliable maximal sEMG over 24 h for the main muscles actuating the forearm. These results confirm the potential of sEMG for muscle motor functional monitoring.

  17. A Magnetoencephalographic Study of Sensorimotor Activity Differences during Unilateral and Bilateral Forearm Movements

    ERIC Educational Resources Information Center

    Nakagawa, Kei

    2010-01-01

    This study compared activation of the sensorimotor area using magnetoencephalography after unilateral and bilateral movements. Thirteen healthy individuals and a patient with mild hemiplegia performed unilateral and bilateral forearm pronation movements. Among healthy participants, there were no significant differences in motor-evoked field during…

  18. Surgeon experience affects outcome of forearm arteriovenous fistulae more than outcomes of upper-arm fistulae.

    PubMed

    Regus, Susanne; Almási-Sperling, Veronika; Rother, Ulrich; Meyer, Alexander; Lang, Werner

    2017-03-21

    There is still an ongoing discussion about the influence of vascular surgeon experience on the immediate and long-term outcome of newly created arteriovenous fistula (AVF) for patients on hemodialysis (HD). The aim of this study was to compare failure and patency rates of AVF between experienced consultants and resident trainees with special focus on location of the anastomosis on the forearm or upper arm. Between November 2012 and September 2016, 159 patients (83 on HD and 76 preemptive) received an AVF (90 radiocephalic [RCAVF] on the forearm; 69 brachiocephalic [BCAVF] in the elbow) by two experienced vascular surgeons (group A; n = 74) or five residents in training with one-to-four years of experience (group B; n = 85). We compared the two groups for demographic and treatment data, immediate failures (IF), bleeding complications and patency rates. There were no significant differences in demographic data between the two groups. Vessel diameters were significantly lower for forearm compared to upper arm arteries (p = 0.026) and veins (p = 0.05). There was a significantly increased risk for IF in group B for RCAVF (p = 0.003), but not for BCAVF (p = 1.000). Furthermore, the cumulative primary patency was reduced in group B for RCAVF (p<0.001), but not for BCAVF (p = 0.899). Surgeon experience seems to have more influence on the immediate and long-term outcome of newly created forearm AVF compared to those located on the upper arm.

  19. [Vascular supply of the free fasciocutaneous forearm flap--an anatomical study].

    PubMed

    Trümper, K; Löwicke, G; Raschke, N

    1987-01-01

    The vascular supply of the forearm skin--especially of the ventral antebrachial region--was investigated by means of selective angiographies and intravascular dye injections in 43 upper extremities of corpses. Besides the definition of the interesting supply regions assertions were made about the kind and the character of the angioarchitecture as well as recommendations for the flap planning and other clinical references.

  20. Evaluation of wrist and forearm motion in college-aged baseball pitchers.

    PubMed

    Solomito, Matthew J; Garibay, Erin J; Woods, Jessica R; Ounpuu, Sylvia; Nissen, Carl W

    2014-11-01

    Current pitching literature focuses primarily on the elbow and glenohumeral joints. This has led to a paucity of information regarding the forearm and wrist, and the limited data available are inconsistent. Therefore, this article seeks to provide a comprehensive description of the kinematics and kinetics of the wrist and forearm for the fastball, curveball, slider/cutter, and change-up for college-level baseball pitchers. Thirty-six collegiate pitchers were evaluated using motion analysis techniques. Results indicated that pitching the curveball generated the greatest forearm supination (16 ± 13°) compared with the other three pitch types (p < 0.05). The curveball and slider/cutter were pitched with less wrist extension and greater ulnar deviation compared with the fastball and change-up. The curveball was found to produce the greatest ulnar moment (7.3 ± 2.2 Nm) and was significantly different from the moments noted when pitching the fastball and change-up (5.1 ± 1.9 and 4.9 ± 1.9 Nm, respectively; p < 0.05). These results indicate that it may be possible to objectively determine pitch type from kinematic data of the wrist and forearm. It may also be possible that coaches may be able to identify abnormal pitching mechanics from more proximal segments by understanding the motion of the wrist.

  1. The effect of swimmer's hand/forearm acceleration on propulsive forces generation using computational fluid dynamics.

    PubMed

    Rouboa, Abel; Silva, António; Leal, Luís; Rocha, Jorge; Alves, Francisco

    2006-01-01

    Propulsive forces generated by swimmers hand/forearm, have been studied through experimental tests. However, there are serious doubts as to whether forces quantified in this way are accurate enough to be meaningful. In order to solve some experimental problems, some numerical techniques have been proposed using Computational Fluid Dynamics (CFD). The main purpose of the present work was threefold. First, disseminate the use of CFD as a new tool in swimming research. Second, apply the CFD method in the calculation of drag and lift coefficients resulting from the numerical resolution equations of the flow around the swimmers hand/forearm using the steady flow conditions. Third, evaluate the effect of hand/forearm acceleration on drag and lift coefficients. For these purposes three, two-dimensional (2D), models of a right male hand/forearm were studied. A frontal model (theta = 90 degrees, Phi = 90 degrees) and two lateral models, one with the thumb as leading edge (theta = 0 degrees, = 90 degrees), and the other with the small finger as the leading edge (theta = 0 degrees, Phi = 180 degrees). The governing system of equations considered was the incompressible Reynolds averaged Navier-Stokes equations with the standard k-epsilon model. The main results reported that, under the steady-state flow condition, the drag coefficient was the one that contributes more for propulsion, and was almost constant for the whole range of velocities, with a maximum value of 1.16 (Cd = 1.16). This is valid when the orientation of the hand/forearm is plane and the model is perpendicular to the direction of the flow. Under the hand /forearm acceleration condition, the measured values for propulsive forces calculation were approximately 22.5% (54.440 N) higher than the forces produced under the steady flow condition (44.428 N). By the results, pointed out, we can conclude that: (i) CFD can be considered an interesting new approach for hydrodynamic forces calculation on swimming, (ii) the

  2. Electromyographic assessment of forearm muscle function in tennis players with and without Lateral Epicondylitis.

    PubMed

    Alizadehkhaiyat, Omid; Frostick, Simon P

    2015-12-01

    There is no consensus about the main aetiology of Lateral Epicondylitis (LE) or Tennis Elbow. While electromyographic assessment of alterations in neuromuscular control and activation patterns of forearm muscles has received increasing interest as potential intrinsic factors in non-tennis players, there has been insufficient attention in tennis players. The purpose of present review was to search the literature for the electromyographic studies of forearm muscles in tennis players in order to (1) identify related implications for LE, (2) highlight key technical and methodological shortcomings, and (3) suggest potential pathways for future research. An electronic search of PubMed, Scopus, Web of Science, and Google Scholars (1980 to October 2014) was conducted. Titles, abstracts, and full-text articles were screened to identify "peer-reviewed" studies specifically looking into "electromyographic assessment of forearm muscles" in "tennis players". After screening 104 articles, 13 original articles were considered in the main review involving a total of 216 participants (78% male, 22% female). There were indications of increased wrist extensor activity in all tennis strokes and less experienced single-handed players, however with insufficient evidence to support their relationship with the development of LE. Studies varied widely in study population, sample size, gender, level of tennis skills, electrode type, forearm muscles studied, EMG recording protocol, EMG normalisation method, and reported parameters. As a result, it was not possible to present combined results of existing studies and draw concrete conclusions in terms of clinical implications of findings. There is a need for establishment of specific guidelines and recommendations for EMG assessment of forearm musculature particularly in terms of electrode and muscle selection. Further studies of both healthy controls and tennis players suffering from LE with adequate sample sizes and well-defined demographics

  3. Bier block regional anesthesia and casting for forearm fractures: safety in the pediatric emergency department setting.

    PubMed

    Aarons, Chad E; Fernandez, Meagan D; Willsey, Matt; Peterson, Bret; Key, Charles; Fabregas, Jorge

    2014-01-01

    Bier block regional anesthesia was first described in 1908; however, it is uncommonly used for fears of cardiac and neurological complications. Although recent studies have documented safe usage in an adult population, no study to date has investigated its use in a pediatric setting. In addition, most emergency departments feel that splint placement is safer than casting after acute forearm fracture reduction in the pediatric population. However, to our knowledge there is no such study that documents the complication rates associated with immediate casting. The goal of this study was to assess the safety and efficacy of Bier block regional anesthesia and immediate cast application after closed reduction of pediatric forearm fractures. A retrospective review was conducted of patients treated for forearm fractures in a 2-year period at a major metropolitan pediatric hospital. Rates of complications and length and costs of the 2 procedures were analyzed. A total of 600 patients were treated with Bier block regional anesthesia and 645 were treated with conscious sedation for displaced fractures of the forearm in the 2-year study period. No complications requiring admission were seen in either group. No patient experienced compartment syndrome or a need for readmission secondary to cast application. 2.2% and 4.3% (P=0.0382) of patients in the Bier block and sedation groups, respectively, needed their cast bivalved secondary to swelling. The average time from initiation of procedural sedation to discharge was 1 hour and 42 minutes, whereas the time to discharge from initiation of Bier block regional anesthesia was 47 minutes (P<0.0001). The average cost for a patient treated with procedural sedation was $6313, whereas the average cost for the Bier block regional anesthesia group was $4956. Bier block regional anesthesia is a safe, efficient, and cost-effective method of reducing pediatric forearm fractures. Immediate cast application can be used without fear of major

  4. Reverse Adipofascial Radial Forearm Flap Surgery for Soft-Tissue Reconstruction of Hand Defects

    PubMed Central

    Karamese, Mehtap; NebilSelimoglu, Muhammed; Akatekin, Ahmet; Abacı, Malik; Sutcu, Mustafa; Tosun, Zekeriya

    2016-01-01

    Objective: The reverse radial forearm flap has been used for soft-tissue hand defect surgical procedures worldwide. One of the major drawbacks of this flap, however, is donor site morbidity, as the donor site is closed with a skin graft. Problems with skin graft donor areas include adhesion, contracture, and wound-healing complications. In this study, only the adipofascial component of a reverse radial forearm flap was used to prevent these problems; in addition, a skin graft was applied over the flap instead of over the donor site. Methods: Between January 2011 and December 2013, a total of 13 hand defects were reconstructed with a reverse adipofascial radial forearm flap. Patients were evaluated for functional results using total active motion criteria and disability of the arm, shoulder, and hand scores, operation time, hospitalization time, and patient satisfaction. Results: All flaps and grafts placed on flaps survived completely and donor sites healed without complications. The total active motion criteria and the disability of the arm, shoulder, and hand score demonstrated that the functional outcomes were successful. Patient satisfaction scores using the visual analog scale had a mean of 88.3 (SD = 2.95) mm. Operation time for the flap surgery was 126.1 (SD = 21.80) minutes, and patients were discharged at an average of 6.3 (SD = 1.44) days. Conclusion: Use of an adipofascial component in reverse radial forearm flap surgery is appropriate for reducing problems with donor site skin grafts. Patients' functional outcomes denoted that the reverse adipofascial radial forearm flap is a reliable and effective method to cover soft-tissue defects of the hand. Level of Evidence: IV PMID:28090241

  5. Measurement of Distal Ulnar Hounsfield Units Accurately Predicts Bone Mineral Density of the Forearm.

    PubMed

    Wagner, Scott C; Dworak, Theodora C; Grimm, Patrick D; Balazs, George C; Tintle, Scott M

    2017-04-19

    Hounsfield unit (HU) measurement obtained from computed tomography (CT) scans of the wrist is a potential new screening method for low bone mineral density (BMD). We hypothesized that HU measurements of the ulnar head obtained from CT scans would correlate with BMD assessed with dual x-ray absorptiometry (DXA) scans of the forearm. Patients with both upper-extremity CT and DXA scans performed at a single institution were included in the study. Hounsfield units were manually measured in the distal part of the ulna by 1 author blinded to the DXA results. Average values were then compared with forearm BMD values as determined with a DXA scan. Seventy-seven CT scans of 74 patients were included. Average HU values were significantly lower in the osteoporotic and osteopenic groups in comparison with the normal BMD group. The upper limit of the 95% confidence interval for osteopenic patients was 145.9 HU. The average forearm T-score for patients with an HU value at or below the cutoff of 146 was significantly lower than the average T-score for those with an HU value of >146 HU (p < 0.0001). Sensitivity and negative predictive value for low BMD using this cutoff value were calculated to be 91% and 89%, respectively. Distal ulnar HU measurements accurately reflect the BMD of the forearm as diagnosed with a DXA scan. Our results suggest that distal ulnar HU measurements of ≤146 HU are strongly associated with low BMD and that values above this cutoff accurately rule out low forearm BMD with a high degree of sensitivity and negative predictive value. Utilizing this technique may improve the capture of at-risk patients and streamline the screening process for osteoporosis. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  6. Acute forearm compartment syndrome following haemodialysis access fistula puncture in uraemia.

    PubMed

    Lin, Chin-Ta; Dai, Niann-Tzyy; Chen, Shyi-Gen; Chang, Shun-Cheng

    2016-10-01

    Acute compartment syndrome is a well-described surgical emergency that requires immediate diagnosis and operative intervention. Vascular access-associated compartment syndrome is rarely reported in haemodialysis patients. The purpose of this article is to document evidence that catheter-related puncture, which results in arteriovenous fistula injury in uraemia, may cause acute forearm compartment syndrome. Between September 2007 and September 2012, five consecutive patients presented to our section with tense swollen forearms with skin blistering, decreased hand sensation and reduced capillary return in the fingers. Their ages ranged from 65 to 81 years (mean 72.8 years). All of the patients underwent emergent exploration after the diagnosis of acute forearm compartment syndrome. The patients' details were reviewed. The time interval between dialysis completion and return to the emergency department ranged from 6 to 9 h (mean 7.4 h). During operation, the bleeding was found to originate from the site of the fistula puncture and was repaired with 9-0 nylon suture under microscopy. After adequate wound care, a reconstructive procedure with a split-thickness skin graft was performed in all of the five patients. There was no vascular or neurological deficit of the forearm or hand within the mean follow-up period of 14.8 months (range 12-18 months). In this series, we report five cases of forearm compartment syndrome in uraemia, secondary to bleeding from a catheter-related puncture of a haemodialysis access fistula. However, there is no case series that focuses upon this specific topic in the present literature. This problem deserves more attention. © 2014 Royal Australasian College of Surgeons.

  7. Augmented sympathetic vasoconstriction in exercising forearms of postmenopausal women is reversed by oestrogen therapy.

    PubMed

    Fadel, Paul J; Wang, Zhongyun; Watanabe, Hitoshi; Arbique, Debbie; Vongpatanasin, Wanpen; Thomas, Gail D

    2004-12-15

    Sympathetic vasoconstriction is normally attenuated in exercising muscles of young men and women. Recent evidence indicates that such modulation, termed functional sympatholysis, may be impaired in older men. Whether a similar impairment occurs in older women, and what role oestrogen deficiency might play in this impairment, are not known. Based on the strong positive correlation between circulating oestrogen levels and functional sympatholysis previously reported in female rats, we hypothesized that sympatholysis would be impaired in oestrogen-deficient postmenopausal women, and that this impairment would be reversed by oestrogen replacement. To test these hypotheses, we measured vasoconstrictor responses in the forearms of pre- and postmenopausal women using near infrared spectroscopy to detect decreases in muscle oxygenation in response to reflex activation of sympathetic nerves evoked by lower body negative pressure (LBNP). In eight premenopausal women, LBNP decreased muscle oxygenation by 20 +/- 1% in resting forearm, but only by 3 +/- 2% in exercising forearm (P < 0.05). In contrast, in eight postmenopausal women, LBNP decreased muscle oxygenation by 15 +/- 3% in resting forearm, and by 12 +/- 4% in exercising forearm (P > 0.05). After 1 month of transdermal oestradiol replacement in these women, the normal effect of exercise to blunt sympathetic vasoconstriction was restored (rest, -19 +/- 3%; exercise, -2 +/- 3%; P < 0.05). These data indicate that functional sympatholysis is impaired in oestrogen-deficient postmenopausal women. The effect of short-term unopposed oestrogen replacement to correct this impairment implicates a role for oestrogen in the sympathetic neural control of muscle haemodynamics during exercise.

  8. Associations between Handgrip Strength and Ultrasound-Measured Muscle Thickness of the Hand and Forearm in Young Men and Women.

    PubMed

    Abe, Takashi; Counts, Brittany R; Barnett, Brian E; Dankel, Scott J; Lee, Kofan; Loenneke, Jeremy P

    2015-08-01

    It is unknown whether muscle size of intrinsic hand muscles is associated with handgrip strength. To investigate the relationships between handgrip strength and flexor muscle size of the hand and forearm, muscle thickness (MT) of 86 young adults (43 men and 43 women) between the ages of 18 and 34 y was measured by ultrasound. Two MTs (forearm radius and forearm ulna MT) in the anterior forearm, two MTs (lumbrical and dorsal interosseous MT) in the anterior hand and handgrip strength were measured on the right side. Linear regression with part (also referred to as semipartial) correlation coefficients revealed that forearm ulna MT positively correlated with handgrip strength in both men (part = 0.379, p = 0.001) and women (part = 0.268, p = 0.002). Dorsal interosseous MT correlated with handgrip strength in women only (part = 0.289, p = 0.001). Our results suggest that the forearm ulna and dorsal interosseous MTs for women and forearm ulna MTs for men are factors contributing to prediction of handgrip strength in young adults. Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  9. Correlation between dorsovolar translation and rotation of the radius on the distal radioulnar joint during supination and pronation of forearm.

    PubMed

    Lee, Sang Ki; Song, Young Dong; Choy, Won Sik

    2015-09-01

    This study aimed to describe the patterns of movements about radius and ulna in individual degrees of forearm rotation. And, we also determined the effect of forearm rotation on translation and rotation of the radius with reference to the ulna, and to measure the relationship between forearm rotation, translation and rotation of the radius. Computed tomography of multiple, individual forearm positions, from 90° pronation to 90° supination, was conducted in 26 healthy volunteers (mean age, 43.9 years) to measure dorsovolar translation and rotation of the radius in the DRUJ in each forearm position. The mean dorsovolar translations were within 1.99 mm at 90° pronation to -2.03 mm at 90° supination. The rotations of the radius were 71.20° at 90° pronation and -46.63° at 90° supination. There were strong correlations between degrees of forearm rotation and dorsovolar translation (r=0.861, p<0.001) and rotation of the radius (r=0.960, p<0.001), suggesting that the DRUJ, carpal joints, and rotatory laxity of the carpal ligament, especially in supination, contribute to forearm supination and pronation. These findings provide an understanding of wrist kinematics, are may be useful in reconstructive wrist surgery to achieve normal range of motion, and are may be helpful for the design of DRUJ reconstruction using prostheses.

  10. The contribution of sensory nerves to cutaneous vasodilatation of the forearm and leg to local skin heating.

    PubMed

    Hodges, Gary J; Del Pozzi, Andrew T; McGarr, Gregory W; Mallette, Matthew M; Cheung, Stephen S

    2015-10-01

    The initial cutaneous vasodilatory response to local skin heating is larger in the forearm than the leg. While the initial vasodilatation of the forearm to local heating is primarily dependent on sensory nerves, their role in the leg is unknown. We compared the contribution of sensory nerves in driving the cutaneous vasodilatory response of the forearm and leg to local heating using local anaesthetic (EMLA) cream. In seven participants, two skin sites were selected on both the dorsal forearm and anterolateral calf; one site on each region received EMLA, with the other an untreated control. All sites were controlled at 33 °C and then locally heated to 42 °C with integrated laser-Doppler local heating probes. Cutaneous vascular conductance (CVC) during the initial vasodilatation to local heating was smaller in the leg (47 ± 9% max) compared to the forearm (62 ± 7 % max) (P = 0.012). EMLA reduced the initial vasodilatation at both the leg (27 ± 13 % max) (P = 0.02) and forearm (33 ± 14% max) (P < 0.001). The times to onset of vasodilatation, initial vasodilatory peak, and plateau phase were longer in the leg compared to the forearm (all P < 0.05), and EMLA increased these times in both regions (both P < 0.05). CVC during the plateau phase to sustained local skin heating was higher in the leg compared to the forearm at both the untreated (93 ± 6 vs. 85 ± 4% max) (P = 0.33) and EMLA-treated (94 ± 5 vs. 86 ± 6% max) (P = 0.001) sites; EMLA did not affect CVC (P > 0.05). The differences in the initial vasodilatory peak to local skin heating between the forearm and the leg are due to the contribution of sensory nerves.

  11. The effect of warmth or/and vitamin E supplementation on forearm blood flow and forearm vascular resistance in sickle cell and non sickle cell anaemia subjects.

    PubMed

    Jaja, S I; Gbadamosi, T A; Kehinde, M O; Gbenebitse, S

    2003-03-01

    The effects of warmth stimulation and/or supplementation with vitamin E (300 mg/day for 6 weeks) on forearm blood flow (FBF) and forearm vascular resistance (FVR) were measured in 8 sickle cell anaemia (SCA) (mean age = 22.8 + 0.8 years) and 11 non sickle cell anaemia (NSCA) subjects (mean age = 23.2 + 1.1 years) of both sexes. Warmth stimulation was induced by immersing the left foot in warm water at 400C for 2 minutes. Forearm blood flow was measured with the venous occlusion plethysmography method. Warmth increased FBF (p <0.01 in each group) and reduced FVR (p <0.05) in NSCA subjects. The change in FBF was greater (p < 0.05) in the NSCA subjects than in the SCA subjects. Supplementation with vitamin E reduced systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) (p < 0.001 in each case) in the NSCA subjects but had little or no effect on the SCA subjects. Vitamin E increased FBF in NSCA subjects (p < 0.05) and SCA subjects (p < 0.01) and decreased FVR in both groups (p < 0.05 in NSCA and p < 0.01 in SCA subjects). The change in FVR seen in the NSCA subjects was less (p < 0.01) than the change in SCA subjects. After supplementation with vitamin E, warmth further decreased SBP (p < 0.01 in each group) and FVR (p < 0.01 in each case) and increased FBF in both groups (p < 0.01 respectively). The changes caused by warmth after vitamin E supplementation on the blood pressure parameters, FBF and FVR were similar in the two groups of subjects.

  12. Continuous infraclavicular block for forearm amputation after being bitten by a saltwater crocodile (Crocodylus porosus): a case report.

    PubMed

    Chiu, Chin-Hsi; Kuo, Yi-Wei; Hsu, Ho-Te; Chu, Koung-Shing; Shieh, Chia-Fang

    2009-08-01

    Two important issues after a complete right forearm amputation are replantation and ongoing pain management. There are no reports of successful forearm replantation as a consequence of a crocodile bite. Here, we discuss our pain management in a case of complete forearm amputation after a bite from a saltwater crocodile (Crocodylus porosus), which necessitated six further operations to achieve successful replantation. Continuous infraclavicular brachial plexus block was effective for acute pain control in this case. We strongly recommend performing the block with an indwelling catheter under ultrasound guidance for higher accuracy and safety.

  13. Surface Electromyography of the Forearm Musculature During the Windmill Softball Pitch.

    PubMed

    Remaley, D Trey; Fincham, Bryce; McCullough, Bryan; Davis, Kirk; Nofsinger, Charles; Armstrong, Charles; Stausmire, Julie M

    2015-01-01

    Previous studies investigating the windmill softball pitch have focused primarily on shoulder musculature and function, collecting limited data on elbow and forearm musculature. Little information is available in the literature regarding the forearm. This study documents forearm muscle electromyographic (EMG) activity that has not been previously published. Elbow and upper extremity overuse injuries are on the rise in fast-pitch softball pitchers. This study attempts to describe forearm muscle activity in softball pitchers during the windmill softball pitch. Overuse injuries can be prevented if a better understanding of mechanics is defined. Descriptive laboratory study. Surface EMG and high-speed videography was used to study forearm muscle activation patterns during the windmill softball pitch on 10 female collegiate-level pitchers. Maximum voluntary isometric contraction of each muscle was used as a normalizing value. Each subject was tested during a single laboratory session per pitcher. Data included peak muscle activation, average muscle activation, and time to peak activation for 6 pitch types: fastball, changeup, riseball, curveball, screwball, and dropball. During the first 4 phases, muscle activity (seen as signal strength on the EMG recordings) was limited and static in nature. The greatest activation occurred in phases 5 and 6, with increased signal strength, evidence of stretch-shortening cycle, and different muscle characteristics with each pitch style. These 2 phases of the windmill pitch are where the arm is placed in the 6 o'clock position and then at release of the ball. The flexor carpi ulnaris signal strength was significantly greater than the other forearm flexors. Timing of phases 1 through 5 was successively shorter for each pitch. There was a secondary pattern of activation in the flexor carpi ulnaris in phase 4 for all pitches except the fastball and riseball. During the 6 pitches, the greatest muscular activity was in phases 5 and 6

  14. Role of nitric oxide and adenosine in the onset of vasodilation during dynamic forearm exercise.

    PubMed

    Casey, Darren P; Mohamed, Essa A; Joyner, Michael J

    2013-02-01

    We tested the hypothesis that nitric oxide (NO) and adenosine contribute to the onset of vasodilation during dynamic forearm exercise. Twenty-two subjects performed rhythmic forearm exercise (20 % of maximum) during control and NO synthase (NOS) inhibition (N (G)-monomethyl-L-arginine; L-NMMA) trials. A subset of subjects performed a third trial of forearm exercise during combined inhibition of NOS and adenosine (aminophylline; n = 9). Additionally, a separate group of subjects (n = 7) performed rhythmic forearm exercise during control, inhibition of adenosine alone and combined inhibition of adenosine and NOS. Forearm vascular conductance (FVC; ml min(-1) · 100 mmHg(-1)) was calculated from blood flow and mean arterial pressure (mmHg). The onset of vasodilation was assessed by calculating the slope of the FVC response for every duty cycle between baseline and steady state, and the number of duty cycles (1-s contraction/2-s relaxation) to reach steady state. NOS inhibition blunted vasodilation at the onset of exercise (11.1 ± 0.8 vs. 8.5 ± 0.6 FVC units/duty cycle; P < 0.001 vs. control) and increased the time to reach steady state (25 ± 1 vs. 32 ± 1 duty cycles; P < 0.001 vs. control). Vasodilation was blunted further with combined inhibition of NOS and adenosine (7.5 ± 0.6 vs. 6.2 ± 0.8 FVC units/duty cycle; P < 0.05 vs. L-NMMA alone), but not with aminophylline alone (16.0 ± 2.2 vs. 14.7 ± 2.0 FVC units/duty cycle; P = 0.67 vs. control). Our data indicate that NO and adenosine (in the absence of NO) contribute to the onset of vasodilation during dynamic forearm exercise.

  15. Surface Electromyography of the Forearm Musculature During the Windmill Softball Pitch

    PubMed Central

    Remaley, D. Trey; Fincham, Bryce; McCullough, Bryan; Davis, Kirk; Nofsinger, Charles; Armstrong, Charles; Stausmire, Julie M.

    2015-01-01

    Background: Previous studies investigating the windmill softball pitch have focused primarily on shoulder musculature and function, collecting limited data on elbow and forearm musculature. Little information is available in the literature regarding the forearm. This study documents forearm muscle electromyographic (EMG) activity that has not been previously published. Purpose: Elbow and upper extremity overuse injuries are on the rise in fast-pitch softball pitchers. This study attempts to describe forearm muscle activity in softball pitchers during the windmill softball pitch. Overuse injuries can be prevented if a better understanding of mechanics is defined. Study Design: Descriptive laboratory study. Methods: Surface EMG and high-speed videography was used to study forearm muscle activation patterns during the windmill softball pitch on 10 female collegiate-level pitchers. Maximum voluntary isometric contraction of each muscle was used as a normalizing value. Each subject was tested during a single laboratory session per pitcher. Data included peak muscle activation, average muscle activation, and time to peak activation for 6 pitch types: fastball, changeup, riseball, curveball, screwball, and dropball. Results: During the first 4 phases, muscle activity (seen as signal strength on the EMG recordings) was limited and static in nature. The greatest activation occurred in phases 5 and 6, with increased signal strength, evidence of stretch-shortening cycle, and different muscle characteristics with each pitch style. These 2 phases of the windmill pitch are where the arm is placed in the 6 o’clock position and then at release of the ball. The flexor carpi ulnaris signal strength was significantly greater than the other forearm flexors. Timing of phases 1 through 5 was successively shorter for each pitch. There was a secondary pattern of activation in the flexor carpi ulnaris in phase 4 for all pitches except the fastball and riseball. Conclusion: During the 6

  16. Computational comparison of tibial diaphyseal fractures fixed with various degrees of prebending of titanium elastic nails and with and without end caps.

    PubMed

    Chen, Yen-Nien; Lee, Pei-Yuan; Chang, Chih-Han; Chang, Chih-Wei; Ho, Yi-Hung; Li, Chun-Ting; Peng, Yao-Te

    2016-10-01

    Elastic stable intramedullary nailing (ESIN) is a treatment strategy for the management of diaphyseal long-bone fractures in adolescents and children, but few studies have investigated the mechanical stability of tibial diaphyseal fractures treated with various degrees of prebending of the elastic nails. Therefore, the aim of this study was to compare the mechanical stability, including the gap deformation and nail dropping, of a tibia fracture with various fracture sites and fixed with various degrees of prebending of the elastic nails by the finite element method. Furthermore, the contribution of end caps to stability was taken into consideration in the simulation. A tibia model was developed with a transverse fracture at the proximal, middle and distal parts of the diaphysis, and fixed with three degrees of prebending of elastic nails, including those equal to, two times and three times the diameter of the intramedullary canal. The outer diameter of the nail used in the computation was 3.5mm, and the fractured tibia was fixed with two elastic double C-type nails. Furthermore, the proximal end of each nail was set to free or being tied to the surrounding bone by a constraint equation to simulate with or without using end caps. The results indicated that using end caps can prevent the fracture gap from collapsing by stopping the ends of the nails from dropping back in all prebending conditions and fracture patterns, and increasing the prebending of the nails to a degree three times the diameter of the canal reduced the gap shortening and the dropping distance of the nail end in those without using end caps under axial compression and bending. Insufficient prebending of the nails and not using end caps caused the gap to collapse and the nail to drop back at the entry point under loading. Using end caps or increasing the prebending of the nails to three times the diameter of the canal is suggested to stop the nail from dropping back and thus produce a more stable

  17. [Cement-free diaphyseal fixation principle for hip shaft exchange in large bone defects--analysis of 12 years experience with the Wagner revision shaft].

    PubMed

    Böhm, P; Bischel, O

    2001-01-01

    Considering the increasing incidence of revision for failed total hip arthroplasty, we evaluated if the principle of uncemented diaphyseal fixation which is realised with the Wagner SL revision stem, can solve the technical problems of significant bone loss of the proximal femur and can offer good preconditions for bony restoration in the medium term. A consecutive series of 129 femoral revisions with the Wagner SL revisions stem was evaluated. In 87 cases, the acetabular component was revised simultaneously. The revision was indicated in 97 cases of aseptic loosening, in 13 periprosthetic fractures (12 aseptic and 1 septic hip), in 16 cases of septic loosening and in 3 Girdlestone-hips after chronic deep infection. At the time of revision, the mean age of the patients was 64.9 (36.7-86.3) years. For classification of the preoperative defects, both the classification system proposed by Pak et al. and our own classification system were used. The mean period of time between operation and latest follow-up examination, rerevision, or death of the patient was 5.4 years (0.13-11.7 years). Six revision stems required rerevision because of malpositioning (1), significant subsidence (1), periprosthetic fracture (1), and deep infection (3). The mean Merle d'Aubigné score improved from preoperatively 7.7 points to 14.8 at follow-up. Cumulative survival (end point removal of the stem for any cause) was 94.4 percent at 11.7 years. A clear, good, or excellent bony restoration of the proximal femur was seen in 87.6 percent of the cases. The cumulative survival of the revised acetabular components was 97.7 percent at 11.7 years and for the non-revised cups it was 86.9 percent at 10.9 years. Due to the encouraging results with the Wagner revision stem, the principle of uncemented diaphyseal fixation seems to us to be able to solve most of the technical problems in cases of significant bone loss and obviously offers good preconditions for bony restoration. Our own classification

  18. Forearm blood flow during body temperature transients produced by leg exercise

    NASA Technical Reports Server (NTRS)

    Wenger, C. B.; Roberts, M. F.; Stolwijk, J. A. J.; Nadel, E. R.

    1975-01-01

    Subjects exercised for 30 min on a bicycle ergometer at 30, 50, and 70% of maximal aerobic power in ambient temperatures of 15, 25, and 35 C and vapor pressures of less than 18 torr. Exercise was used to vary internal temperature during an experiment, and different ambient temperatures were used to vary skin temperatures independently of internal temperature. Forearm skin temperature was fixed at about 36.5 C. Esophageal temperature was measured with a thermocouple at the level of the left atrium, and mean skin temperature was calculated from a weighted mean of thermocouple temperatures at eight skin sites. Forearm blood flow was measured by electrocapacitance plethysmography. Data are well accounted for by a linear equation independent of exercise intensity, although some subjects showed an equivocal vasodilator effect of exercise.

  19. Unusual injuries on the right hand and forearm caused by unidentified wild animals.

    PubMed

    Kiuchi, Takayuki; Matoba, Kotaro; Terazawa, Koichi

    2008-11-01

    An old man was found dead in a rice paddy with his face down in the water. His right forearm and hand were severely injured and the shapes of injuries were unusual. It was initially suspected that the injuries had been caused by a cultivator placed at the site. However, they proved to be postmortem injuries because vital reactions were not observed. The skin was widely torn away. Some edges of the injuries looked like a bite mark and other parts looked like scratches. There were many parallel injuries on the right forearm and hand and footmark-like injuries on the right hand. They were probably caused by wild animals. Judging from the sizes and shapes of the footprint, bite marks and scratches, we estimated that the animal which caused the injuries was weasels.

  20. Variation of forearm, hand, and finger blood flow indices with ambient temperature

    NASA Technical Reports Server (NTRS)

    Montgomery, L. D.; Williams, B. A.

    1977-01-01

    Forearm, hand, and finger blood flow (impedance) changes are measured by impedance rheography on seven healthy male subjects aged 20-35 yr during exposure to ambient temperatures ranging from 10 to 46 C. All observations are made in an environmental chamber at a dew point temperature of 13 + or - 0.25 C. It is shown that impedance rheography is suitable for quantifying peripheral circulatory responses to thermal stress. The measured blood flow indices are found to be consistent with previously reported values for the forearm, hand, and fingers obtained using air or water displacement plethysmography. In particular, the more distal body segments exhibit relatively larger vasomotor responses to changes in ambient temperature than do the more proximal body segments.

  1. Forearm mineral content in normal men: relationship to weight, height and plasma testosterone concentrations

    SciTech Connect

    McElduff, A.; Wilkinson, M.; Ward, P.; Posen, S.

    1988-01-01

    We measured forearm bone mineral content by single photon absorptiometry together with height, weight and the plasma concentrations of testosterone, free testosterone and sex steroid binding globulin in 66 normal Caucasian males aged 29-46 years. Multiple regression analysis suggests that bone mineral content in either the dominant or the nondominant arm is correlated with weight and sex steroid binding globulin (p less than 0.05 for both parameters). The partial negative correlation of bone mineral content (corrected for weight and sex steroid binding globulin) with plasma testosterone failed to reach statistical significance (p = 0.07). The parsimonious regression equation which best explained the bone mineral content measurements in the nondominant forearm in these men was bone mineral content = 29.1-0.374 (plasma testosterone) + 0.383 (weight) + 0.220 (sex steroid binding globulin) with an R2 value of 29.7%. A similar equation was generated for the dominant arm.

  2. Chondroid Syringoma of the Forearm: A Case Report of a Rare Localization

    PubMed Central

    Askari, Koroush; Ghorbani, Ghazaleh; Yousefi, Navid; Saadat, Seyed Mohammad Seyed; Saadat, Seyedeh Nazanin Seyed; Zargari, Omid

    2014-01-01

    Chondroid syringoma (CS) is an uncommon benign adnexal tumor of the skin with eccrine and apocrine origin, which usually involves the head and neck region. The presentation of CS in other areas of the body is rare. A 45-year-old male patient presented to the dermatology clinic with a chief complaint of a painless, slow-growing mass on his left forearm, which gradually developed over the course of 2 years. A solitary, firm, purple, mobile, non-tender nodule was located in the distal part of left dorsal forearm, which was 1.8 cm in diameter. The tumor was surgically excised and sent for the histopathological evaluation. Results of biopsy and hematoxylin and eosin staining confirmed the diagnosis of CS and showed no evidence of malignancy. Although CS is an uncommon tumor in uppr limb region, it should be considered as one of the differential diagnoses, when dealing with tumors of this area. PMID:25284863

  3. Forearm blood flow during body temperature transients produced by leg exercise

    NASA Technical Reports Server (NTRS)

    Wenger, C. B.; Roberts, M. F.; Stolwijk, J. A. J.; Nadel, E. R.

    1975-01-01

    Subjects exercised for 30 min on a bicycle ergometer at 30, 50, and 70% of maximal aerobic power in ambient temperatures of 15, 25, and 35 C and vapor pressures of less than 18 torr. Exercise was used to vary internal temperature during an experiment, and different ambient temperatures were used to vary skin temperatures independently of internal temperature. Forearm skin temperature was fixed at about 36.5 C. Esophageal temperature was measured with a thermocouple at the level of the left atrium, and mean skin temperature was calculated from a weighted mean of thermocouple temperatures at eight skin sites. Forearm blood flow was measured by electrocapacitance plethysmography. Data are well accounted for by a linear equation independent of exercise intensity, although some subjects showed an equivocal vasodilator effect of exercise.

  4. Mechanical design of EFW Exo II: A hybrid exoskeleton for elbow-forearm-wrist rehabilitation.

    PubMed

    Bian, Hui; Chen, Ziye; Wang, Hao; Zhao, Tieshi

    2017-07-01

    The use of rehabilitation exoskeleton has become an important means for the treatment of stroke patients. A hybrid exoskeleton named EFW Exo II is developed for the motor function rehabilitation of elbow, forearm and wrist. The EFW Exo II is based on a parallel 2-URR/RRS mechanism and a serial R mechanism. It could fit both left and right arms for the symmetrical and open structure, and the distance between the elbow and wrist could automatically adjust for different forearm length. Details of the mechanical design are introduced. Brushless DC servo motors with planetary gear reducer are used as the actuators of the exoskeleton. Gear drive and belt drive are used for power transmission. A three dimensional force sensor is mounted in the handle to regulate the interaction between the exoskeleton and patient. The EFW Exo II can realize rehabilitation exercise for each joint and the ranges of motion meet the rehabilitation demands of daily living.

  5. [An original "double-arched" radial forearm flap for soft palate reconstruction. Case report].

    PubMed

    Pauchot, J; Feuvrier, D; Pluvy, I; Floret, F; Mauvais, O

    2016-12-01

    Reconstruction of the soft palate after oncologic resection remains a surgical challenge. Speech and swallowing problems are the consequences of velopharyngeal incompetence following soft palate resection. Free tissue transfer like radial forearm flaps can be used in larger defects for complex reconstruction. The conformation of the flap in order to be closer to the shape of the soft palate improves the functional outcome. In the same way, we describe an original "double-arched" flap design. A double arch of the exact length of the soft palate tumor resection is designed. After suturing, the flap spontaneously formed a double arch of the exact dimensions of the resected piece. The patient achieved good functional recovery without any surgical complications. The original "double-arched" forearm flap design allows a tailored reconstruction with exactly the same shape and dimensions, preserving the functional requirements of speech and deglutition. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  6. Functional results of microvascular reconstruction after hemiglossectomy: free anterolateral thigh flap versus free forearm flap.

    PubMed

    Tarsitano, A; Vietti, M V; Cipriani, R; Marchetti, C

    2013-12-01

    The aim of the present study is to assess functional outcomes after hemiglossectomy and microvascular reconstruction. Twenty-six patients underwent primary tongue microvascular reconstruction after hemiglossectomy. Twelve patients were reconstructed using a free radial forearm flap and 14 with an anterolateral thigh flap. Speech intelligibility, swallowing capacity and quality of life scores were assessed. Factors such as tumour extension, surgical resection and adjuvant radiotherapy appeared to be fundamental to predict post-treatment functional outcomes. The data obtained in the present study indicate that swallowing capacity after hemiglossectomy is better when an anterolateral thigh flap is used. No significant differences were seen for speech intelligibility or quality of life between free radial forearm flap and anterolateral thigh flap.

  7. Reconstruction of full-thickness buccal defects with folded radial forearm flaps

    PubMed Central

    Liu, Fei; Wang, Lei; Pang, Shuang; Kan, Quancheng

    2017-01-01

    Abstract Our goal was to describe our experience of the folded radial forearm flap (RFF) flap in through-and-through buccal defect reconstructions. Patients who had received a folded RFF flap for full-thickness cheek defect reconstruction were included. The flap success rate and functional results were evaluated. Six patients were enrolled. All flaps survived totally without any complication; the mean flap size was 75.5 (range 32–135) cm2. The mean mouth-open width was 4.2 (range 3.5–4.7) cm at 6 months after operation. All patients were satisfied with the appearance and were capable of maintaining a regular oral diet, and no patients complained of an inability to eat in a public setting, microstomia, or drooling. Radial forearm flap was a reliable method for through-and-through buccal reconstruction with high success rate and good functional result. PMID:28796029

  8. Treatment and functional result of desmoplastic fibroma with repeated recurrences in the forearm: A case report

    PubMed Central

    RUI, JING; GUAN, WENJIE; GU, YUDONG; LAO, JIE

    2016-01-01

    Desmoplastic fibroma, alternatively known as aggressive fibromatosis or desmoid tumors, occurs in the form of benign locally aggressive tumors that possess a high rate of recurrence. The forearm bones are rarely involved. The current study presents a case of desmoplastic fibroma in the distal forearm of a 23-year-old man. The tumor was widely resected, and the bone defect was reconstructed using an autologous vascularized fibular graft during the resection procedure. The patient experienced recurrence three times and underwent four resections during the subsequent 3 years following the initial resection. After 10 years of follow-up, the patient's functional recovery remains positive. Despite the implication that surgical resection may be involved in the development of aggressive fibromatosis, surgical wide local excision and functional reconstruction were recommended for the treatment of the present patient. PMID:26893769

  9. Immediate effects of forearm elastic and nonelastic taping on wrist flexor muscle and grip strength of normal adults

    PubMed Central

    Cha, Hyun-Gyu; Kim, Myoung-Kwon; Shin, Young-Jun

    2016-01-01

    [Purpose] The purpose of this study was to examine the effects of forearm elastic taping on grip and wrist flexor muscle strength. [Subjects and Methods] This was a single-blind, crossover study. This study selected 40 healthy subjects with no history of orthopedic disorders and was conducted after consent to participate was obtained. Grip and wrist flexor muscle strength of subjects were assessed by a handheld dynamometer and a Commander Muscle Tester, respectively, with forearm elastic taping or nonelastic taping. [Results] After application of forearm elastic taping, grip strength and wrist flexor muscle strength significantly increased compared with the nonelastic taping group. [Conclusion] Application of forearm elastic taping is considered to have positive effects on improving wrist and grip strength. PMID:27821932

  10. Long-term results of free radial forearm flap used for oral reconstruction: functional and histological evaluation.

    PubMed

    Shibahara, Takahiko; Mohammed, Ashiraf Fathy; Katakura, Akira; Nomura, Takeshi

    2006-08-01

    The aim of this study was to evaluate the radial forearm flap with regard to recovery of sensory function, general performance status, cutaneous blood flow and histological observations. Thirty patients (23 male and 7 female) with oral carcinoma underwent immediate reconstruction with radial forearm flap after ablative surgery and returned for evaluation. Interviews were conducted to assess the degree of articulation and mastication. Sensory function tests suggested the restoration of cutaneous sensibility of the forearm flap. Histological findings indicated mucosa-like changes of flaps about 10 months after reconstruction. The clarity of conversation recovered favorably in most patients. However, the degree of recovery was generally related to the time after surgery. The radial forearm flap is a unique flap with specific characters that allowed for best available functional reconstruction of the oral cavity in terms of restoration of sensation, performance, and histological changes to adapt to the new oral environment.

  11. Effect of the Forearm Tissue Temperature on the Cold Induced Vasodilation

    DTIC Science & Technology

    2005-05-01

    substantial role in reducing the risk of local cold injuries [ 2 ], and may be beneficial for improving dexterity and tactile sensitivity during exposure...collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE 01 MAY 2005 2 . REPORT TYPE N/A 3. DATES COVERED...ANSI Std Z39-18 Effect of the Forearm Tissue Temperature on the Cold Induced Vasodilation 14 - 2 RTO-MP-HFM-126 skin and core temperatures on

  12. Leg and Forearm Muscle Power Changes Associated with Two Types of Underwater Exposure.

    DTIC Science & Technology

    1987-03-01

    before and after each dive.’OAn ischemic handgrip test measured developed force at a contraction rate of I per sec for a period of 60 sec. The Wingate...effort on a bicycle ergometer (6). An Ischemic handgrip test measured forearm muscle force anaerobicallv during temporary Vl ~ V V VV ~ ~ ~ occlusion of...computer. Averages of the handgrip force were made over each 15 sec segment of the test. Each force measurement was further expressed as a percent of

  13. Successful replantation following an accidental forearm amputation. Case report and review of the literature.

    PubMed

    Sauma, A; Quiroga, R; Brockmann, C; Montaño, M; Flores, G; Barrenechea, J P

    2002-04-01

    We report a patient who suffered an accidental complete amputation of the right forearm followed by a successful replantation and comment on the indications and management of macro-replantations of the upper limbs. This is the first time that a successful surgical procedure of this nature has been performed in Bolivia, with no post-operative complications and excellent long-term functional recovery.

  14. Heterogeneous vascular responses to hypoxic forearm exercise in young and older adults.

    PubMed

    Limberg, Jacqueline K; Evans, Trent D; Pegelow, David F; Eldridge, Marlowe W; Sebranek, Joshua J; Proctor, Lester T; Schrage, William G

    2012-08-01

    We aimed to assess age-related differences in compensatory hypoxic vasodilation during moderate-to-high dynamic exercise at absolute workloads. We hypothesized healthy older adults (n = 12, 61 ± 1 years) would exhibit impaired hypoxic vasodilation at a moderate absolute workload, and this effect would be exaggerated at a higher workload when compared to young adults (n = 17, 27 ± 2 years). Forearm blood flow (FBF) was measured with Doppler ultrasound. Dynamic forearm exercise (20 contractions/min) was completed at two absolute workloads (8 and 12 kg) under normoxic (0.21 FiO2, ~98% SpO2) and isocapnic hypoxic (~0.10 FiO2, 80% SpO2) conditions performed in random order. FBF was normalized as forearm vascular conductance (FBF / mean arterial blood pressure = FVC) to control for differences in blood pressure and to assess vasodilation. FVC increased with exercise and hypoxia (main effects, p < 0.05); vascular responses were not different between young and older adults (interaction effect exercise × group p = 0.37 and hypoxia × group p = 0.96). Results were confirmed when analyzed as either an absolute or relative change in FVC (ΔFVC and %ΔFVC, respectively). Although group responses to hypoxia were not different, individual results were highly variable (i.e., some adults constricted and others dilated to hypoxia). These data suggest (1) compensatory hypoxic vasodilation in older adults is not impaired during forearm exercise at both moderate and higher absolute exercise intensities, and (2) vascular responses to hypoxia are heterogeneous in both young and older adults. Results suggest unique individual differences exist in factors regulating vascular responses to hypoxia.

  15. Differential Effects of Unilateral Concentric Vs. Eccentric Exercise on the Dominant and Nondominant Forearm Flexors.

    PubMed

    Beck, Travis W; Ye, Xin; Wages, Nathan P

    2016-03-01

    The purpose of this study was to compare the electromyographic (EMG) intensity patterns after unilateral concentric vs. eccentric exercise in the dominant (DOM) and nondominant (NONDOM) forearm flexors. Twenty-six men (mean ± SD: age, 24.0 ± 3.7 years) volunteered to perform a maximal isometric muscle action of the DOM and NONDOM forearm flexors before (PRE) and immediately after (POST) a series of maximal concentric isokinetic or maximal eccentric isokinetic muscle actions of the DOM forearm flexors. The concentric isokinetic and eccentric isokinetic muscle actions were performed on separate days that were randomly ordered. However, in both cases, the subjects performed 6 sets of 10 maximal muscle actions. A bipolar surface EMG signal was detected from the biceps brachii of the DOM and NONDOM limbs during the PRE and POST isometric muscle actions. The signals were then analyzed with a wavelet analysis, and the resulting intensity patterns were classified with a paired pattern classification procedure. The results indicated that the EMG intensity patterns could be correctly classified into their respective PRE vs. POST categories with an accuracy rate that was significantly better than random (20 of 26 patterns = 76.9% accuracy) but only for the DOM limb following the eccentric muscle actions. All other classifications were not significantly better than random. These findings indicated that eccentric exercise had a significant influence on the muscle activation pattern for the forearm flexors. It is possible that the muscle damage resulting from eccentric exercise affects muscle spindle or golgi tendon organ or both activity, thereby altering the muscle activation pattern.

  16. Forearm articular proportions and the antebrachial index in Homo sapiens, Australopithecus afarensis and the great apes.

    PubMed

    Williams, Frank L'Engle; Cunningham, Deborah L; Amaral, Lia Q

    2015-12-01

    When hominin bipedality evolved, the forearms were free to adopt nonlocomotor tasks which may have resulted in changes to the articular surfaces of the ulna and the relative lengths of the forearm bones. Similarly, sex differences in forearm proportions may be more likely to emerge in bipeds than in the great apes given the locomotor constraints in Gorilla, Pan and Pongo. To test these assumptions, ulnar articular proportions and the antebrachial index (radius length/ulna length) in Homo sapiens (n=51), Gorilla gorilla (n=88), Pan troglodytes (n=49), Pongo pygmaeus (n=36) and Australopithecus afarensis A.L. 288-1 and A.L. 438-1 are compared. Intercept-adjusted ratios are used to control for size and minimize the effects of allometry. Canonical scores axes show that the proximally broad and elongated trochlear notch with respect to size in H. sapiens and A. afarensis is largely distinct from G. gorilla, P. troglodytes and P. pygmaeus. A cluster analysis of scaled ulnar articular dimensions groups H. sapiens males with A.L. 438-1 ulna length estimates, while one A.L. 288-1 ulna length estimate groups with Pan and another clusters most closely with H. sapiens, G. gorilla and A.L. 438-1. The relatively low antebrachial index characterizing H. sapiens and non-outlier estimates of A.L. 288-1 and A.L. 438-1 differs from those of the great apes. Unique sex differences in H. sapiens suggest a link between bipedality and forearm functional morphology. Copyright © 2015 Elsevier GmbH. All rights reserved.

  17. The effect of acute and chronic nicardipine therapy on forearm arterial haemodynamics in essential hypertension

    PubMed Central

    Levenson, J.; Simon, A. Ch.; Bouthier, J.; Maarek, B. C.; Safar, M. E.

    1985-01-01

    1 By using simultaneous recording curves obtained with pulsed Doppler velocimetry and strain gauge mechanography, forearm arterial haemodynamics were studied in 26 patients with mild to moderate essential hypertension. Fifteen patients received a single oral dose of nicardipine 40 mg, and 11 patients were treated with nicardipine 30 mg three times daily for 3 months. 2 In both groups of patients there was a similar and significant (P < 0.001) reduction in mean, systolic, and diastolic pressures. There was a slight increase in heart rate (P < 0.05) after the single dose, but no change after 3 months of treatment. 3 The diameter, blood velocity, and blood flow of the brachial artery increased significantly in both treatment groups. The decrease in forearm vascular resistance was significant for both treatment groups. 4 Brachial artery compliance increased (P < 0.01) and characteristic impedance decreased (P < 0.01) after both single-dose and long-term therapy with nicardipine. 5 In patients who received nicardipine for 3 months, there were close correlations between the baseline serum calcium level and the percent change in vascular resistance (r = -0.73, P < 0.01), blood flow (r = 0.89, P < 0.001), and blood velocity (r = 0.91. P < 0.001) of the forearm. No correlation was found between the baseline serum calcium and the change in arterial pressure. 6 This study provided evidence that the blood-pressure-lowering effect of nicardipine was accompanied by a direct vasodilatory action in the small and large arteries of the forearm. An increase in peripheral blood flow with concomitant improvement of arterial compliance are the consequences of these arterial actions. PMID:4027144

  18. Electromagnetic effects on forearm disuse osteopenia: a randomized, double-blind, sham-controlled study.

    PubMed

    Spadaro, Joseph A; Short, Walter H; Sheehe, Paul R; Hickman, Rebecca M; Feiglin, David H

    2011-05-01

    A randomized, double-blind, sham-controlled, feasibility and dosing study was undertaken to determine if a common pulsing electromagnetic field (PEMF) treatment could moderate the substantial osteopenia that occurs after forearm disuse. Ninety-nine subjects were randomized into four groups after a distal radius fracture, or carpal surgery requiring immobilization in a cast. Active or identical sham PEMF transducers were worn on the distal forearm for 1, 2, or 4 h/day for 8 weeks starting after cast removal ("baseline") when bone density continues to decline. Bone mineral density (BMD) and bone geometry were measured in the distal forearm by dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) at entry ("baseline") and 8, 16, and 24 weeks later. Significant average BMD losses after baseline were observed in the affected forearm at all time points (5-7% distally and 3-4% for the radius/ulna shaft). However, after adjusting for age, gender, and baseline BMD there was no evidence of a positive effect of active versus sham PEMF treatment on bone loss by DXA or pQCT for subjects completing all visits (n = 82, ∼20 per group) and for an intent-to-treat analysis (n = 99). Regardless of PEMF exposure, serum bone-specific alkaline phosphatase (BSAP) was normal at baseline and 8 weeks, while serum c-terminal collagen teleopeptide (CTX-1) was markedly elevated at baseline and less so at 8 weeks. Although there was substantial variability in disuse osteopenia, these results suggested that the particular PEMF waveform and durations applied did not affect the continuing substantial disuse bone loss in these subjects. Copyright © 2010 Wiley-Liss, Inc.

  19. Forearm hair density and risk of keratinocyte cancers in Australian adults.

    PubMed

    von Schuckmann, L A; Hughes, M C; Green, A C; van der Pols, J C

    2016-11-01

    Evidence suggests that progenitor cells of keratinocyte cancers (basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)) may originate from epidermal stem cells including hair follicle stem cells. We hypothesised that, therefore, a relatively higher density of hair follicles on human skin may increase keratinocyte cancer risk. To evaluate this, we assessed density of mid-forearm hair in Australian adults who were randomly selected participants in a community-based cohort study of skin cancer. Hair density was assessed clinically against a set of four standard photographs showing grades of hair density, and incidence data on histologically confirmed BCC and SCC across a 20-year period were collected. Incidence rate ratios were calculated for categories of forearm hair density using multivariable regression analysis with adjustment for age, sex, phenotypic characteristics and markers of chronic sun exposure. Among the 715 participants (43 % male, average age 61 years), 237 developed at least one BCC and 115 persons developed at least one SCC. Participants with dense forearm hair (n = 169, all male) had a higher incidence of BCC (IRR = 2.24, 95 % CI 1.20, 4.18, P = 0.01) and SCC (IRR = 2.80, 95 % CI 1.20, 6.57, P = 0.02) compared to individuals with sparse forearm hair after multivariable adjustment. Stratified analyses showed that among men, those with dense versus sparse hair developed SCC more commonly (IRR = 3.01, 95 % CI 1.03, 8.78, P = 0.04). Women with moderate versus sparse hair density were more likely affected by BCC (IRR = 2.29, 95 % CI 1.05, 5.00, P = 0.038). Thus, our study suggests that in both men and women, a higher density of body hair may be associated with increased BCC and SCC risk.

  20. [Successful treatment of subglottic tracheal stenosis with a mucosa-lined radial forearm fascia flap].

    PubMed

    Mandapathil, M; Hoffmann, T K; Freitag, L; Reddy, N; Lang, S; Delaere, P

    2012-12-01

    Short-segment tracheal stenosis is often treated by segmental resection and end-to-end anastomosis. Longer-segment stenosis can sometimes be treated using dilation, laser therapy, bronchoscopic stent insertion and segmental resection and reconstruction. Long-segment restenosis with a buildup of scar tissue due to successful resection surgery in the past represents a particular therapeutic challenge and a sufficiently vascularized transplant may be the only option. We describe the case of a 37-year-old patient who underwent a tracheal reconstruction using a mucosa-lined radial forearm flap. Subsequent to a traumatic laryngotracheal fracture, long-term ventilation and multiple surgical interventions, the patient had developed a functionally relevant subglottic stenosis (5.5 cm). Following longitudinal anterior resection of the trachea 1 cm above and below the stenosis, a Dumon® stent was inserted. Simultaneously, a radial forearm fascia flap was harvested, as were two full-thickness buccal mucosa grafts, which were sutured onto the subcutaneous tissue and fascia of the forearm flap. Beginning caudally, the mucosa-lined flap was then sutured, air-tight, into the anterior tracheal defect with the mucosa facing the lumen. Finally, end-to-end anastomosis connected the blood vessels of the radial forearm flap to the recipient blood vessels in the neck. The patient was successfully extubated after 24 h and discharged after 5 days. A postoperative CT scan revealed optimal placement of the stent and the patient's speech and breathing were sufficiently re-established. The stent was removed bronchoscopically 6 weeks after surgery. Examinations during the 6-month follow-up period showed that the diameter of the reconstructed airway was retained and the patient remained symptom-free.

  1. Skin and muscle components of forearm blood flow in directly heated resting man.

    NASA Technical Reports Server (NTRS)

    Detry, J.-M. R.; Brengelmann, G. L.; Rowell, L. B.; Wyss, C.

    1972-01-01

    Changes in forearm muscle blood flow (FMBF) during direct whole-body heating were measured in 17 normal subjects using three different methods. We conclude that FMBF is not increased by direct whole-body heating. Since renal and splanchnic blood flow fall 30% under these conditions, maximal total skin blood flow in 12 previously studied subjects can be estimated from the rise in cardiac output to be 7.6 L/min (3.0-11.1 L/min).

  2. Immediate and Delayed Effects of Forearm Kinesio Taping on Grip Strength

    PubMed Central

    Kouhzad Mohammadi, Hosein; Khademi Kalantari, Khosro; Naeimi, Sedighe Sadat; Pouretezad, Mohammad; Shokri, Esmaeil; Tafazoli, Mojdeh; Dastjerdi, Mahboobeh; Kardooni, Leila

    2014-01-01

    Background: Due to the fundamental role of gripping in most upper limb activities, grip strength promotion is a chief goal in the treatment of patients with upper limb musculoskeletal disorders. Kinesio taping is a novel and effective therapeutic technique believed to facilitate muscle contraction through stimulating mechanoreceptors and increasing the sensory feedback around the taped region. Objectives: The present study aimed to identify the best region (flexor, extensor and flexor/extensor regions) and time (immediate, 0.5, 1, 1.5, and 2 hours) of forearm Kinesio taping to obtain the maximum improvement in grip strength. Materials and Methods: In this longitudinal study, 40 healthy men and women (the mean age of 22.3 ± 2.19 years) were selected among students of Shahid Beheshti University of Medical Sciences, Tehran, Iran by simple, nonrandom sampling method. A dynamometer was used to measure grip strength immediately and every 30 minutes during the two hours after I-shaped application of tape (with 50% stretch) to the flexor, extensor, and flexor/extensor forearm muscles. Results: Grip strength was significantly increased in various muscle groups for males (P = 0.002) and females (P = 0.000) of the forearm and at different intervals for males (P = 0.000) and females (P = 0.000). Moreover, in both men and women, tape application to the extensor region provided greater grip strength compared to taping of the flexor and flexor/extensor regions (P = 0.000 for both). Furthermore, the maximum increase in grip strength were 0.5 (10.8% increase, P = 0.001) and 1.5 h (23.9% increase, P = 0.000) after taping in males and females, respectively. Conclusions: Taping the extensor region of forearm is recommended to achieve higher grip strength. Although grip strength increased at a slower pace in females than males, the final values were higher in women. PMID:25389492

  3. Skin and muscle components of forearm blood flow in directly heated resting man.

    NASA Technical Reports Server (NTRS)

    Detry, J.-M. R.; Brengelmann, G. L.; Rowell, L. B.; Wyss, C.

    1972-01-01

    Changes in forearm muscle blood flow (FMBF) during direct whole-body heating were measured in 17 normal subjects using three different methods. We conclude that FMBF is not increased by direct whole-body heating. Since renal and splanchnic blood flow fall 30% under these conditions, maximal total skin blood flow in 12 previously studied subjects can be estimated from the rise in cardiac output to be 7.6 L/min (3.0-11.1 L/min).

  4. Interosseous membrane reconstruction with a suture-button construct for treatment of chronic forearm instability.

    PubMed

    Gaspar, Michael P; Kane, Patrick M; Pflug, Emily M; Jacoby, Sidney M; Osterman, A Lee; Culp, Randall W

    2016-09-01

    The purpose of this study was to report outcomes of interosseous membrane (IOM) reconstruction with a suture-button construct for treatment of chronic longitudinal forearm instability. We performed a retrospective review with prospective follow-up of patients who underwent ulnar shortening osteotomy and IOM reconstruction with the Mini TightRope device from 2011 through 2014. Bivariate statistical analysis was used for comparison of preoperative and postoperative Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, range of motion, grip strength, and ulnar variance. Complications and patient satisfaction were also recorded. Ten patients (mean age, 45.3 years) satisfied inclusion criteria: 8 treated for post-traumatic sequelae of Essex-Lopresti-type injuries, 1 for forearm instability secondary to previous elbow surgery, and 1 for instability secondary to trauma and multiple elbow surgeries. Surgeries were performed an average of 28.6 months from initial injury. At mean follow-up of 34.6 months after surgery, significant improvement was observed in elbow flexion-extension arc (+23° vs. preoperatively; P = .007), wrist flexion-extension arc (+22°; P = .016), QuickDASH score (-48; P = .000), and ulnar variance (-3.3 mm; P = .006). Three patients required additional surgery: 1 revision ulnar shortening osteotomy for persistent impingement, 1 revision ulnar osteotomy and Mini TightRope removal for lost forearm supination, and 1 fixation of a radial shaft fracture after a fall. IOM reconstruction using a suture-button construct is an effective treatment option for chronic forearm instability. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  5. Osteosarcoma of the distal radius treated with segmental forearm resection, hand replantation, and subsequent limb lengthening: case report.

    PubMed

    Hatano, Hiroshi; Morita, Tetsuro; Kobayashi, Hiroto; Iwabuchi, Yasuhiro

    2014-06-01

    A 9-year-old girl with osteosarcoma of the radius was treated with segmental forearm resection and replantation followed by forearm lengthening of 11 cm. At 9-year follow-up, she had recovered sensory function, and her pinch and grasp were sufficient for performing daily activities. Functional outcomes evaluated by the Disabilities of the Arm, Shoulder, and Hand questionnaire and International Society of Limb Salvage functional score system were 4/100 and 23/30, respectively.

  6. Two-stage reconstruction in congenital pseudarthrosis of the forearm using the Ilizarov technique and vascularized osteoseptocutaneous fibula.

    PubMed

    Mateev, Musa; Imanaliev, Arstan

    2006-04-01

    The authors present nine patients with congenital pseudarthrosis of the forearm. The reconstruction was carried out in two stages. At the first stage, Ilizarov's device was applied to the forearm in order to lengthen the affected extremity and to eliminate deformity. At the second stage, the bone defect was replaced a with free vascularized fibula osteoseptocutaneous graft. All patients had complete survival of the transferred fibula grafts. Bone consolidation was achieved in 4 to 6 months after the reconstruction.

  7. [Extranodal NK/T-cell lymphoma arising from soft tissue of the left forearm].

    PubMed

    Kunami, Naoko; Takamatsu, Yasushi; Fujita, Mana; Katsuya, Hiroo; Sasaki, Hidenori; Wakamatsu, Shinichi; Ishitsuka, Kenji; Nabeshima, Kazuki; Tamura, Kazuo

    2010-06-01

    A 72-year-old man with extranodal natural killer cell lymphoma (ENKL) presented with a painless swelling of the left forearm. He was initially diagnosed as having a bacterial cellulitis and received antimicrobial therapy. However, his left arm became increasingly swollen in association with fever and redness of the lesion. Therefore, he underwent focal dissection. Because of persistent swelling, the left arm was rebiopsied 9 months later, and a diagnosis of ENKL developing in the subcutis was established. He was treated with focal radiation therapy in combination with dexamethasone, etoposide, ifosfamide, methotrexate and L-asparaginase. The lesion was significantly reduced in size but did not disappear completely. Two months later the lesion became necrotic, although swelling of the forearm lesion, left axillary and cervical lymph nodes were kept under control. We then performed amputation of the left forearm since it could not be saved medically. The patient currently remains alive and well without progression 2 years after amputation. When evaluating panniculitis, which is difficult to cure, ENKL should be considered in the differential diagnosis and treated appropriately.

  8. Chronic exertional compartment syndrome of the forearm in motocross racers: findings on MRI.

    PubMed

    Gielen, Jan Louis; Peersman, Benjamin; Peersman, Geert; Roelant, Ella; Van Dyck, Pieter; Vanhoenacker, Filip; Roeykens, Johan

    2009-12-01

    The purpose of this prospective study was to demonstrate the findings of MRI in motocross racers with chronic exertional compartment syndrome (CECS) of the forearm. Racers with proven CECS and without CECS and male individuals not involved in strenuous activities with the forearm were included. Signal intensity (SI) and signal-to-noise ratio (SNR) obtained before and after exercise were compared (D-SNR). Magnetic resonance imaging after exercise showed an increase in SI and SNR in the muscles on T2-WI. The SI increase was obvious in the flexor digitorum superficialis (FDS) and profundus (FDP) in all CECS patients. In addition, a minor SI and SNR increase in the extensor carpi radialis longus (ECRL) was noted. In the non-symptomatic group of motocross racers, there was only a minor increase in SI and the SNR, which was similar in the FDP and ECRL muscles. In the untrained individuals a remarkable increase in the SI and SNR of the FDS/FDP-ECRL was noted. This increased SI and SNR was not present in the majority of non-symptomatic racers. Post-exertional MRI produces significant findings in CECS of the forearm. The motocross racers without post-exertional oedema in the FDP/FDS had no CECS.

  9. Endoscopic Fascia Release for Forearm Chronic Exertional Compartment Syndrome: Case Report and Surgical Technique.

    PubMed

    Miller, Elizabeth A; Cobb, Anna L; Cobb, Tyson K

    2017-09-01

    Chronic exertional compartment syndrome (CECS) of the forearm is traditionally treated with open compartment release requiring large incisions that can result in less than optimal esthetic results. The purpose of this study is to describe a case report of 2 professional motocross patients with forearm CECS treated endoscopically using a minimally invasive technique. Two professional motocross racers presented with a history of chronic proximal volar forearm pain when motocross riding. Other symptoms included paresthesia and weakness, which, at times, led to an inability to continue riding. Both failed conservative management. Compartment pressure measurements were performed before and after provocative exercises to confirm diagnosis of CECS. Release of both the volar and dorsal compartments was performed endoscopically through a single incision. Symptoms resolved after surgery. The first patient resumed riding at 1 week, competing at 3 weeks, and continues to ride competitively without symptoms at 3 years postoperative. The second patient began riding at 1 week and won second place in the National Supercross finals 5 weeks after simultaneous bilateral release. This technique is simple and effective. The cannula used protects the superficial nerves while allowing release through a small, cosmetically pleasing incision.

  10. Vascular effects of anandamide and N-acylvanillylamines in the human forearm and skin microcirculation.

    PubMed

    Movahed, Pouya; Evilevitch, Vladimir; Andersson, Tomas L G; Jönsson, Bo A G; Wollmer, Per; Zygmunt, Peter M; Högestätt, Edward D

    2005-09-01

    The endocannabinoid anandamide is an emerging potential signalling molecule in the cardiovascular system. Anandamide causes vasodilatation, bradycardia and hypotension in animals and has been implicated in the pathophysiology of endotoxic, haemorrhagic and cardiogenic shock, but its vascular effects have not been studied in man. Human forearm blood flow and skin microcirculatory flow were recorded using venous occlusion plethysmography and laser-Doppler perfusion imaging (LDPI), respectively. Each test drug was infused into the brachial artery or applied topically on the skin followed by a standardized pin-prick to disrupt the epidermal barrier. Anandamide failed to affect forearm blood flow when administered intra-arterially at infusion rates of 0.3-300 nmol min(-1). The highest infusion rate led to an anandamide concentration of approximately 1 microM in venous blood as measured by mass spectrometry. Dermal application of anandamide significantly increased skin microcirculatory flow and coapplication of the transient receptor potential vanilloid 1 (TRPV1) antagonist capsazepine inhibited this effect. The TRPV1 agonists capsaicin, olvanil and arvanil all induced concentration-dependent increases in skin blood flow and burning pain when administered dermally. Coapplication of capsazepine inhibited blood flow and pain responses to all three TRPV1 agonists. This study shows that locally applied anandamide is a vasodilator in the human skin microcirculation. The results are consistent with this lipid being an activator of TRPV1 on primary sensory nerves, but do not support a role for anandamide as a circulating vasoactive hormone in the human forearm vascular bed.

  11. Prospective evaluation of ischemia in brachial-basilic and forearm prosthetic arteriovenous fistulas for hemodialysis.

    PubMed

    Keuter, X H A; Kessels, A G H; de Haan, M H; van der Sande, F M; Tordoir, J H M

    2008-05-01

    Ischemia is a devastating complication after arteriovenous fistula (AVF) creation. When not timely corrected, it may lead to amputation. Symptomatic ischemia occurs in 3.7-5% of the hemodialysis population. Upper arm AVFs have a higher incidence of ischemia compared to forearm AVFs. As more patients may need upper arm AVFs in the growing and older hemodialysis population, occurrence of symptomatic ischemia may increase. The purpose of this study is to identify predictors for occurrence of ischemia. A prospective evaluation of ischemia was performed in patients randomised for either a brachial-basilic (BB-) AVF or a prosthetic forearm loop AVF. Clinical parameters, preoperative vessel diameters, access flows, digital blood pressures, digit-to-brachial indices (DBI) and interventions for ischemia were recorded. Sixty-one patients (BB-AVF 28) were studied. Seventeen patients (BB-AVF 8) developed ischemic symptoms. Six patients (BB-AVF 3) needed interventions for severe symptoms. Age, history of peripheral arterial reconstruction and radial artery volume flow were significant predictors for the occurrence of ischemia. Symptomatic ischemia occurred in 28% of patients with brachial-basilic and prosthetic forearm AVFs. Age, history of peripheral arterial reconstruction and radial artery volume flow might be important for prediction of ischemia.

  12. Modified Sauvé-Kapandji procedure for restoration of forearm rotation in devascularized hands.

    PubMed

    Wang, W; Liu, S; Liu, J; Ruan, H; Cai, Z; Fan, C

    2014-12-01

    The purpose of this study is to evaluate the clinical outcomes in patients with forearm rotation limitation after successful wrist-level revascularization who underwent a modified Sauvé-Kapandji (S-K) procedure. This was a retrospective review of the clinical records of nine patients (three women, six men) after successful wrist-level revascularization who underwent late restoration of forearm rotation. All patients were evaluated using a Mayo Modified Wrist Score. The mean patient age was 35 (range 19-45) years. Mean time to reconstruction was 2.5 (range 0.5-4) years. Mean postoperative pronation was 74°; mean postoperative supination was 80°. Overall results were excellent/good in seven patients, fair in one, and poor in one. No bone bridge was formed between the pseudarthrosis in any patient. Two patients had neurapraxia. Moderate pain and snapping occurred in one patient during movement at the ulnar amputation site. This modification of the S-K procedure can restore rotation of the forearm after hand revascularization; as such, it provides an alternative salvage procedure.

  13. Wrist postures while keyboarding: effects of a negative slope keyboard system and full motion forearm supports.

    PubMed

    Hedge, A; Powers, J R

    1995-03-01

    Video-motion analysis was used to analyse hand/wrist posture for subjects typing at a 101-key QWERTY keyboard on a 68 cm high worksurface. Three conditions were tested: subjects typed at the keyboard without arm support, subjects typed with adjustable full motion forearm supports, and subjects typed with an adjustable negative slope keyboard support system. The average declination of the negative slope keyboard support chosen by subjects was 12 degrees below horizontal, which flattened the angle of the key tops. Ulnar deviation was comparable in all conditions and averaged 13 degrees for the right hand and 15 degrees for the left hand. Full motion forearm supports did not significantly affect any postural measures. Dorsal wrist extension averaged 13 degrees when typing with or without the full motion forearm supports, but this was reduced to an average -1 degree with the use of the negative slope keyboard support system. Subjects chose to sit at a distance of 79 cm from the computer screen when using the negative slope keyboard system compared with 69 cm without this.

  14. Evaluating Bone Health in Egyptian Children with Forearm Fractures: A Case Control Study

    PubMed Central

    Elbatrawy, Salwa; Gobashy, Amr; Moreira, Alvaro

    2016-01-01

    Objective. To determine the likelihood of vitamin D deficiency and low bone mineral density in Egyptian children with forearm fractures. Methods. A case control study of 46 children aged 3 to 10 years with or without forearm fractures. Validated questionnaires were used to assess calcium and vitamin D intake as well as sun exposure. Serum calcium, phosphorus, alkaline phosphatase, and 25-hydroxy-vitamin D were collected. Bone mineral density was evaluated using dual-energy X-ray absorptiometry. Results. Compared to the Control group, calcium and vitamin D intake was lower in the Cases group (p = 0.03). Cases had higher Body Mass Index than Controls, p = 0.01. Children in the Cases group had lower mean serum calcium values 8.3 ± 1.4 compared to 9.3 ± 1.1 in Controls (p = 0.01). Alkaline phosphatase was higher in Cases 265 ± 65.8 than Controls 226 ± 54.6 (p = 0.03). Vitamin D and bone mineral density scores were significantly lower in the Cases group (p < 0.05). Conclusion. Our data shows an increased rate of vitamin D deficiency and decreased bone mineral density in Egyptian children with forearm fractures. PMID:27651803

  15. Penile reconstruction: combined use of an innervated forearm osteocutaneous flap and big toe pulp.

    PubMed

    Sasaki, K; Nozaki, M; Morioka, K; Huang, T T

    1999-09-01

    The use of a radial forearm flap has become the most popular method to reconstruct a phallus in recent years. This method of reconstruction, however, is plagued with problems such as urethral fistula and loss of phallic girth as a result of tissue atrophy, rendering a phallic contour that is cosmetically unsatisfactory. We had the opportunity of modifying the technique of penile reconstruction using a forearm osteocutaneous flap to minimize these problems. Specifically, a segment of the big toe pulp is used to reconstruct a glans penis. Sensory restoration in the "glans" and "penile shaft" is restored by coapting the digital and the antebrachial nerves to the penile nerve remnants. A segment of flexor carpi radialis muscle is included in the design of a forearm flap to reinforce the coaptation site of the urethral tract. An arteriovenous shunt is incorporated in the shaft as a mechanism to elicit erection of the penis by compressing the root of the neophallus. We had used these technical modifications in a 51-year-old man who had undergone penile amputation because of cancer. The cosmetic appearance and erotic and tactile sensation in the shaft and glans were proper and satisfactory at the end of fourth year after the surgery. The coital function was also satisfactory.

  16. Forearm Skin Blood Flow After Kinesiology Taping in Healthy Soccer Players: An Exploratory Investigation.

    PubMed

    Woodward, Kirsty A; Unnithan, Vish; Hopkins, Nicola D

    2015-10-01

    Kinesiology tape (KT) has become popular among athletes for both injury prevention and rehabilitation due to its reported therapeutic effects, including facilitation of lymphatic flow and enhanced peripheral blood flow. However, evidence to support such claims is insufficient. To determine whether KT improves skin blood flow (SkBF) responses in young, elite soccer players. Randomized crossover study. Research laboratory. Thirteen healthy, elite, adolescent male soccer players (age = 14.7 ± 0.6 years). Participants completed 2 experimental trials; during trial 1, the volar aspect of the dominant forearm was taped. Forearm SkBF was measured within the taped area and 3 cm lateral to the taped area. During trial 2, no tape was applied to either site. Both trials were performed within 7 days. Baseline and maximal thermally (42°C) stimulated SkBF responses were assessed using laser Doppler flowmetry. Continuously measured SkBF and derived mean arterial pressure obtained at 5-minute intervals were used to calculate cutaneous vascular conductance (CVC), the primary outcome measure. No differences were observed for baseline SkBF or CVC between trials or measurement sites. After local heating, no differences were evident for SkBF or CVC between trials or measurement sites. Our findings suggest that, in healthy, trained adolescent males, KT was not associated with increased forearm SkBF.

  17. Development of a photographic scale for consistency and guidance in dermatologic assessment of forearm sun damage.

    PubMed

    McKenzie, Naja E; Saboda, Kathylynn; Duckett, Laura D; Goldman, Rayna; Hu, Chengcheng; Curiel-Lewandrowski, Clara N

    2011-01-01

    To develop a photographic sun damage assessment scale for forearm skin and test its feasibility and utility for consistent classification of sun damage. For a blinded comparison, 96 standardized 8 × 10 digital photographs of participants' forearms were taken. Photographs were graded by an expert dermatologist using an existing 9-category dermatologic assessment scoring scale until all categories contained photographs representative of each of 4 clinical signs. Triplicate photographs were provided in identical image sets to 5 community dermatologists for blinded rating using the dermatologic assessment scoring scale. Academic skin cancer prevention clinic with high-level experience in assessment of sun-damaged skin. Volunteer sample including participants from screenings, chemoprevention, and/or biomarker studies. Reproducibility and agreement of grading among dermatologists by Spearman correlation coefficient to assess the correlation of scores given for the same photograph, κ statistics for ordinal data, and variability of scoring among dermatologists, using analysis of variance models with evaluating physician and photographs as main effects and interaction effect variables to account for the difference in scoring among dermatologists. Correlations (73% to >90%) between dermatologists were all statistically significant (P < .001). Scores showed good to substantial agreement but were significantly different (P < .001) for each of 4 clinical signs and the difference varied significantly (P < .001) among photographs. With good to substantial agreement, we found the development of a photographic forearm sun damage assessment scale highly feasible. In view of significantly different rating scores, a photographic reference for assessment of sun damage is also necessary.

  18. Supinator Extender (SUE): a pneumatically actuated robot for forearm/wrist rehabilitation after stroke.

    PubMed

    Allington, James; Spencer, Steven J; Klein, Julius; Buell, Meghan; Reinkensmeyer, David J; Bobrow, James

    2011-01-01

    The robot described in this paper, SUE (Supinator Extender), adds forearm/wrist rehabilitation functionality to the UCI BONES exoskeleton robot and to the ArmeoSpring rehabilitation device. SUE is a 2-DOF serial chain that can measure and assist forearm supination-pronation and wrist flexion-extension. The large power to weight ratio of pneumatic actuators allows SUE to achieve the forces needed for rehabilitation therapy while remaining lightweight enough to be carried by BONES and ArmeoSpring. Each degree of freedom has a range of 90 degrees, and a nominal torque of 2 ft-lbs. The cylinders are mounted away from the patient's body on the lateral aspect of the arm. This is to prevent the danger of a collision and maximize the workspace of the arm robot. The rotation axis used for supination-pronation is a small bearing just below the subject's wrist. The flexion-extension motion is actuated by a cantilevered pneumatic cylinder, which allows the palm of the hand to remain open. Data are presented that demonstrate the ability of SUE to measure and cancel forearm/wrist passive tone, thereby extending the active range of motion for people with stroke.

  19. Forearm Skin Blood Flow After Kinesiology Taping in Healthy Soccer Players: An Exploratory Investigation

    PubMed Central

    Woodward, Kirsty A.; Unnithan, Vish; Hopkins, Nicola D.

    2015-01-01

    Context Kinesiology tape (KT) has become popular among athletes for both injury prevention and rehabilitation due to its reported therapeutic effects, including facilitation of lymphatic flow and enhanced peripheral blood flow. However, evidence to support such claims is insufficient. Objective To determine whether KT improves skin blood flow (SkBF) responses in young, elite soccer players. Design Randomized crossover study. Setting Research laboratory. Patients or Other Participants Thirteen healthy, elite, adolescent male soccer players (age = 14.7 ± 0.6 years). Intervention(s) Participants completed 2 experimental trials; during trial 1, the volar aspect of the dominant forearm was taped. Forearm SkBF was measured within the taped area and 3 cm lateral to the taped area. During trial 2, no tape was applied to either site. Both trials were performed within 7 days. Main Outcome Measure(s) Baseline and maximal thermally (42°C) stimulated SkBF responses were assessed using laser Doppler flowmetry. Continuously measured SkBF and derived mean arterial pressure obtained at 5-minute intervals were used to calculate cutaneous vascular conductance (CVC), the primary outcome measure. Results No differences were observed for baseline SkBF or CVC between trials or measurement sites. After local heating, no differences were evident for SkBF or CVC between trials or measurement sites. Conclusions Our findings suggest that, in healthy, trained adolescent males, KT was not associated with increased forearm SkBF. PMID:26445024

  20. [Forearm osteomusculocutaneous free filet flap for arm reconstruction after amputation as an alternative to shoulder disarticulation].

    PubMed

    Gachie, E; Alet, J-M; Nguyen, P; Della Volpe, C; Casanova, D

    2015-04-01

    We report the case of a 55-year-old woman suffering from a type I neurofibromatosis (also known as Von Recklinghausen neurofibromatosis) who was diagnosed with a high-grade schwannosarcoma of the median nerve, between the upper third and the medium third of the arm, upon contact with the humerus, invading the humeral vessels. The oncologic treatment of this tumour consisted in the amputation of the arm through the surgical neck of the humerus. In order to create a laterothoracic claw, to bring a partial function of the upper limb back, we decided to realize a free fillet forearm flap. This composite flap was composed of the radius and the ulna, all the forearm muscles and the skin of the anterior side of the forearm. A humeroradial plate osteosynthesis was done and the flap was then harvested with the radial pedicle, and anastomosed to the axillar artery. This procedure gave our patient a functional stump, giving back the arm functionality, especially the claw movement.

  1. String vibration dampers do not reduce racket frame vibration transfer to the forearm.

    PubMed

    Li, F X; Fewtrell, D; Jenkins, M

    2004-01-01

    In this study, we examined the effect of string vibration damping devices on reducing racket frame vibration transfer to the forearm. Twenty participants volunteered to hold a tennis racket stationary in a forehand and backhand stroking position while tennis balls were fired at 20 m x s(-1) towards two impact locations, the node of vibration and the dead spot. A three-way analysis of variance with repeated measures on damping condition, impact location and stroke condition was performed on the data. The resonant frequency of the hand-held racket was found to be approximately 120 Hz. No significant differences in amplitude of vibration at the resonant frequency were found for the wrist or the elbow when damped and non-damped impacts were compared. Impacts at the dead spot produced greater amplitudes of vibration (P < 0.01) but no interaction between impact location and string dampers was evident. The string dampers had no effect on the grip force used or the muscle electrical activity in the forearm after impact. In conclusion, we found that string dampers do not reduce the amount of racket frame vibration received at the forearm. We suggest that string dampers remain a popular accessory among tennis players because of their acoustic effects and psychological support rather than any mechanical advantage.

  2. Coriolis-induced cutaneous blood flow increase in the forearm and calf.

    PubMed

    Cheung, B; Hofer, K

    2001-04-01

    Using venous occlusion plethysmography, Sunahara et al. reported that Coriolis-induced nausea was accompanied by an increase in forearm blood flow, suggesting a decrease in sympathetic activity to this vascular bed. No significant blood pressure and heart rate changes were observed. Vasodilation of the limbs theoretically impairs orthostatic tolerance, particularly if blood flow is shown to increase simultaneously in the lower limbs. This study examined the latter possibility. Seventeen subjects were exposed to the Coriolis cross-coupling effects induced by 20 RPM yaw rotation, and a simultaneous 45 degrees pitch forward head movement in the sagittal plane every 12 s. Forearm and calf skin blood flow were monitored in real-time using laser Doppler flowmetry (PeriFlux 4001). Our results indicated a significant (p < 0.001) simultaneous forearm and calf skin blood flow increase as a result of Coriolis cross-coupling across all 15 susceptible subjects. No significant changes in blood pressure and heart rate were observed. Coriolis-induced cardiovascular changes may confound previous reports on reduced G tolerance using ground-based centrifuges that invariably evoke cross-coupling effects.

  3. Individuals with chronic hemiparetic stroke can correctly match forearm positions within a single arm.

    PubMed

    Gurari, Netta; Drogos, Justin M; Dewald, Julius P A

    2017-01-01

    Previous studies determined, using between arms position matching assessments, that at least one-half of individuals with stroke have an impaired position sense. We investigated whether individuals with chronic stroke who have impairments mirroring arm positions also have impairments identifying the location of each arm in space. Participants with chronic hemiparetic stroke and age-matched participants without neurological impairments (controls) performed a between forearms position matching task based on a clinical assessment and a single forearm position matching task, using passive and active movements, based on a robotic assessment. 12 out of our 14 participants with stroke who had clinically determined between forearms position matching impairments had greater errors than the controls in both their paretic and non-paretic arm when matching positions during passive movements; yet stroke participants performed comparable to the controls during active movements. Many individuals with chronic stroke may have impairments matching positions in both their paretic and non-paretic arm if their arm is moved for them, yet not within either arm if these individuals control their own movements. The neural mechanisms governing arm location perception in the stroke population may differ depending on whether arm movements are made passively versus actively. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  4. Individuals with chronic hemiparetic stroke can correctly match forearm positions within a single arm

    PubMed Central

    Gurari, Netta; Drogos, Justin M.; Dewald, Julius P.A.

    2017-01-01

    Objective Previous studies determined, using between arms position matching assessments, that at least one-half of individuals with stroke have an impaired position sense. We investigated whether individuals with chronic stroke who have impairments mirroring arm positions also have impairments identifying the location of each arm in space. Methods Participants with chronic hemiparetic stroke and age-matched participants without neurological impairments (controls) performed a between forearms position matching task based on a clinical assessment and a single forearm position matching task, using passive and active movements, based on a robotic assessment. Results 12 out of our 14 participants with stroke who had clinically determined between forearms position matching impairments had greater errors than the controls in both their paretic and non-paretic arm when matching positions during passive movements; yet stroke participants performed comparable to the controls during active movements. Conclusions Many individuals with chronic stroke may have impairments matching positions in both their paretic and non-paretic arm if their arm is moved for them, yet not within either arm if these individuals control their own movements. Significance The neural mechanisms governing arm location perception in the stroke population may differ depending on whether arm movements are made passively versus actively. PMID:27866116

  5. Access blood flow and the risk of complications in mature forearm and upper arm arteriovenous fistulas.

    PubMed

    Huijbregts, Henricus J T A M; Bots, Michiel L; Wittens, Cees H A; Schrama, Yvonne C; Blankestijn, Peter J

    2009-01-01

    Optimization of vascular access use in the 'fistula first' era requires comprehension of its clinical behavior. Little is known about mature arteriovenous fistula (AVF) performance and the role of fistula location. Widely used access flow (Qa) was used to analyze complication risks and functionality after first hemodialysis use. 178 Mature AVFs were analyzed. Complication was defined as permanent failure or >or=1 intervention. Factors associated with complications and mean Qa were determined using Cox proportional-hazards and linear regression models. Baseline Qa was significantly lower in complicated versus uncomplicated forearm and upper arm AVFs. In complicated forearm AVFs, preoperative arterial diameter was smaller while the risk of complications was graded per 100 ml/min baseline Qa increase. Diabetics had an increased risk of upper arm AVF complications. In uncomplicated forearm AVFs, diabetes was related to lower mean Qa, and BMI to higher Qa. In mature AVFs, baseline Qa depends on fistula location and is related to the risk of complications in a graded manner.

  6. 3D Measurement of Forearm and Upper Arm during Throwing Motion using Body Mounted Sensor

    NASA Astrophysics Data System (ADS)

    Koda, Hideharu; Sagawa, Koichi; Kuroshima, Kouta; Tsukamoto, Toshiaki; Urita, Kazutaka; Ishibashi, Yasuyuki

    The aim of this study is to propose the measurement method of three-dimensional (3D) movement of forearm and upper arm during pitching motion of baseball using inertial sensors without serious consideration of sensor installation. Although high accuracy measurement of sports motion is achieved by using optical motion capture system at present, it has some disadvantages such as the calibration of cameras and limitation of measurement place. Whereas the proposed method for 3D measurement of pitching motion using body mounted sensors provides trajectory and orientation of upper arm by the integration of acceleration and angular velocity measured on upper limb. The trajectory of forearm is derived so that the elbow joint axis of forearm corresponds to that of upper arm. Spatial relation between upper limb and sensor system is obtained by performing predetermined movements of upper limb and utilizing angular velocity and gravitational acceleration. The integration error is modified so that the estimated final position, velocity and posture of upper limb agree with the actual ones. The experimental results of the measurement of pitching motion show that trajectories of shoulder, elbow and wrist estimated by the proposed method are highly correlated to those from the motion capture system within the estimation error of about 10 [%].

  7. EFFECT OF USING WRIST ORTHOSES ON FOREARM FLEXOR AND EXTENSOR MUSCLE ACTIVATION

    PubMed Central

    Novais Van Petten, Adriana Maria Valladão; Ávila, Antônio Ferreira

    2015-01-01

    Objective: To investigate the effect of using wrist immobilization orthoses made from different materials, on activation of the flexor and extensor musculature of the forearm while performing specific tasks. Methods: Twenty-six adults, with an average age of 26.2 years, underwent the Jebsen-Taylor functional hand test and the grip strength test (Jamar® dynamometer) under three conditions: free hand, wearing a composite orthosis and wearing a thermoplastic orthosis. The tests were carried out using the dominant hand only. During the tests, surface electrodes were attached to the flexor and extensor muscles of the forearm to record the muscle electrical activity. The results obtained under the three conditions were compared and analyzed using the Wilcoxon statistical test. Results: Significant differences in muscle activation were found between using the free hand and using any of the orthoses. There was no significant difference in muscle activation between the two types of orthosis. A decrease in activity of the extensor muscles of the forearm was observed during all the tasks, as well as an increase in activation of the flexor muscles with the use of the orthoses. Conclusion: These results are important for defining whether an orthosis should be prescribed during the rehabilitation process for a wide range of disorders, such as tendinitis of the flexors and extensors of the wrist and fingers, as well as for predicting the length of time for which these devices should be used. PMID:27022523

  8. [Anatomical rationale for elevating revascularized ulnar forearm fasciocutaneous flap for head and neck reconstruction].

    PubMed

    Verbo, E V; Petrosyan, A A; Gileva, K S

    2015-01-01

    In this paper we studied in detail features of the blood supply to the tissues of the forearm of the pools ulnar and radial arteries, the technique of line access and the formation of skin-fascial ulnar flap by using a layered dissection with contrast vessels on non fixed human cadavers. Blood supply of the forearm carried out by branches radial and ulnar arteries, which allows to create in this area radial flap and ulnar flap loo. The size of the skin-fascial ulnar flap can reach 3-10 cm in length, 2-6 cm in width, the length of vessel pedicle of the transplant can reach 12 cm. The research studied the characteristics of blood supply of the forearm and the comparative evaluation of tissue perfusion of the radial and ulnar arteries; proved localization forming ulnar flap. Studies have shown that revascularised skin-fascial ulnar flap may be can be an alternative donor material for elimination of soft tissue defects with less traumatization donor area and reduce upper limb function compared with radial flap.

  9. Primary hip spica with crossed retrograde intramedullary rush pins for the management of diaphyseal femur fractures in children: A prospective, randomized study

    PubMed Central

    Ruhullah, Mohammad; Singh, H. R.; Shah, Sanjay; Shrestha, Dipak

    2014-01-01

    Background: Femoral fractures are common in children aged between 2 and 12 yearsand 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as a conservative treatment. We compared primary hip spica or traction followed by hip spica with closed reduction and fixation with retrogradely passed crossed Rush pins for diaphyseal femur fracture in 25 children of the age group 3-12 years, randomly distributed in each group. Materials and Methods: Fifty children (age: 3-13 years, mean; 9 years) with femoral fractures were evaluated; 25 of them underwent the conservative treatment using immediate hip spica (group A) and 25 underwent treatment with crossed retrograde Rush pins (group B). Results: Mean duration of fracture union was within 15 weeks in group A and 12 weeks in group B. Mean duration of weight bearing was 14weeks in group A and 7 weeks in group A. Mean hospital stay were 4 days in group A and 8days in group B. The man follow-up period was 16 months in group A and 17 months in group B. Complications like angulation, shortening and infection were compared. Bursitis and penetration of pins at the site of Rush pin insertion is a complication associated with this method of treatment. Conclusion: Closed reduction and internal fixation with crossed Rush pins was a superior treatment method in terms of early weight bearing and restoration of normal anatomy. PMID:24791042

  10. Does morbid obesity negatively affect the hospital course of patients undergoing treatment of closed, lower-extremity diaphyseal long-bone fractures?

    PubMed

    Baldwin, Keith D; Matuszewski, Paul E; Namdari, Surena; Esterhai, John L; Mehta, Samir

    2011-01-03

    Obesity is prevalent in the developed world and is associated with significant costs to the health care system. The effect of morbid obesity in patients operatively treated for long-bone fractures of the lower extremity is largely unknown. The National Trauma Data Bank was accessed to determine if morbidly obese patients (body mass index >40) with lower extremity fractures have longer length of hospital stay, higher cost, greater rehabilitation admission rates, and more complications than nonobese patients. We identified patients with operatively treated diaphyseal femur (6920) and tibia (5190) fractures. Polytrauma patients and patients younger than 16 years were excluded. Morbidly obese patients were identified by ICD-9 and database comorbidity designation (femur, 131 morbidly obese; tibia, 75 morbidly obese). Patients meeting these criteria who were not morbidly obese were used as controls. Sensitivity analyses were performed to analyze patients with isolated trauma to the tibia or femur. Morbidly obese patients were more likely to be admitted to a subacute facility. Length of stay trended higher in morbidly obese patients. There was no significant relationship between obesity and inpatient mortality or inpatient complications. These trends held true when considering patients with multiple injuries and patients who had isolated long-bone injuries. Our study showed that morbidly obese patients may have greater rehabilitation needs following long-bone fractures in the lower extremity. Our study showed no difference in mortality or complications, although further studies are needed to confirm these findings. Copyright 2011, SLACK Incorporated.

  11. Regeneration of bone using nanoplex delivery of FGF-2 and BMP-2 genes in diaphyseal long bone radial defects in a diabetic rabbit model.

    PubMed

    Khorsand, Behnoush; Nicholson, Nate; Do, Anh-Vu; Femino, John E; Martin, James A; Petersen, Emily; Guetschow, Brian; Fredericks, Douglas C; Salem, Aliasger K

    2017-02-28

    Bone fracture healing impairment related to systemic diseases such as diabetes can be addressed by growth factor augmentation. We previously reported that growth factors such as fibroblast growth factor-2 (FGF-2) and bone morphogenetic protein-2 (BMP-2) work synergistically to encourage osteogenesis in vitro. In this report, we investigated if BMP-2 and FGF-2 together can synergistically promote bone repair in a leporine model of diabetes mellitus, a condition that is known to be detrimental to union. We utilized two kinds of plasmid DNA encoding either BMP-2 or FGF-2 formulated into polyethylenimine (PEI) complexes. The fabricated nanoplexes were assessed for their size, charge, in vitro cytotoxicity, and capacity to transfect human bone marrow stromal cells (BMSCs). Using diaphyseal long bone radial defects in a diabetic rabbit model it was demonstrated that co-delivery of PEI-(pBMP-2+pFGF-2) embedded in collagen scaffolds resulted in a significant improvement in bone regeneration compared to PEI-pBMP-2 embedded in collagen scaffolds alone. This study demonstrated that scaffolds loaded with PEI-(pBMP-2+pFGF-2) could be an effective way of promoting bone regeneration in patients with diabetes. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Reality-augmented virtual fluoroscopy for computer-assisted diaphyseal long bone fracture osteosynthesis: a novel technique and feasibility study results.

    PubMed

    Zheng, G; Dong, X; Gruetzner, P A

    2008-01-01

    In this paper, a novel technique to create a reality-augmented virtual fluoroscopy for computer-assisted diaphyseal long bone fracture osteosynthesis and feasibility study results are presented. With this novel technique, repositioning of bone fragments during closed fracture reduction and osteosynthesis can lead to image updates in the virtual imaging planes of all acquired images without any radiation. The technique is achieved with a two-stage method. After acquiring a few (normally two) calibrated fluoroscopic images and before fracture reduction, the first stage, data preparation, interactively identifies and segments the bone fragments from the background in each image. After that, the second stage, image updates, repositions the fragment projection on to each virtual imaging plane in real time during fracture reduction and osteosynthesis using an OpenGL-based texture warping. Combined with a photorealistic virtual implant model rendering technique, the present technique allows the control of a closed indirect fracture osteosynthesis in the real world through direct insight into the virtual world. The first clinical study results show the reduction in the X-ray radiation to the patient as well as to the surgical team, and the improved operative precision, guaranteeing more safety for the patient. Furthermore, based on the experiences gained from this clinical study, two technical enhancements are proposed. One focuses on eliminating the user interactions with automated identifications and segmentations of bone fragments. The other focuses on providing non-photorealistic implant visualization. Further experiments are performed to validate the effectiveness of the proposed enhancements.

  13. The mechanical integrity of healed diaphyseal bone defects grafted with calcium hydroxyapatite/calcium triphosphate ceramic in a new animal model.

    PubMed

    Black, R J; Zardiackas, L D; Teasdall, R; Hughes, J L

    1990-01-01

    The need for an animal model to test bone graft materials simulating a weight bearing clinical situation is identified. The concept, design and operative detail of a new model is described. This model involved the creation of a mid-diaphyseal wedge defect in the femur of the adult beagle which separated both cortices, plating with a six-hole dynamic compression plate, and allowed immediate full weight bearing. At six months plates were removed and immediate weight bearing was allowed for an additional six months to sacrifice. The initial animal project utilizing this model to evaluate a hydroxyapatite based synthetic graft material was performed using 12 dogs. In addition to the operative procedure, the retrieval testing in torsion of 12 healed grafted bones and their 12 contralateral unoperated controls is described and evaluated. Results showed no statistically significant difference between the torsional strength of test and control femurs (p less than or equal to 0.05). In addition, the future development of the model is discussed.

  14. Long-term results of surgical decompression of chronic exertional compartment syndrome of the forearm in motocross racers.

    PubMed

    Winkes, Michiel B; Luiten, Ernest J T; van Zoest, Wart J F; Sala, Harm A; Hoogeveen, Adwin R; Scheltinga, Marc R

    2012-02-01

    Chronic exertional compartment syndrome (CECS) is occasionally observed in the forearm flexor muscles of motocross racers. Long-term results of fasciectomy and fasciotomy for this syndrome are scarce. To study the long-term effects of 2 surgical techniques for forearm flexor CECS. Case series; Level of evidence, 4. A database of patients with forearm CECS who underwent surgery was analyzed. Long-term pain reduction (visual analog scale [VAS], 0-100) and efficacy were evaluated using a questionnaire. Data of 24 motocross racers were available for analysis. Intracompartmental pressures during rest, during provocation, and after 1 and 5 minutes of provocation were 15 ± 4, 78 ± 24, 29 ± 10, and 25 ± 7 mm Hg, respectively. Painful sensations in the forearm were reduced from 53 to 7 (median VAS; P < .001). Both fasciectomy (n = 14) and fasciotomy (n = 10) were equally effective. More than 95% (23/24) of the patients were satisfied with the postoperative result after 5 ± 2 years' follow-up. Surgical fasciotomy and fasciectomy of the forearm flexor compartment are equally successful in motocross racers suffering from forearm CECS.

  15. The Effects of Forearm Support on Upper Body for People in Front of Monitor: A Meta-Analysis.

    PubMed

    Lyu, Jingtong; Wu, Xiaojing; Duan, Xin; Xiang, Zhou

    2015-01-01

    With the ever-growing number of people who work at visual display terminals, the work-related musculoskeletal disorders of the upper body are believed to be an important problem all over the world. The forearm support, which can keep the forearm and wrist in biomechanical posture, is a possible protective factor of the development of upper body syndrome. This meta-analysis examines the efficacy of forearm support in reducing upper body syndrome. The Cochrane Library, EMBASE, Ovid, ScienceDirect, SpringerLink, Google Scholar, CNKI database, and Wanfang database were searched from inception until May 29, 2013. Relevant studies were included after the screening of title, abstract, and the full text. Impact of bias was assessed independently by 2 authors. Four studies that met all the inclusion criteria were included finally. The combined results based on all studies suggested that statistically the forearm support had a nonsignificant effect on upper body syndrome (odds ratio [OR] = 0.70, 95% confidence interval [CI]: 0.49, 1.02). The result of subgroup analysis suggested that forearm support has a significant effect on neck or shoulder syndrome (OR = 0.70, 95% CI: 0.43, 1.14) and the effect on upper extremity syndrome (OR = 0.76, 95% CI: 0.49, 1.19) is not significant. This meta-analysis suggested that the forearm support had statistically nonsignificant effect on preventing upper body syndrome on the whole.

  16. Forearm fractures in Central Norway, 1999-2012: incidence, time trends, and seasonal variation.

    PubMed

    Hoff, Mari; Torvik, Ingrid Ask; Schei, Berit

    2016-01-01

    The incidence of forearm fractures for men and women ≥40 years in Central Norway was high during the period 1999-2012. A decline in fractures was observed only among women over 50 years. A seasonal variation with highest incidence in the winter months was found among women. The aim of this study was to examine the incidence of forearm fractures in Central Norway in men and women 40 years and older from 1999 to 2012 and assess time trends as well as seasonal variations. Data is from the fracture registry in Nord-Trøndelag, including all forearm fractures in persons ≥40 sustained from 1999 to 2012. Annual incidence of forearm fractures were calculated and tested for trends. Variations in the occurrence of fractures were explored by comparing proportion of fractures by month and seasons. The study population consisted of 4003 subjects (77.1% women). The total number of fractures were 4240. There was an increase in fractures for women with increasing age, steepest, a three-fold increase between age group 40-50 and the age group 50-60. Among men, this pattern was not observed as incidences did not change with increasing age. The age-standardized incidence rate for all fractures among women ≥50 ranged from 82 fractures per 1000 (95% CI 71-94) to 100 (88-114) and among men from 19 (14-27) to 31 (24-39). Restricting the analysis to the first fracture sustained during the observed period, women ≥50 years showed a reduction in fractures of 1.30% per year (95% CI 0.01%: 2.56%,) and 12.18% per 10 years (3.61%: 19.98%). For all women, there was a trend towards a decline of 0.73% per year (-2.29%: 0.85%), although not significant. For men, there was a trend towards an increase in fractures of 1.66% per year (-0.11%: 3.45%). The occurrence of fractures among women varied by season of the year, with higher fracture rates in the winter months. The incidence rate of forearm fractures in Central Norway was high. However, a small decline in the incidence of the first fracture

  17. Posterior interosseous nerve localization within the proximal forearm - a patient normalized parameter.

    PubMed

    Kamineni, Srinath; Norgren, Crystal R; Davidson, Evan M; Kamineni, Ellora P; Deane, Andrew S

    2017-04-18

    To provide a "patient-normalized" parameter in the proximal forearm. Sixty-three cadaveric upper extremities from thirty-five cadavers were studied. A muscle splitting approach was utilized to locate the posterior interosseous nerve (PIN) at the point where it emerges from beneath the supinator. The supinator was carefully incised to expose the midpoint length of the nerve as it passes into the forearm while preserving the associated fascial connections, thereby preserving the relationship of the nerve with the muscle. We measured the transepicondylar distance (TED), PIN distance in the forearm's neutral rotation position, pronation position, supination position, and the nerve width. Two individuals performed measurements using a digital caliper with inter-observer and intra-observer blinding. The results were analyzed with the Wilcoxon-Mann-Whitney test for paired samples. In pronation, the PIN was within two confidence intervals of 1.0 TED in 95% of cases (range 0.7-1.3 TED); in neutral, within two confidence intervals of 0.84 TED in 95% of cases (range 0.5-1.1 TED); in supination, within two confidence intervals of 0.72 TED in 95% of cases (range 0.5-0.9 TED). The mean PIN distance from the lateral epicondyle was 100% of TED in a pronated forearm, 84% in neutral, and 72% in supination. Predictive accuracy was highest in supination; in all cases the majority of specimens (90.47%-95.23%) are within 2 cm of the forearm position-specific percentage of TED. When comparing right to left sides for TEDs with the signed Wilcoxon-Mann-Whitney test for paired samples as well as a significance test (with normal distribution), the P-value was 0.0357 (significance - 0.05) indicating a significant difference between the two sides. This "patient normalized" parameter localizes the PIN crossing a line drawn between the lateral epicondyle and the radial styloid. Accurate PIN localization will aid in diagnosis, injections, and surgical approaches.

  18. The effect of forearm posture on wrist flexion in computer workers with chronic upper extremity musculoskeletal disorders

    PubMed Central

    Burgess, Ronald A; Thompson, R Terry; Rollman, Gary B

    2008-01-01

    Background Occupational computer use has been associated with upper extremity musculoskeletal disorders (UEMSDs), but the etiology and pathophysiology of some of these disorders are poorly understood. Various theories attribute the symptoms to biomechanical and/or psychosocial stressors. The results of several clinical studies suggest that elevated antagonist muscle tension may be a biomechanical stress factor. Affected computer users often exhibit limited wrist range of motion, particularly wrist flexion, which has been attributed to increased extensor muscle tension, rather than to pain symptoms. Recreational or domestic activities requiring extremes of wrist flexion may produce injurious stress on the wrist joint and muscles, the symptoms of which are then exacerbated by computer use. As these activities may involve a variety of forearm postures, we examined whether changes in forearm posture have an effect on pain reports during wrist flexion, or whether pain would have a limiting effect on flexion angle. Methods We measured maximum active wrist flexion using a goniometer with the forearm supported in the prone, neutral, and supine postures. Data was obtained from 5 subjects with UEMSDs attributed to computer use and from 13 control subjects. Results The UEMSD group exhibited significantly restricted wrist flexion compared to the control group in both wrists at all forearm postures with the exception of the non-dominant wrist with the forearm prone. In both groups, maximum active wrist flexion decreased at the supine forearm posture compared to the prone posture. No UEMSD subjects reported an increase in pain symptoms during testing. Conclusion The UEMSD group exhibited reduced wrist flexion compared to controls that did not appear to be pain related. A supine forearm posture reduced wrist flexion in both groups, but the reduction was approximately 100% greater in the UEMSD group. The effect of a supine forearm posture on wrist flexion is consistent with known

  19. The in vivo behaviour of a sol-gel glass and a glass-ceramic during critical diaphyseal bone defects healing.

    PubMed

    Gil-Albarova, Jorge; Salinas, Antonio J; Bueno-Lozano, Antonio L; Román, Jesus; Aldini-Nicolo, Nicolo; García-Barea, Agustina; Giavaresi, Gianluca; Fini, Milena; Giardino, Roberto; Vallet-Regí, Maria

    2005-07-01

    The in vivo evaluation, in New Zealand rabbits, of a sol-gel glass 70% CaO-30% SiO2 (in mol%) and a glass-ceramic obtained from thermal treatment of the glass, both bioactive in Kokubo's simulated body fluid (SBF), is presented. Femoral bone diaphyseal critical defects were filled with: (i) sol-gel glass cylinders, (ii) glass-ceramic cylinders, or (iii) no material (control group). Osteosynthesis was done by means of anterior screwed plates with an associate intramedullar Kirschner wire. Each group included 10 mature rabbits, 9 months old. Follow-up was 6 months. After sacrifice, macroscopic study showed healing of bone defects, with bone coating over the cylinders, but without evidence of satisfactory repair in control group. Radiographic study showed good implant stability and periosteal growth and bone remodelling around and over the filled bone defect. The morphometric study showed minimum evidences of degradation or resorption in glass-ceramic cylinders, maintaining its original shape, but sol-gel glass cylinders showed abundant fragmentation and surface resorption. An intimate union of the new-formed bone to both materials was observed. Mechanical study showed the higher results in the glass-ceramic group, whereas sol-gel glass and control group showed no differences. The minimum degradation of glass-ceramic cylinders suggests their application in critical bone defects locations of transmission forces or load bearing. The performance of sol-gel glass cylinders suggests their usefulness in locations where a quick resorption should be preferable, considering the possibility of serving as drug or cells vehicle for both of them.

  20. Three-dimensional printing of rhBMP-2-loaded scaffolds with long-term delivery for enhanced bone regeneration in a rabbit diaphyseal defect.

    PubMed

    Shim, Jin-Hyung; Kim, Se Eun; Park, Ju Young; Kundu, Joydip; Kim, Sung Won; Kang, Seong Soo; Cho, Dong-Woo

    2014-07-01

    In this study, recombinant human bone morphogenetic protein-2 (rhBMP-2) delivery system with slow mode was successfully developed in three-dimensional (3D) printing-based polycaprolactone (PCL)/poly(lactic-co-glycolic acid) (PLGA) scaffolds for bone formation of critical-sized rabbit segmental diaphyseal defect. To control the delivery of the rhBMP-2, collagen (for long-term delivery up to 28 days) and gelatin (for shor-term delivery within a week) solutions encapsulating rhBMP-2 were dispensed into a hollow cylinderical type of PCL/PLGA scaffold. An effective dose of 5μg/mL was determined by measuring the alkaline phosphatase and osteocalcin gene expression levels of human nasal inferior turbinate-derived mesenchymal stromal cells (hTMSCs) seeded on the PCL/PLGA/collagen scaffold in vitro. However, it was found that a burst release of rhBMP-2 from the PCL/PLGA/gelatin scaffold did not induce the osteogenic differentiation of hTMSCs in vitro at an equivalent dose. In the in vivo animal experiements, microcomputed tomography and histological analyses confirmed that PCL/PLGA/collagen/rhBMP-2 scaffolds (long-term delivery mode) showed the best bone healing quality at both weeks 4 and 8 after implantation without inflammatory response. On the other hand, a large number of macrophages indicating severe inflammation provoked by burst release of rhBMP-2 were observed in the vicinity of PCL/PLGA/gelatin/rhBMP-2 (short-term delivery mode) at week 4.

  1. Three-Dimensional Printing of rhBMP-2-Loaded Scaffolds with Long-Term Delivery for Enhanced Bone Regeneration in a Rabbit Diaphyseal Defect

    PubMed Central

    Shim, Jin-Hyung; Kim, Se Eun; Park, Ju Young; Kundu, Joydip; Kim, Sung Won

    2014-01-01

    In this study, recombinant human bone morphogenetic protein-2 (rhBMP-2) delivery system with slow mode was successfully developed in three-dimensional (3D) printing-based polycaprolactone (PCL)/poly(lactic-co-glycolic acid) (PLGA) scaffolds for bone formation of critical-sized rabbit segmental diaphyseal defect. To control the delivery of the rhBMP-2, collagen (for long-term delivery up to 28 days) and gelatin (for shor-term delivery within a week) solutions encapsulating rhBMP-2 were dispensed into a hollow cylinderical type of PCL/PLGA scaffold. An effective dose of 5μg/mL was determined by measuring the alkaline phosphatase and osteocalcin gene expression levels of human nasal inferior turbinate-derived mesenchymal stromal cells (hTMSCs) seeded on the PCL/PLGA/collagen scaffold in vitro. However, it was found that a burst release of rhBMP-2 from the PCL/PLGA/gelatin scaffold did not induce the osteogenic differentiation of hTMSCs in vitro at an equivalent dose. In the in vivo animal experiements, microcomputed tomography and histological analyses confirmed that PCL/PLGA/collagen/rhBMP-2 scaffolds (long-term delivery mode) showed the best bone healing quality at both weeks 4 and 8 after implantation without inflammatory response. On the other hand, a large number of macrophages indicating severe inflammation provoked by burst release of rhBMP-2 were observed in the vicinity of PCL/PLGA/gelatin/rhBMP-2 (short-term delivery mode) at week 4. PMID:24517081

  2. Long-term Formation of Aggressive Bony Lesions in Dogs with Mid-Diaphyseal Fractures Stabilized with Metallic Plates: Incidence in a Tertiary Referral Hospital Population

    PubMed Central

    Gilley, Robert S.; Hiebert, Elizabeth; Clapp, Kemba; Bartl-Wilson, Lara; Nappier, Michael; Werre, Stephen; Barnes, Katherine

    2017-01-01

    The incidence of complications secondary to fracture stabilization, particularly osteolytic lesions and bony tumor formation, has long been difficult to evaluate. The objective of this study was to describe the long-term incidence of aggressive bony changes developing in dogs with long bone diaphyseal fractures stabilized by metallic bone plates compared to a breed-, sex-, and age-matched control group. The medical records of a tertiary referral center were retrospectively reviewed for dogs that matched each respective criterion. Signalment, history, cause of death (if applicable), and aggressive bony changes at previous fracture sites were recorded. Ninety dogs met the criteria for inclusion in the fracture group and were matched with appropriate control dogs. Four of the dogs in the fracture group developed aggressive bony changes at the site of previous fracture repairs most consistent with osseous neoplasia. One lesion was confirmed with cytology as neoplastic. The population of dogs was mixed with regard to breed and body weight, but all dogs with aggressive bony lesions were male. Incidence of aggressive bony lesion formation in the fracture group was 4 (4.4%) and was 0 (0%) in the control group; three (75%) of the affected dogs in the fracture group included cerclage as a component of their primary fracture stabilizations. Incidence of aggressive bony lesions in the fracture group compared to the control group was determined to be statistically significant (p = 0.0455), as was the incidence of cerclage among dogs affected by aggressive bony lesions compared to the rest of the fracture group (p = 0.0499). Development of aggressive bony lesions is an uncommon complication of fracture fixation. Additional research is needed to further identify and elucidate the long-term effects of metallic implants in dogs. PMID:28197406

  3. Long-term Formation of Aggressive Bony Lesions in Dogs with Mid-Diaphyseal Fractures Stabilized with Metallic Plates: Incidence in a Tertiary Referral Hospital Population.

    PubMed

    Gilley, Robert S; Hiebert, Elizabeth; Clapp, Kemba; Bartl-Wilson, Lara; Nappier, Michael; Werre, Stephen; Barnes, Katherine

    2017-01-01

    The incidence of complications secondary to fracture stabilization, particularly osteolytic lesions and bony tumor formation, has long been difficult to evaluate. The objective of this study was to describe the long-term incidence of aggressive bony changes developing in dogs with long bone diaphyseal fractures stabilized by metallic bone plates compared to a breed-, sex-, and age-matched control group. The medical records of a tertiary referral center were retrospectively reviewed for dogs that matched each respective criterion. Signalment, history, cause of death (if applicable), and aggressive bony changes at previous fracture sites were recorded. Ninety dogs met the criteria for inclusion in the fracture group and were matched with appropriate control dogs. Four of the dogs in the fracture group developed aggressive bony changes at the site of previous fracture repairs most consistent with osseous neoplasia. One lesion was confirmed with cytology as neoplastic. The population of dogs was mixed with regard to breed and body weight, but all dogs with aggressive bony lesions were male. Incidence of aggressive bony lesion formation in the fracture group was 4 (4.4%) and was 0 (0%) in the control group; three (75%) of the affected dogs in the fracture group included cerclage as a component of their primary fracture stabilizations. Incidence of aggressive bony lesions in the fracture group compared to the control group was determined to be statistically significant (p = 0.0455), as was the incidence of cerclage among dogs affected by aggressive bony lesions compared to the rest of the fracture group (p = 0.0499). Development of aggressive bony lesions is an uncommon complication of fracture fixation. Additional research is needed to further identify and elucidate the long-term effects of metallic implants in dogs.

  4. Load/Strain Distribution between Ulna and Radius in the Mouse Forearm Compression Loading Model

    PubMed Central

    Lu, Yunkai; Thiagarajan, Ganesh; Nicolella, Daniel P.; Johnson, Mark L.

    2011-01-01

    Finite element analysis (FEA) of the mouse forearm compression loading model is used to relate strain distributions with downstream changes in bone formation and responses of bone cells. The objective of this study was to develop two FEA models – the first one with the traditional ulna only and the second one in which both the ulna and radius are included, in order to examine the effect of the inclusion of the radius on the strain distributions in the ulna. The entire mouse forearm was scanned using microCT and images were converted into FEA tetrahedral meshes using a suite of software programs. The performance of both linear and quadratic tetrahedral elements and coarse and fine meshes were studied. A load of 2 N was applied to the ulna/radius model and a 1.3 N load (based on previous investigations of load sharing between the ulna and radius in rats) was applied to the ulna only model for subsequent simulations. The results showed differences in the cross sectional strain distributions and magnitude within the ulna for the combined ulna/radius model versus the ulna only model. The maximal strain in the combined model occurred about 4 mm towards the distal end from the ulna mid-shaft in both models. Results from the FEA model simulations were also compared to experimentally determined strain values. We conclude that inclusion of the radius in FE models to predict strains during in vivo forearm loading increases the magnitude of the estimated ulna strains compared to those predicted from a model of the ulna alone but the distribution was similar. This has important ramifications for future studies to understand strain thresholds needed to activate bone cell responses to mechanical loading. PMID:21903442

  5. Role of spinal premotoneurones in mediating corticospinal input to forearm motoneurones in man

    PubMed Central

    Pauvert, V; Pierrot-Deseilligny, E; Rothwell, J C

    1998-01-01

    Evidence was sought to support the suggestion that corticospinal input can be relayed to motoneurones (MNs) via a population of interneurones (premotoneurones) in the cervical cord, and that this pathway operates in parallel with the direct monosynaptic pathway. Single motor units were recorded in forearm muscles and post-stimulus time histograms (PSTHs) of their firing pattern were constructed during voluntary activation. Weak transcranial magnetic stimulation of the contralateral motor cortex was used to produce a small facilitation in the PSTH. We then examined how the size of this peak was affected by low threshold electrical stimulation of either the homonymous muscle nerve or the musculo-cutaneous nerve at various interstimulus intervals (ISIs). Homonymous nerve stimulation had the following characteristics: (a) the cortical peak was facilitated when stimuli were timed so that both inputs arrived simultaneously at the MN; (b) the amount of facilitation was only slightly greater than the sum of the effects of each stimulus given alone; and (c) facilitation affected even the earliest bins of the cortically evoked peak. These three features are consistent with a monosynaptic input onto the MN from both sources. Stimulation of the musculo-cutaneous nerve (which has no monosynaptic connections with forearm MNs) had no effect at similar timings. It (a) produced facilitation only at longer intervals corresponding to an extra central delay of 4–6 ms; (b) always gave a significantly larger facilitation than expected from the algebraic sum of the effects of each stimulus given alone; and (c) never affected the earliest bins of the cortical peak. These features are compatible with interaction of peripheral and cortical inputs at a population of premotoneurones. These results confirm the suggestion that premotoneurones mediate part of the cortical command to MNs innervating forearm muscles. Excitation is followed by an inhibition which may almost completely suppress

  6. Spatial localization of electromyographic amplitude distributions associated to the activation of dorsal forearm muscles.

    PubMed

    Gallina, Alessio; Botter, Alberto

    2013-01-01

    In this study we investigated whether the spatial distribution of surface electromyographic (EMG) amplitude can be used to describe the activation of muscle portions with different biomechanical actions. Ten healthy subjects performed isometric contractions aimed to selectively activate a number of forearm muscles or muscle subportions. Monopolar electromyographic signals were collected with an electrode grid of 128 electrodes placed on the proximal, dorsal portion of the forearm. The monopolar EMG amplitude [root mean square (RMS) value] distribution was calculated for each contraction, and high-amplitude channels were identified through an automatic procedure; the position of the EMG source was estimated with the barycenter of these channels. Each of the contractions tested was associated to a specific EMG amplitude distribution, whose location in space was consistent with the expected anatomical position of the main agonist muscle (or subportion). The position of each source was significantly different from the others in at least one direction (ANOVA; transversally to the forearm: P < 0.01, F = 125.92; longitudinally: P < 0.01, F = 35.83). With such an approach, we could distinguish the spatial position of EMG distributions related to the activation of contiguous muscles [e.g., extensor carpi ulnaris (ECU) and extensor digitorum communis (EDC)], different heads of the same muscle (i.e., extensor carpi radialis (ECR) brevis and longus) and different functional compartments (i.e., EDC, middle, and ring fingers). These findings are discussed in terms of how forces along a given direction can be produced by recruiting population of motor units clustered not only in specific muscles, but also in muscle sub-portions. In addition, this study supports the use of high-density EMG systems to characterize the activation of muscle subportions with different biomechanical actions.

  7. Spatial localization of electromyographic amplitude distributions associated to the activation of dorsal forearm muscles

    PubMed Central

    Gallina, Alessio; Botter, Alberto

    2013-01-01

    In this study we investigated whether the spatial distribution of surface electromyographic (EMG) amplitude can be used to describe the activation of muscle portions with different biomechanical actions. Ten healthy subjects performed isometric contractions aimed to selectively activate a number of forearm muscles or muscle subportions. Monopolar electromyographic signals were collected with an electrode grid of 128 electrodes placed on the proximal, dorsal portion of the forearm. The monopolar EMG amplitude [root mean square (RMS) value] distribution was calculated for each contraction, and high-amplitude channels were identified through an automatic procedure; the position of the EMG source was estimated with the barycenter of these channels. Each of the contractions tested was associated to a specific EMG amplitude distribution, whose location in space was consistent with the expected anatomical position of the main agonist muscle (or subportion). The position of each source was significantly different from the others in at least one direction (ANOVA; transversally to the forearm: P < 0.01, F = 125.92; longitudinally: P < 0.01, F = 35.83). With such an approach, we could distinguish the spatial position of EMG distributions related to the activation of contiguous muscles [e.g., extensor carpi ulnaris (ECU) and extensor digitorum communis (EDC)], different heads of the same muscle (i.e., extensor carpi radialis (ECR) brevis and longus) and different functional compartments (i.e., EDC, middle, and ring fingers). These findings are discussed in terms of how forces along a given direction can be produced by recruiting population of motor units clustered not only in specific muscles, but also in muscle sub-portions. In addition, this study supports the use of high-density EMG systems to characterize the activation of muscle subportions with different biomechanical actions. PMID:24379788

  8. Effect of repeated forearm muscle cooling on the adaptation of skeletal muscle metabolism in humans

    NASA Astrophysics Data System (ADS)

    Wakabayashi, Hitoshi; Nishimura, Takayuki; Wijayanto, Titis; Watanuki, Shigeki; Tochihara, Yutaka

    2017-07-01

    This study aimed to investigate the effect of repeated cooling of forearm muscle on adaptation in skeletal muscle metabolism. It is hypothesized that repeated decreases of muscle temperature would increase the oxygen consumption in hypothermic skeletal muscle. Sixteen healthy males participated in this study. Their right forearm muscles were locally cooled to 25 °C by cooling pads attached to the skin. This local cooling was repeated eight times on separate days for eight participants (experimental group), whereas eight controls received no cold exposure. To evaluate adaptation in skeletal muscle metabolism, a local cooling test was conducted before and after the repeated cooling period. Change in oxy-hemoglobin content in the flexor digitorum at rest and during a 25-s isometric handgrip (10% maximal voluntary construction) was measured using near-infrared spectroscopy at every 2 °C reduction in forearm muscle temperature. The arterial blood flow was occluded for 15 s by upper arm cuff inflation at rest and during the isometric handgrip. The oxygen consumption in the flexor digitorum muscle was evaluated by a slope of the oxy-hemoglobin change during the arterial occlusion. In the experimental group, resting oxygen consumption in skeletal muscle did not show any difference between pre- and post-intervention, whereas muscle oxygen consumption during the isometric handgrip was significantly higher in post-intervention than in pre-test from thermoneutral baseline to 31 °C muscle temperature ( P < 0.05). This result indicated that repeated local muscle cooling might facilitate oxidative metabolism in the skeletal muscle. In summary, skeletal muscle metabolism during submaximal isometric handgrip was facilitated after repeated local muscle cooling.

  9. Intramuscular and subcutaneous forearm parathyroid autograft hyperplasia in renal dialysis patients: A retrospective cohort study.

    PubMed

    Hsu, Yu-Chen; Hung, Chung-Jye

    2015-11-01

    Intramuscular and subcutaneous forearm parathyroid autograft are proved to have compatible short-term outcome. However, long-term clinical courses have not been studied. A single-surgeon retrospective cohort study of parathyroid autograft hyperplasia from August 1998 to January 2013 was performed. According to the location of their parathyroid autograft, patients were divided into an Intramuscular group and a Subcutaneous group. Clinical parameters were analyzed to assess the risk factors and clinical course of autograft hyperplasia. There were 888 consecutive patients who underwent total parathyroidectomy with forearm autotransplantation for renal hyperparathyroidism during the period. The median age at the time of total parathyroidectomy with forearm autotransplantation was 54.2 years (range, 12-86) and the median follow-up time was 4.0 years (range 0.1-16). Autograftectomy was performed on 29 of 888 patients. The incidence of autograftectomy was 15 of 65 in the Intramuscular group and 14 of 823 in the Subcutaneous group; the incidence of repeated autograftectomy was 4 of 65 in the Intramuscular group and 1 of 823 in the Subcutaneous group. The cumulative frequency of autograftectomy was greater in the Intramuscular group than that in the Subcutaneous group (11.6 vs 3.1% at 6 years, P < .001). The location of the autograft was the only significant factor affecting the autograftectomy frequency (P = .002). The Intramuscular group reoperation patients experienced a longer period between their first operation and the autograftectomy (6.6 vs 3.3 years, P = .003), longer operating times (79 vs 37 minutes, P = .002), and a greater level of pre-autograftectomy systemic intact parathyroid hormone (1,044 vs 559 ng/L, P = .014) than the Subcutaneous group. Intramuscular parathyroid autotransplantation results in a high incidence of autograftectomy, repeated autograftectomy, and a high cumulative frequency of autograftectomy. Copyright © 2015 Elsevier Inc. All rights

  10. Differences in forearm strength, endurance, and hemodynamic kinetics between male boulderers and lead rock climbers.

    PubMed

    Fryer, S; Stone, K J; Sveen, J; Dickson, T; España-Romero, V; Giles, D; Baláš, J; Stoner, L; Draper, N

    2017-07-28

    This study examined differences in the oxygenation kinetics and strength and endurance characteristics of boulderers and lead sport climbers. Using near infrared spectroscopy, 13-boulderers, 10-lead climbers, and 10-controls completed assessments of oxidative capacity index and muscle oxygen consumption (mV˙O2) in the flexor digitorum profundus (FDP), and extensor digitorum communis (EDC). Additionally, forearm strength (maximal volitional contraction MVC), endurance (force-time integral FTI at 40% MVC), and forearm volume (FAV and ΔFAV) was assessed. MVC was significantly greater in boulderers compared to lead climbers (mean difference = 9.6, 95% CI 5.2-14 kg). FDP and EDC oxidative capacity indexes were significantly greater (p = .041 and .013, respectively) in lead climbers and boulderers compared to controls (mean difference = -1.166, 95% CI (-3.264 to 0.931 s) and mean difference = -1.120, 95% CI (-3.316 to 1.075 s), respectively) with no differences between climbing disciplines. Climbers had a significantly greater FTI compared to controls (mean difference = 2205, 95% CI= 1114-3296 and mean difference = 1716, 95% CI = 553-2880, respectively) but not between disciplines. There were no significant group differences in ΔFAV or mV˙O2. The greater MVC in boulderers may be due to neural adaptation and not hypertrophy. A greater oxidative capacity index in both climbing groups suggests that irrespective of climbing discipline, trainers, coaches, and practitioners should consider forearm specific aerobic training to aid performance.

  11. Type I collagen nerve conduits for median nerve repairs in the forearm.

    PubMed

    Dienstknecht, Thomas; Klein, Silvan; Vykoukal, Jody; Gehmert, Sebastian; Koller, Michael; Gosau, Martin; Prantl, Lukas

    2013-06-01

    To evaluate patients with median nerve damage in the distal forearm treated with type 1 collagen nerve conduits. Nine patients with damage to the median nerve in the distal forearm underwent treatment with a type 1 collagen nerve conduit. The nerve gaps ranged between 1 and 2 cm. An independent observer reexamined patients after treatment at a minimal follow-up of 14 months and a mean follow-up of 21 months. Residual pain was evaluated using a visual analog scale. Functional outcome was quantified by assessing static 2-point discrimination, nerve conduction velocity relative to the uninjured limb, and Disabilities of the Arm, Shoulder, and Hand outcome measure scoring. We also recorded quality of life measures including patients' perceived satisfaction with the results and return to work latency. We observed no implant-related complications. Of 9 patients, 7 were free of pain, and the mean visual analog scale was 0.6. The mean Disabilities of the Arm, Shoulder, and Hand score was 6. The static 2-point discrimination was less than 6 mm in 3 patients, between 6 and 10 mm in 4 patients, and over 10 mm in 2 patients. Six patients reached a status of M4 or higher. Eight patients were satisfied with the procedure and would undergo surgery again. This study indicates that purified type 1 bovine collagen conduits are a practical and efficacious method for the repair of median nerves in the distal forearm. Therapeutic IV. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. Reliability of near infrared spectroscopy (NIRS) for measuring forearm oxygenation during incremental handgrip exercise.

    PubMed

    Celie, Bert; Boone, Jan; Van Coster, Rudy; Bourgois, Jan

    2012-06-01

    The purpose of this study was to test the reliability of a new handgrip exercise protocol measuring forearm oxygenation in 20 healthy subjects on two occasions. The retest took place 48 h later and at the same time of the day. The incremental exercise consisted of 2 min steps of cyclic handgrip contraction (1/2 Hz) separated by 1 min of recovery. The exercise started at 20% MVC, was increased with 10% MVC each step and was performed until exhaustion (69.5 and 73% MVC). Near infrared spectroscopy (NIRS) was used to measure deoxygenation (deoxy[Hb + Mb]) and oxygen saturation (SmO(2)) in the forearm muscles. Prior to the exercise protocol an arterial occlusion of the forearm was performed until deoxy(Hb + Mb) did no longer increase. Maximal increase in deoxy[Hb + Mb] during 10 s of each exercise bout was expressed relative to the occlusion amplitude. ICC was used to examine the test-retest reliability. Significant ICC's were reported at 50% (r = 0.466, p = 0.017) and 60% MVC (r = 0.553, p = 0.005). The group mean of the maximum increase in oxygen extraction was 45.6 ± 16.7% and at the retest 44.9 ± 17.0% with an ICC of r = 0.867 (p < 0.001) which could be classified (Landis and Koch 1979) as almost perfect. The absolute SmO(2) values showed reliable ICC's for every submaximal intensity except at 60% MVC. An ICC of r = 0.774 (p < 0.001) was found at maximal intensity. The results of the present study show that deoxy[Hb + Mb] and SmO(2) responses during this protocol are highly reliable and indicate that this protocol could be used to get insight into deoxygenation and oxygen saturation in a population with low exercise tolerance.

  13. Forearm and Hand Function after Radial Artery Harvest for Coronary Artery Bypass Grafting: Subjective Patients' Assessment.

    PubMed

    Drohomirecka, Anna; Kwinecki, Paweł; Gwóźdź, Witold; Mieczyński, Mariusz; Stępiński, Piotr; Jasiński, Jarosław; Stręk, Krzysztof; Cichoń, Romulad

    2016-08-23

    As arterial myocardial revascularization is proved to provide great results, radial artery use as a graft and its consequences remain an important issue. The aim of the study was to evaluate how patients assess their forearm and hand function after radial artery harvest for coronary artery bypass grafting (CABG). 50 patients (mean age 52.2 ± 7.4 years) who underwent CABG at least 6 months (median follow up 11.75 months) earlier filled in a questionnaire concerning hand and forearm efficiency and discomfort. The global efficiency of the operated upper extremity was scored mean 8.87 ± 1.26 points on a 10-point scale and it was worse in patients who noticed at least one sort of disorder than in patients with no problems (8.6 ± 1.4 versus 9.4 ± 0.7 points; P = .04). Paresthesias were the most often reported disorders; 21 patients felt some tingling and/or numbness, but in only 14 (28%) could the symptoms be considered as related to the operation. 20 patients (40%) declared that they felt some scar-related discomfort. Reduced grip strength and excessive hand fatigue were reported by 20% and 10% of patients, respectively. None of those interviewed answered that symptoms reported affected his or her life activity on any level. The hand and forearm efficiency after radial artery harvest for CABG was highly evaluated by the majority of patients. Despite the fact that many patients reported some surgery-related problems, they did not notice extremity dysfunction that could limit their life activity.

  14. Cortical Porosity Identifies Women with Osteopenia at Increased Risk for Forearm Fractures

    PubMed Central

    Bala, Yohann; Zebaze, Roger; Ghasem-Zadeh, Ali; Atkinson, Elizabeth J.; Iuliano, Sandra; Peterson, James M.; Amin, Shreyasee; Bjørnerem, Åshild; Melton, L. Joseph; Johansson, Helena; Kanis, John A.; Khosla, Sundeep; Seeman, Ego

    2014-01-01

    Background Most fragility fractures arise among the many women with osteopenia, not the smaller number with osteoporosis at high risk for fracture. Thus, most women at risk for fracture assessed only by measuring areal bone mineral density (aBMD) will remain untreated. Methods We measured cortical porosity and trabecular bone volume/total volume (BV/TV) of the ultradistal radius (UDR) using high-resolution peripheral quantitative computed tomography, aBMD using densitometry, and 10-year fracture probability using the country-specific FRAX tool in 68 postmenopausal women with forearm fractures and 70 age-matched community controls in Olmsted County, Minnesota. Results Women with forearm fractures had 0.4 standard deviations (SD) higher cortical porosity and 0.6 SD lower trabecular BV/TV. Compact-appearing cortical porosity predicted fracture independent of aBMD; odds ratio [OR] 1.92 (95%CI, 1.10–3.33). In women with osteoporosis at the UDR, cortical porosity did not distinguish those with, from those without, fractures because high porosity was present in 92% and 86% of each group respectively. By contrast, in women with osteopenia at the UDR, high porosity of the compact-appearing cortex conferred an OR for fracture of 4.00 (95%CI, 1.15–13.90). Conclusion In women with osteoporosis, porosity is captured by aBMD and so measuring UDR cortical porosity does not improve diagnostic sensitivity. However, in women with osteopenia, cortical porosity was associated with forearm fractures. PMID:24519558

  15. Feasibility and safety of same-day discharge after complex percutaneous coronary intervention using forearm approach.

    PubMed

    Koutouzis, Michael; Karatasakis, Aris; Brilakis, Emmanouil S; Agelaki, Maria; Maniotis, Christos; Dimitriou, Panagiotis; Lazaris, Efstathios

    2017-06-01

    We sought to assess the feasibility and safety of same-day discharge (SDD) after complex percutaneous coronary intervention (PCI) using a forearm approach. SDD has been shown to be safe after elective, low-risk PCI. However, the feasibility and safety of SDD in more complex patients and lesions has received limited study. We retrospectively reviewed 1190 elective PCIs that were performed between January 2013 and December 2015 at the Red Cross General Hospital. Of the 1190 PCIs, 166 (13.9%) were complex (bifurcations, vein and arterial grafts, unprotected left main, last remaining vessel, chronic total occlusions, or with utilization of rotational atherectomy or hemodynamic support). As compared with non-complex cases, complex cases were associated with older age, male gender, higher prevalence of diabetes mellitus and prior coronary artery bypass graft surgery, lower prevalence of smoking, higher utilization of femoral access and 7F guiding catheters, higher contrast utilization and fluoroscopy dose, longer fluoroscopy time, more stents per lesion, more frequent single vessel treatment and non-complete revascularization, and treatment with ticagrelor and bivalirudin. Among the patients who underwent complex PCI (n=166), twenty eight (16.9%) were discharged the same day. SDD after complex PCI was associated with younger age and more frequent use of forearm access. The 30-day incidence of major adverse cardiac events after complex PCI was 0% vs 3.6% (p=0.59) in patients with SDD vs. overnight hospitalization. SDD is feasible and safe in selected patients undergoing elective complex PCI using the forearm approach. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. MR intensity measurements of nondenervated muscle in patients following severe forearm trauma.

    PubMed

    Viddeleer, A R; Sijens, P E; van Ooijen, P M A; Kuypers, P D L; Hovius, S E R; Oudkerk, M

    2011-08-01

    Fluid increases resulting in higher MRI signal intensities in T(2) -weighted and short tau inversion recovery (STIR) sequences can be used to diagnose nerve injury. By comparing the signal intensities over time, MRI may become a new method for monitoring the healing process. Muscle edema is assessed by comparing the signal intensity of affected muscle with that of nonaffected muscle. However, in severe forearm trauma, the signal of nondenervated muscle may also be increased by wound edema, thus masking the effect of denervation. Hence, the purpose of this study was to investigate the influence of wound edema on muscle signal intensity in 29 consecutive patients examined on a 1.5-T MRI scanner at 1, 3, 6, 9 and 12 months after severe forearm trauma. The long-term course of wound edema and the influence of wound distance were thus investigated using a standardized imaging, calibration and post-processing protocol. The signal intensities of nondenervated intrinsic hand muscles were measured in the affected and contralateral sides. Muscle signal intensities were increased on the trauma side at 1 and 3 months (18% and 7.4%, respectively; p < 0.001) and normalized thereafter. In the contralateral hand, no significant signal changes were seen. No relationship was found between wound distance and the severity of wound edema. This study shows that wound edema influences muscle signal intensity comparisons in patients with forearm trauma. When comparing denervated muscle with nondenervated muscle, an additional scan of the contralateral side is indicated during the first 6 months after trauma to assess the extent of wound edema. After 6 months, the ipsilateral side can be used for muscle signal intensity comparisons.

  17. Effect of sport training on forearm bone sites in female handball and soccer players.

    PubMed

    Boshnjaku, Arben; Dimauro, Ivan; Krasniqi, Ermira; Grazioli, Elisa; Tschan, Harald; Migliaccio, Silvia; DI Luigi, Luigi; Caporossi, Daniela

    2016-12-01

    The objective of this study was to evaluate the bone mineral density (BMD) and Z-score of a skeletal region, considered as weight-bearing site in trained handball players (HP), but as non-weight-bearing site in trained soccer players (SP). The bone health status of the same site was also analyzed in an untrained group (CG). BMD and Z-score at distal forearm regions (dominant, D; non-dominant, ND) were evaluated in 30 female HP and in 30 female SP, who have been training for 7.7±3.8 years, 17 hours per week, as well as in 30 females CG. Playing handball was associated with higher BMD of the skeleton at both measured sites than in CG. Also in comparison with SP, HPs' arms showed a significant increase in BMD. On the other hand, female SP have been reported to exhibit an enhanced ND arm BMD compared with controls. The benefits of exercise appeared to be significantly improved only in SP sub-group who started sport activity before or at menarche. These athletes showed at ND forearm a BMD 4% greater than those SP who started later, reaching a BMD of 11.6% higher than CG, a value similar to the corresponding in HP sub-group. Moreover, their D arm BMD was 7.1% higher compared with CG. This study indicates that, compared with non-trained subjects, long-term high-impact sport participation is associated with an higher bone health state, especially if the playing careers were started before or at menarche. This effect was observed at level of both forearms in HP, which are considered as weight-bearing sites for this discipline but also on the same skeletal regions of SP, which are not directly loaded by sport-related regular training.

  18. Prospective biomechanical evaluation of donor site morbidity after radial forearm free flap.

    PubMed

    Riecke, Björn; Kohlmeier, Carsten; Assaf, Alexandre T; Wikner, Johannes; Drabik, Anna; Catalá-Lehnen, Philip; Heiland, Max; Rendenbach, Carsten

    2016-02-01

    Although the radial forearm free flap (RFF) is a commonly-used microvascular flap for orofacial reconstruction, we are aware of few prospective biomechanical studies of the donor site. We have therefore evaluated the donor site morbidity biomechanically of 30 consecutive RFF for orofacial reconstruction preoperatively and three months postoperatively. This included the Mayo wrist score, the Disabilities of the Arm, Shoulder and Hand (DASH) score, grip strength, followed by tip pinch, key pinch, palmar pinch, and range of movement of the wrist. Primary defects were all closed with local full-thickness skin grafts from the donor site forearm, thereby circumventing the need for a second defect. Postoperative functional results showed that there was a reduction in hand strength measured by (grip strength: -24.1%, in tip pinch: -23.3%, in key pinch: -16.5, and in palmar pinch: -19.3%); and wrist movement measured by extension (active=14.3% / passive= -11.5%) and flexion = -14.8% / -8.9%), and radial (-9.8% / -9.8%) and ulnar (-11.0% / -9.3%) abduction. The Mayo wrist score was reduced by 9.4 points (-12.9%) and the DASH score increased by 16.1 points (+35.5%) compared with the same forearm preoperatively. The local skin graft resulted in a robust wound cover with a good functional result. Our results show that the reduction in hand strength and wrist movement after harvest of a RFF is objectively evaluable, and did not reflect the subjectively noticed extent and restrictions in activities of daily living. Use of a local skin graft avoids a second donor site and the disadvantages of a split-thickness skin graft.

  19. Effect of repeated forearm muscle cooling on the adaptation of skeletal muscle metabolism in humans

    NASA Astrophysics Data System (ADS)

    Wakabayashi, Hitoshi; Nishimura, Takayuki; Wijayanto, Titis; Watanuki, Shigeki; Tochihara, Yutaka

    2017-01-01

    This study aimed to investigate the effect of repeated cooling of forearm muscle on adaptation in skeletal muscle metabolism. It is hypothesized that repeated decreases of muscle temperature would increase the oxygen consumption in hypothermic skeletal muscle. Sixteen healthy males participated in this study. Their right forearm muscles were locally cooled to 25 °C by cooling pads attached to the skin. This local cooling was repeated eight times on separate days for eight participants (experimental group), whereas eight controls received no cold exposure. To evaluate adaptation in skeletal muscle metabolism, a local cooling test was conducted before and after the repeated cooling period. Change in oxy-hemoglobin content in the flexor digitorum at rest and during a 25-s isometric handgrip (10% maximal voluntary construction) was measured using near-infrared spectroscopy at every 2 °C reduction in forearm muscle temperature. The arterial blood flow was occluded for 15 s by upper arm cuff inflation at rest and during the isometric handgrip. The oxygen consumption in the flexor digitorum muscle was evaluated by a slope of the oxy-hemoglobin change during the arterial occlusion. In the experimental group, resting oxygen consumption in skeletal muscle did not show any difference between pre- and post-intervention, whereas muscle oxygen consumption during the isometric handgrip was significantly higher in post-intervention than in pre-test from thermoneutral baseline to 31 °C muscle temperature (P < 0.05). This result indicated that repeated local muscle cooling might facilitate oxidative metabolism in the skeletal muscle. In summary, skeletal muscle metabolism during submaximal isometric handgrip was facilitated after repeated local muscle cooling.

  20. Tadalafil increases muscle capillary recruitment and forearm glucose uptake in women with type 2 diabetes

    PubMed Central

    Murdolo, G.; Sjögren, L.; Nyström, B.; Sjöstrand, M.; Strindberg, L.; Lönnroth, P.

    2010-01-01

    Aims/hypothesis Recent evidence suggests that reduced synthesis of nitric oxide in endothelial cells, i.e. endothelial dysfunction, contributes to the impaired action of insulin in the vasculature of patients with type 2 diabetes. We investigated whether selective inhibition of phosphodiesterase-5 by tadalafil has beneficial effects on peripheral microcirculation and glucose uptake in these patients. Methods We enrolled seven postmenopausal women with type 2 diabetes and ten age-matched healthy women as controls in a placebo-controlled study to evaluate the acute metabolic effects of tadalafil. We performed microdialysis and blood flow measurements in muscle, and sampled arterial and deep venous blood before and after a single dose of tadalafil 20 mg or placebo. Circulating glucose and insulin levels, muscle capillary recruitment as reflected by permeability surface area for glucose (PSglu) and forearm glucose uptake were measured. Results In women with type 2 diabetes, but not in the control group, tadalafil induced increases in the incremental AUC for PSglu (tadalafil vs placebo 41 ± 11 vs 4 ± 2 ml [100 g]−1 min−1, p < 0.05) and forearm glucose uptake (46 ± 9 vs 8 ± 4 µmol [100 g]−1 min−1, p < 0.05). The variable that best predicted forearm glucose uptake was PSglu, which explained 70% of its variance. However, fasting glucose and insulin concentrations were similar following treatment with placebo or tadalafil in the two groups. Conclusions/interpretation This study suggests that tadalafil evokes positive metabolic effects in insulin-resistant women with type 2 diabetes. Electronic supplementary material The online version of this article (doi:10.1007/s00125-010-1819-4) contains supplementary material, which is available to authorised users. PMID:20535445

  1. Functional outcomes after primary oropharyngeal cancer resection and reconstruction with the radial forearm free flap.

    PubMed

    Seikaly, Hadi; Rieger, Jana; Wolfaardt, John; Moysa, Gerald; Harris, Jeffery; Jha, Naresh

    2003-05-01

    To report prospectively collected aeromechanical, acoustical, and perceptual speech outcomes, as well as preliminary swallowing data, in patients having reconstruction with radial forearm free flaps after primary resection for oropharyngeal cancer. Prospective cohort study. Acoustical, aeromechanical, and perceptual speech data and swallowing data were gathered at three evaluation times (preoperatively and before and after radiation therapy) for patients treated for oropharyngeal cancer by means of primary resection and reconstruction with a radial forearm free flap. Degree of involvement of the soft palate and base of tongue, along with reconstructive techniques, were entered as between-group factors in the analysis. There were no significant differences in speech intelligibility between the patient groups based on the degree of palate and tongue resected. However, patients with resections of half or more than half of the soft palate had significantly higher nasalance values and larger velopharyngeal orifice areas than individuals who had less than half of the soft palate resected. Significant within-subject differences were revealed across evaluation times for the dependent variables nasalance, velopharyngeal orifice area, and word intelligibility. Ninety-four percent of the patients were able to resume a normal or soft diet. There was a 6% incidence of aspiration in 128 swallows that were analyzed. The amount of base of tongue resected did not significantly affect any of the speech or swallowing parameters. Radial forearm free flaps are a good reconstructive option after oropharyngeal cancer extirpation. Our acoustic and aeromechanical results indicated that issues related to quality of the speech signal require further study for resections of half or more than half of the soft palate.

  2. Bone Mineral Density and Vitamin D Status Among African American Children With Forearm Fractures

    PubMed Central

    Teach, Stephen J.; Singer, Steven A.; Wood, Rachel; Freishtat, Robert; Wright, Joseph L.; McCarter, Robert; Tosi, Laura; Chamberlain, James M.

    2012-01-01

    OBJECTIVE: To determine whether African American children with forearm fractures have decreased bone mineral density and an increased prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D level ≤20 ng/mL) compared with fracture-free control patients. METHODS: This case-control study in African American children, aged 5 to 9 years, included case patients with forearm fracture and control patients without fracture. Evaluation included measurement of bone mineral density and serum 25-hydroxyvitamin D level. Univariable and multivariable analyses were used to test for associations between fracture status and 2 measures of bone health (bone mineral density and 25-hydroxyvitamin D level) while controlling for other potential confounders. RESULTS: The final sample included 76 case and 74 control patients. There were no significant differences between case and control patients in age, gender, parental education level, enrollment season, outdoor play time, height, or mean dietary calcium nutrient density. Cases were more likely than control patients to be overweight (49.3% vs 31.4%, P = .03). Compared with control patients, case patients had lower whole body z scores for bone mineral density (0.62 ± 0.96 vs 0.98 ± 1.09; adjusted odds ratio 0.38 [0.20–0.72]) and were more likely to be vitamin D deficient (47.1% vs 40.8%; adjusted odds ratio 3.46 [1.09–10.94]). CONCLUSIONS: These data support an association of lower bone mineral density and vitamin D deficiency with increased odds of forearm fracture among African American children. Because suboptimal childhood bone health also negatively impacts adult bone health, interventions to increase bone mineral density and correct vitamin D deficiency are indicated in this population to provide short-term and long-term benefits. PMID:22926174

  3. Do split paediatric forearm POP casts need to be completed? A biomechanical study.

    PubMed

    Patel, Nimesh; Wilson, Lance; Wansbrough, Guy

    2015-07-01

    Displaced paediatric forearm fractures are most often treated by manipulation under anaesthetic, followed by the application of a circumferential Plaster of Paris (POP) splint. Some surgeons choose to split the cast in order to facilitate immediate "spreading" with minimal distress to the patient, should the distal limb become compromised. Usually however, this does not occur, and the cast is completed at a later visit to the plaster room. Time, money and inconvenience could be saved if this modification was not necessary, and the final plaster would be lighter. To establish whether the mechanical properties of a split POP are sufficient to stabilise a forearm fracture, and protect the patient from further injury. The repeatability of all tests was established on control samples before undertaking the trial. 42 standardised 8 layer POP cylinders of appropriate dimensions were fabricated, of which 21 were split longitudinally. The splints were subjected to non-destructive tests in 4-point bending (Bending), 3-Point Kinking (kinking) and torsion modes, and the load at clinically relevant end-points was recorded. These simulated the deformity at which the splint no longer provided adequate stability and alignment, or at which the wearer was no longer protected. The splints were then loaded to destruction to establish the mode of ultimate failure. The mean loads at the clinical end points for split POP splints were: 1375N in Bending, 544N in Kinking and 12 Nm in Torsion (equalling 67.3%, 70.4% and 47.4% of the equivalent values for a circumferential splints). Loads were in excess of body weight for most paediatric patients. After ultimate failure, the proportion of casts that became unstable was similar (44% of full casts and 50% of split casts). Split POP splints which have not been spread, provide adequate stabilisation and protection of paediatric forearm fractures, and do not routinely require completion. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Effect of repeated forearm muscle cooling on the adaptation of skeletal muscle metabolism in humans.

    PubMed

    Wakabayashi, Hitoshi; Nishimura, Takayuki; Wijayanto, Titis; Watanuki, Shigeki; Tochihara, Yutaka

    2017-07-01

    This study aimed to investigate the effect of repeated cooling of forearm muscle on adaptation in skeletal muscle metabolism. It is hypothesized that repeated decreases of muscle temperature would increase the oxygen consumption in hypothermic skeletal muscle. Sixteen healthy males participated in this study. Their right forearm muscles were locally cooled to 25 °C by cooling pads attached to the skin. This local cooling was repeated eight times on separate days for eight participants (experimental group), whereas eight controls received no cold exposure. To evaluate adaptation in skeletal muscle metabolism, a local cooling test was conducted before and after the repeated cooling period. Change in oxy-hemoglobin content in the flexor digitorum at rest and during a 25-s isometric handgrip (10% maximal voluntary construction) was measured using near-infrared spectroscopy at every 2 °C reduction in forearm muscle temperature. The arterial blood flow was occluded for 15 s by upper arm cuff inflation at rest and during the isometric handgrip. The oxygen consumption in the flexor digitorum muscle was evaluated by a slope of the oxy-hemoglobin change during the arterial occlusion. In the experimental group, resting oxygen consumption in skeletal muscle did not show any difference between pre- and post-intervention, whereas muscle oxygen consumption during the isometric handgrip was significantly higher in post-intervention than in pre-test from thermoneutral baseline to 31 °C muscle temperature (P < 0.05). This result indicated that repeated local muscle cooling might facilitate oxidative metabolism in the skeletal muscle. In summary, skeletal muscle metabolism during submaximal isometric handgrip was facilitated after repeated local muscle cooling.

  5. Forequarter Amputation and Immediate Reconstruction with a Free Extended Humeral-Radial Forearm Flap

    PubMed Central

    Espinoza, Absalon; Sanchez, Jair; Gonzalez, Carlos; Martinez, Eliseo; Tamez, Juan Carlos; Rangel, Jesus María

    2015-01-01

    A forequarter amputation is a radical ablative surgical procedure that includes the entire upper extremity with its shoulder girdle. We present a 53-year-old woman with a solid slow growing tumor in her right shoulder of 15 x 20 cm in diameter. Resection and immediate reconstruction with a free radial forearm flap extended from the distal third of the arm to the midpalmar region, taking the humeral artery and the cephalic vein as a main peddicle. The final outcome is shown at six weeks after the surgery. PMID:26893993

  6. [Reconstruction of oral mucosa with a micro-vascularized fascia-cutaneous flap from the forearm].

    PubMed

    Burgueño García, Miguel; Cebrián Carretero, José Luis; Muñoz Caro, Jesús Manuel; Arias Gallo, Javier

    2002-01-01

    Epidermoid carcinoma of jugal mucosa is an aggressive tumor. Its treatment is based on broad excision and reconstruction in order to avoid fibrosis and restriction of mouth opening. Neck dissection and radiotherapy are indicated in selected cases. We display our experience with microvascularized flaps with the aim of preventing the flaws. We reconsider 8 patients (representing 10 flaps) handle in our Department. Besides we discuss other therapeutic alternatives after the growth's removal. The conclusion reached is that the mucovascularized forearm flaps give a great quantity of thin tissue and therefore so results to be the best option for the reconstruction of the jugal mucosa.

  7. Quantitative values of blood flow through the human forearm, hand, and finger as functions of temperature

    NASA Technical Reports Server (NTRS)

    Montgomery, L. D.

    1974-01-01

    A literature search was made to obtain values of human forearm, hand and finger blood flow as functions of environmental temperature. The sources used include both government and laboratory reports and the research presented in the open literature. An attempt was made to review many of the more quantitative noninvasive determinations and to collate the results in such a way as to yield blood flow values for each body segment as continuous functions of temperature. A brief review of the various ways used to measure blood flow is included along with an abstract of each work from which data was taken.

  8. The effects of surface-induced loads on forearm muscle activity during steering a bicycle.

    PubMed

    Arpinar-Avsar, Pinar; Birlik, Gülin; Sezgin, Onder C; Soylu, Abdullah R

    2013-01-01

    On the bicycle, the human upper extremity has two essential functions in steering the bicycle and in supporting the body. Through the handlebar, surface- induced loads are transmitted to the hand and arm of the bicycle rider under vibration exposure conditions. Thus, the purpose of the study was to investigate the effect of vibration exposure on forearm muscle activity for different road surfaces (i.e. smooth road, concrete stone pavement, rough road) and for different bicycles. Ten subjects participated in experiments and two types of bicycles, i.e. Road Bike (RB) and Mountain Bike (MTB) are compared. The acceleration magnitudes were dominant along x and z-axes. The r.m.s acceleration values in the z direction at the stem of MTB were at most 2.56, 7.04 and 10.76 m·s(-2) when pedaling respectively on asphalt road, concrete pavement and rough road. In the case of RB the corresponding values were respectively 4.43, 11.75 and 27.31 m·s(-2). The cumulative normalized muscular activity levels during MTB trials on different surfaces had the same tendency as with acceleration amplitudes and have ranked in the same order from lowest to highest value. Although road bike measurements have resulted in a similar trend of increment, the values computed for rough road trials were higher than those in MTB trials. During rough road measurements on MTB, rmsEMG of extensor muscles reached a value corresponding to approximately 50% of MVC (Maximum Voluntary Contraction). During RB trials performed on rough road conditions, rmsEMG (%MVC) values for the forearm flexor muscles reached 45.8% of their maximal. The level of muscular activity of forearm muscles in controlling handlebar movements has been observed to be enhanced by the increase in the level of vibration exposed on the bicycle. Since repeated forceful gripping and pushing forces to a handle of a vibratory tool can create a risk of developing circulatory, neurological, or musculoskeletal disorder, a bicycle rider can be

  9. Development of Proprioceptive Acuity in Typically Developing Children: Normative Data on Forearm Position Sense

    PubMed Central

    Holst-Wolf, Jessica M.; Yeh, I-Ling; Konczak, Jürgen

    2016-01-01

    This study mapped the development of proprioception in healthy, typically developing children by objectively measuring forearm position sense acuity. We assessed position sense acuity in a cross-sectional sample of 308 children (5–17 years old; M/F = 127/181) and a reference group of 26 healthy adults (18–25 years old; M/F = 12/14) using a body-scalable bimanual manipulandum that allowed forearm flexion/extension in the horizontal plane. The non-dominant forearm was passively displaced to one of three target positions. Then participants actively matched the target limb position with their dominant forearm. Each of three positions was matched five times. Position error (PE), calculated as the mean difference between the angular positions of the matching and reference arms, measured position sense bias or systematic error. The respective standard deviation of the differences between the match and reference arm angular positions (SDPdiff) indicated position sense precision or random error. The main results are as follows: First, systematic error, measured by PE, did not change significantly from early childhood to late adolescence (Median PE at 90° target: −2.85° in early childhood; −2.28° in adolescence; and 1.30° in adults). Second, response variability as measured by SDPdiff significantly decreased with age (Median SDPdiff at 90° target: 9.66° in early childhood; 5.30° in late adolescence; and 3.97° in adults). The data of this large cross-sectional sample of children document that proprioceptive development in typically developing children is characterized as an age-related improvement in precision, not as a development or change in bias. In other words, it is the reliability of the perceptual response that improves between early childhood and adulthood. This study provides normative data against which position sense acuity in pediatric patient populations can be compared. The underlying neurophysiological processes that could explain the observed

  10. Forequarter Amputation and Immediate Reconstruction with a Free Extended Humeral-Radial Forearm Flap.

    PubMed

    de la Parra, Miguel; Espinoza, Absalon; Sanchez, Jair; Gonzalez, Carlos; Martinez, Eliseo; Tamez, Juan Carlos; Rangel, Jesus María

    2015-11-01

    A forequarter amputation is a radical ablative surgical procedure that includes the entire upper extremity with its shoulder girdle. We present a 53-year-old woman with a solid slow growing tumor in her right shoulder of 15 x 20 cm in diameter. Resection and immediate reconstruction with a free radial forearm flap extended from the distal third of the arm to the midpalmar region, taking the humeral artery and the cephalic vein as a main peddicle. The final outcome is shown at six weeks after the surgery.

  11. Architectural properties of the neuromuscular compartments in selected forearm skeletal muscles

    PubMed Central

    Liu, An-Tang; Liu, Ben-Li; Lu, Li-Xuan; Chen, Gang; Yu, Da-Zhi; Zhu, Lie; Guo, Rong; Dang, Rui-Shan; Jiang, Hua

    2014-01-01

    The purposes f this study were to (i) explore the possibility of splitting the selected forearm muscles into separate compartments in human subjects; (ii) quantify the architectural properties of each neuromuscular compartment; and (iii) discuss the implication of these properties in split tendon transfer procedures. Twenty upper limbs from 10 fresh human cadavers were used in this study. Ten limbs of five cadavers were used for intramuscular nerve study by modified Sihler's staining technique, which confirmed the neuromuscular compartments. The other 10 limbs were included for architectural analysis of neuromuscular compartments. The architectural features of the compartments including muscle weight, muscle length, fiber length, pennation angle, and sarcomere length were determined. Physiological cross-sectional area and fiber length/muscle length ratio were calculated. Five of the selected forearm muscles were ideal candidates for splitting, including flexor carpi ulnaris, flexor carpi radials, extensor carpi radialis brevis, extensor carpi ulnaris and pronator teres. The humeral head of pronator teres contained the longest fiber length (6.23 ± 0.31 cm), and the radial compartment of extensor carpi ulnaris contained the shortest (2.90 ± 0.28 cm). The ulnar compartment of flexor carpi ulnaris had the largest physiological cross-sectional area (5.17 ± 0.59 cm2), and the ulnar head of pronator teres had the smallest (0.67 ± 0.06 cm2). Fiber length/muscle length ratios of the neuromuscular compartments were relatively low (average 0.27 ± 0.09, range 0.18–0.39) except for the ulnar head of pronator teres, which had the highest one (0.72 ± 0.05). Using modified Sihler's technique, this research demonstrated that each compartment of these selected forearm muscles has its own neurovascular supply after being split along its central tendon. Data of the architectural properties of each neuromuscular compartment provide insight into the ‘design’ of their

  12. [Update in Current Care guidelines: repetitive strain injuries of the hand and forearm].

    PubMed

    Liira, Helena; Haukka, Eija; Karppinen, Jaro; Linnanen, Päivi; Malmivaara, Antti; Pasternack, Iris; Sirola, Joonas; Viikari-Juntura, Eira; Waris, Eero

    2013-01-01

    Repetitive strain injuriesof the upper extremities refer to pain in the forearm, wrist and hand, caused by excessive strain. Diagnoses include tenosynovitis, epicondylitis and carpal tunnel syndrome. Treatment is aimed at alleviating pain, restoring normal physical functioning and maintain ability to work. Preventive interventions have shown some attenuation of discomfort but no effects on disease prevalance or sick leave days. Return to work interventions seem to decrease length of sickness absences. Part time work has hastened return to work and decreased sickness absences in musculoskeletal disorders.

  13. Evaluation of the efficacy of the forearm basilic vein transposition arteriovenous fistula.

    PubMed

    Son, Hae-Jung; Min, Seung-Kee; Min, Sang-Il; Park, Yang Jin; Ha, Jongwon; Kim, Sang Joon

    2010-03-01

    Since the publication of Dialysis Outcomes Quality Initiative (DOQI) guidelines, the use of native veins for the construction of arteriovenous fistulas (AVF) for hemodialysis has been highly recommended rather than prosthetic arteriovenous grafts (AVG). Upper arm basilic vein transposition (BVT) has been accepted widely, with superior patency compared with AVG, but only a few studies have reported outcomes of forearm BVT (FBVT). This study evaluated the efficacy of FBVT compared with direct AVF (DAVF) and AVG in a tertiary referral center. From January 2005 to December 2007, 461 patients underwent AV access for hemodialysis in Seoul National University Hospital. We retrospectively reviewed the medical records and dialysis sheets and evaluated the current AVF function in the outpatient clinic or by telephone interviews. Patients were grouped by the operation type: DAVF, FBVT, and AVG. The outcomes compared were primary, assisted-primary and secondary patency rates, maturation failure, and complications. The mean age was 59 years (range, 14-92 years), and 280 patients (60.7%) were male. By operation type, the 461 accesses were 389 DAVF (84.4%), 34 FBVT (7.4%), and 38 AVG (8.2%). Mean follow-up duration was 21 months (range, 1-51 months). The primary patency rates for DAVF, FBVT, and AVG were 67.6%, 41.5%, 35% at 12 months and 53.9%, 30.2%, 10.3% at 24 months, respectively. The secondary patency rates were 89.2%, 79.1%, 78.3% at 12 months and 83.8%, 74.4%, 64.9% at 24 months, respectively. Maturation failure occurred in five DAVF patients and in one FBVT patient. The infection rate was 0.3% in DAVF and 12.5% in AVG, but no infection occurred in patients with FBVT. Multivariate analysis revealed that age and history of previous access were associated with lower primary patency. Forearm BVT showed an acceptable, high 2-year patency rate and fewer thromboses and infectious complications than AVG. Forearm BVT could be considered before forming an upper arm AVF or forearm

  14. Posterior interosseous nerve localization within the proximal forearm - a patient normalized parameter

    PubMed Central

    Kamineni, Srinath; Norgren, Crystal R; Davidson, Evan M; Kamineni, Ellora P; Deane, Andrew S

    2017-01-01

    AIM To provide a “patient-normalized” parameter in the proximal forearm. METHODS Sixty-three cadaveric upper extremities from thirty-five cadavers were studied. A muscle splitting approach was utilized to locate the posterior interosseous nerve (PIN) at the point where it emerges from beneath the supinator. The supinator was carefully incised to expose the midpoint length of the nerve as it passes into the forearm while preserving the associated fascial connections, thereby preserving the relationship of the nerve with the muscle. We measured the transepicondylar distance (TED), PIN distance in the forearm’s neutral rotation position, pronation position, supination position, and the nerve width. Two individuals performed measurements using a digital caliper with inter-observer and intra-observer blinding. The results were analyzed with the Wilcoxon-Mann-Whitney test for paired samples. RESULTS In pronation, the PIN was within two confidence intervals of 1.0 TED in 95% of cases (range 0.7-1.3 TED); in neutral, within two confidence intervals of 0.84 TED in 95% of cases (range 0.5-1.1 TED); in supination, within two confidence intervals of 0.72 TED in 95% of cases (range 0.5-0.9 TED). The mean PIN distance from the lateral epicondyle was 100% of TED in a pronated forearm, 84% in neutral, and 72% in supination. Predictive accuracy was highest in supination; in all cases the majority of specimens (90.47%-95.23%) are within 2 cm of the forearm position-specific percentage of TED. When comparing right to left sides for TEDs with the signed Wilcoxon-Mann-Whitney test for paired samples as well as a significance test (with normal distribution), the P-value was 0.0357 (significance - 0.05) indicating a significant difference between the two sides. CONCLUSION This “patient normalized” parameter localizes the PIN crossing a line drawn between the lateral epicondyle and the radial styloid. Accurate PIN localization will aid in diagnosis, injections, and surgical

  15. Increased breathing resistance compromises the time course of rhythmical forearm movements-a pilot study.

    PubMed

    Tabary, Ariane; Rassler, Beate

    2015-01-01

    Skeletal muscle dysfunction is a major problem among the co-morbidities associated with chronic obstructive pulmonary disease (COPD). However, muscle weakness and increased fatigability are not the only limitations of skeletal muscle function. Motor-respiratory coordination (MRC) may occur even during movements at lowest workloads. MRC modifies the temporal pattern of motor actions, thus probably impairing motor performance and movement precision. Little attention has been paid to the question of whether motor functions may be compromised in COPD patients independent of workload and required muscle strength and endurance. The present pilot study was designed to investigate the effects of a simulated obstruction (SO) in healthy subjects on their breathing pattern and the timing of a rhythmical forearm movement. Twenty-one subjects performed flexion- extension movements with their right forearm at a self-chosen rate within a range between 0.2 and 0.4 Hz. After a control experiment with normal breathing, a plug with a narrow hole was inserted between face mask and pneumotachograph to simulate obstruction. Subjects were required to repeat the rhythmical forearm movement at the same rate as in the control experiment. The condition of SO significantly prolonged breath duration but reduced tidal volume and ventilation. In addition, period duration of the forearm movement increased significantly under this condition while the movement-to-breathing frequency ratio remained almost constant. Increased breathing resistance was considered to cause prolonged breath duration accompanied by an increase in movement period duration. The constant near-integer ratio between movement and breathing rates indicates that the change in movement period duration resulted from MRC. The findings of this pilot study demonstrate that increased breathing resistance may compromise motor performance even at lower workloads. This means that in COPD patients, not only muscle strength and endurance

  16. Instability in human forearm movements studied with feed-back-controlled electrical stimulation of muscles.

    PubMed

    Jacks, A; Prochazka, A; Trend, P S

    1988-08-01

    1. Amplitude-modulated electrical stimulation was applied to the elbow flexors and extensors to produce movements of the forearm in normal subjects. The parameters of the modulating (command) signal were set in isometric trials so as to produce equal and opposite background torques, and equal and supportive torque modulations. 2. Bode plots relating forearm movement to command signal (modulating) frequency showed the muscle-load to have a low-pass characteristic similar to that previously described in the cat, and a slightly larger bandwidth than described previously in man. 3. The transduced forearm signals were fed back to provide the command signal to the stimulators via a filter which mimicked the transfer function of muscle spindle primary endings. In effect this replaced the neural part of the reflex arc with an accessible model, but left the muscle-load effector intact. 4. All six subjects developed forearm oscillations (tremor) when the loop gain exceeded a threshold value. The mean tremor frequency at onset was 4.4 Hz, which was similar to that of the equivalent vibration-evoked tremor (previous paper, Prochazka & Trend, 1988). 5. With the linear spindle model, oscillations tended to grow rapidly in amplitude, and the stimuli became painful. The inclusion of a logarithmic limiting element resulted in stable oscillations, without significant alterations in frequency. This allowed us to study the effect on tremor of including analog delays in the loop, mimicking those associated with peripheral nerve transmission and central reflexes. In one subject, loop delays of 0, 20, 40 and 100 ms resulted in tremor at 4.0, 3.6, 3.0 and 2.1 Hz respectively, as quantified by spectral analysis. 6. By considering separately the phase contributions of the different elements of the reflex arc, including delays, it became clear that muscle-load properties were important in setting the upper limit of tremor frequencies which could conceivably be supported by reflexes. 7. The

  17. Tardy palsy of descending branch of posterior interosseous nerve: sequela to plate osteosynthesis of forearm bones.

    PubMed

    Lal, Hitesh; Bansal, Pankaj; Khare, Rahul; Mittal, Deepak

    2010-02-01

    We report a case of tardy paralysis of the descending branch of the posterior interosseous nerve as a consequence of plate osteosynthesis for fracture of both bone forearms. The patient had been operated on 23 years earlier and palsy occurred after a gap of 19 years. The most probable antecedent cause of the palsy was the use of a high-profile implant. The patient was treated by removal of the plate and tendon transfer. Copyright 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  18. Thermal imaging of a vein of the forearm: Analysis and thermal modelling

    NASA Astrophysics Data System (ADS)

    Boué, Christine; Cassagne, Francis; Massoud, Chadi; Fournier, Danièle

    2007-07-01

    We analyse the infrared images obtained on a human forearm. In a first part, we present a basic thermal model explaining the temperature at the surface of the skin in the presence of sources such as veins. In a second part, we propose to analyse the infrared images obtained after thermal solicitation. We show how the use of low amplitude, health-safe, periodical heating or a transient thermal solicitation allows to improve notably the contrast of the images and to extract the radius, depth and the blood flow velocity in a vein.

  19. Melanotic neuroectodermal tumor of infancy in the soft tissue of the forearm: report of a case

    PubMed Central

    Ma, Yangyang; Zheng, Jicui; Yang, Shaobao; Zhu, Haitao; Dong, Kuiran; Xiao, Xianmin; Chen, Lian

    2015-01-01

    Melanotic neuroectodermal tumor of infancy is rare. Only 3 cases have been reported in the soft tissue of the extremities up to date. It has a typically biphasic feature in morphology. Epithelial and melanotic markers are positive in the epitheliod cells and neuron-specific enolase or synaptophysin is positive in the small blue round cells in immunohistochemistry. Radical resection and close follow-up is the treatment strategy in general situation. Here we report one case of MNTI in the upper extremity with review of the literature. This is the first case of MNTI in the forearm. PMID:26722579

  20. The Effects of Surface-Induced Loads on Forearm Muscle Activity During Steering a Bicycle

    PubMed Central

    Arpinar-Avsar, Pinar; Birlik, Gülin; Sezgin, Önder C.; Soylu, Abdullah R.

    2013-01-01

    On the bicycle, the human upper extremity has two essential functions in steering the bicycle and in supporting the body. Through the handlebar, surface- induced loads are transmitted to the hand and arm of the bicycle rider under vibration exposure conditions. Thus, the purpose of the study was to investigate the effect of vibration exposure on forearm muscle activity for different road surfaces (i.e. smooth road, concrete stone pavement, rough road) and for different bicycles. Ten subjects participated in experiments and two types of bicycles, i.e. Road Bike (RB) and Mountain Bike (MTB) are compared. The acceleration magnitudes were dominant along x and z-axes. The r.m.s acceleration values in the z direction at the stem of MTB were at most 2.56, 7.04 and 10.76 m·s-2 when pedaling respectively on asphalt road, concrete pavement and rough road. In the case of RB the corresponding values were respectively 4.43, 11.75 and 27.31 m·s-2. The cumulative normalized muscular activity levels during MTB trials on different surfaces had the same tendency as with acceleration amplitudes and have ranked in the same order from lowest to highest value. Although road bike measurements have resulted in a similar trend of increment, the values computed for rough road trials were higher than those in MTB trials. During rough road measurements on MTB, rmsEMG of extensor muscles reached a value corresponding to approximately 50% of MVC (Maximum Voluntary Contraction). During RB trials performed on rough road conditions, rmsEMG (%MVC) values for the forearm flexor muscles reached 45.8% of their maximal. The level of muscular activity of forearm muscles in controlling handlebar movements has been observed to be enhanced by the increase in the level of vibration exposed on the bicycle. Since repeated forceful gripping and pushing forces to a handle of a vibratory tool can create a risk of developing circulatory, neurological, or musculoskeletal disorder, a bicycle rider can be

  1. Radial forearm versus anterolateral thigh flap reconstruction after hemiglossectomy: functional assessment of swallowing and speech.

    PubMed

    Hsiao, Hung-Tao; Leu, Yi-Shing; Liu, Chung-Ji; Tung, Kwang-Yi; Lin, Chang-Ching

    2008-02-01

    The authors retrospectively compared the results of postoperative speech and swallowing in patients who had undergone hemiglossectomy for carcinoma of the anterior tongue. Immediate reconstruction in 16 patients was with a free radial forearm flap and in another 16 with an anterolateral thigh flap. Clinical speech pathology evaluation included the Fletcher time-to-time maximum syllable repetition rate, multiple rhyme test, and overall quality and intelligibility of the patients' speech. Evaluation of swallowing included deglutition duration, bolus volume, and ingestion rate. The functional results with both flaps were adequate, and the two groups did not differ significantly between each other for either speech or swallowing.

  2. Mini-C-arm fluoroscopy for emergency-department reduction of pediatric forearm fractures.

    PubMed

    Lee, Mark C; Stone, Norman E; Ritting, Andrew W; Silverstein, Eric A; Pierz, Kristan A; Johnson, David A; Naujoks, Ryan; Smith, Brian G; Thomson, Jeffrey D

    2011-08-03

    Reduction of pediatric forearm fractures with the patient under sedation in the emergency department is a common practice throughout the United States. We hypothesized that the use of a mini-c-arm fluoroscopy device as an alternative to routine radiographs for evaluation of fracture reduction would (1) allow a more anatomic fracture reduction, (2) decrease the number of repeat reductions or subsequent procedures, (3) reduce overall radiation exposure to the patient, and (4) decrease the orthopaedic consultation time in the emergency department. A retrospective cohort analysis of 279 displaced forearm and wrist fractures treated with closed reduction and casting with the patient under sedation in the emergency department of a level-I pediatric trauma center was performed, and the data were compared with historical controls. One hundred and thirteen fracture reductions were assessed with a mini-c-arm device, and 166 fracture reductions were evaluated with radiographs. All patients had radiographs of the injury. Blinded, independent reviewers graded the quality of reduction for residual angulation and translation of the reduced fracture. Radiation exposure was determined by the average number of radiographs made through either modality. Emergency department and outpatient charts were reviewed to determine the total orthopaedic consultation time and the need for repeat reductions or operative intervention. Pediatric forearm fractures undergoing closed reduction with assistance of the mini c-arm had a significant improvement in reduction quality (average angulation [and standard deviation], 6° ± 4° vs. 8 ± 6°; p = 0.02), a decrease in repeat fracture reduction and need for subsequent operative treatment (two [2%] of 113 fractures vs. fourteen [8.4%] of 166 fractures; p = 0.0001), and a decrease in radiation exposure to the patient (mean, 14.0 ± 10.3 mrem vs. 50.0 ± 12.7 mrem). The average orthopaedic consultation time was decreased with use of a mini c-arm (28

  3. Architectural properties of the neuromuscular compartments in selected forearm skeletal muscles.

    PubMed

    Liu, An-Tang; Liu, Ben-Li; Lu, Li-Xuan; Chen, Gang; Yu, Da-Zhi; Zhu, Lie; Guo, Rong; Dang, Rui-Shan; Jiang, Hua

    2014-07-01

    The purposes f this study were to (i) explore the possibility of splitting the selected forearm muscles into separate compartments in human subjects; (ii) quantify the architectural properties of each neuromuscular compartment; and (iii) discuss the implication of these properties in split tendon transfer procedures. Twenty upper limbs from 10 fresh human cadavers were used in this study. Ten limbs of five cadavers were used for intramuscular nerve study by modified Sihler's staining technique, which confirmed the neuromuscular compartments. The other 10 limbs were included for architectural analysis of neuromuscular compartments. The architectural features of the compartments including muscle weight, muscle length, fiber length, pennation angle, and sarcomere length were determined. Physiological cross-sectional area and fiber length/muscle length ratio were calculated. Five of the selected forearm muscles were ideal candidates for splitting, including flexor carpi ulnaris, flexor carpi radials, extensor carpi radialis brevis, extensor carpi ulnaris and pronator teres. The humeral head of pronator teres contained the longest fiber length (6.23 ± 0.31 cm), and the radial compartment of extensor carpi ulnaris contained the shortest (2.90 ± 0.28 cm). The ulnar compartment of flexor carpi ulnaris had the largest physiological cross-sectional area (5.17 ± 0.59 cm(2)), and the ulnar head of pronator teres had the smallest (0.67 ± 0.06 cm(2)). Fiber length/muscle length ratios of the neuromuscular compartments were relatively low (average 0.27 ± 0.09, range 0.18-0.39) except for the ulnar head of pronator teres, which had the highest one (0.72 ± 0.05). Using modified Sihler's technique, this research demonstrated that each compartment of these selected forearm muscles has its own neurovascular supply after being split along its central tendon. Data of the architectural properties of each neuromuscular compartment provide insight into the 'design' of their

  4. Maximal isometric force and muscle cross-sectional area of the forearm in fencers.

    PubMed

    Margonato, V; Roi, G S; Cerizza, C; Galdabino, G L

    1994-12-01

    The maximal isometric force (MIF) of a muscle is directly related to its cross-sectional area (CSA). Strength training produces an increase in muscular force while muscular hypertrophy becomes appreciable at a later time; in asymmetric sports, training causes significant increases in force and muscular mass of the dominant limb of the athlete. The aim of this study was to analyse the differences in muscular force and trophism between the dominant and non-dominant forearms in fencers and in controls. The data of 17 male distance runners (age 21.4 +/- 2.4 years, body mass 74.0 +/- 5.0 kg, height 180 +/- 6 cm) were compared with those of 58 male fencers (age 23.0 +/- 6.7 years, body mass 71.9 +/- 9.3 kg, height 178 +/- 7 cm) drawn from the ranking lists of the National Fencing Committee. They trained for a mean of 11.4 +/- 6.0 (range 2-36) years, commencing at 10.7 +/- 4.5 years of age. Cross-sectional area (muscle plus bone) was estimated in the dominant and non-dominant forearm using a simplified anthropometric method. Maximal isometric force was determined using a mechanical handgrip dynamometer. The differences in CSA and isometric force between the two limbs and between fencers and controls were tested using paired and unpaired Student's t-tests, respectively. Significant differences in CSA and maximal force were observed between the dominant and non-dominant forearm in fencers (both P < 0.001) and in controls (P < 0.005 and P < 0.001, respectively). The fencers showed a greater CSA (P < 0.001) and force (P < 0.001) in the dominant forearm compared with the control group. Furthermore, the differences between the dominant and non-dominant limb of the fencers were significantly greater than the differences between the dominant and non-dominant limb of the controls (P < 0.001 for CSA and P < 0.05 for force). No significant differences in stress ratio (force/CSA) were obtained in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Flexible Intramedullary Nailing of Forearm Fractures at the Distal Metadiaphyseal Junction in Adolescents

    PubMed Central

    Kim, Byung Sung; Lee, Yong Sung; Park, Sung Yong; Nho, Jae Hwi; Lee, Sun Geun

    2017-01-01

    Background The purpose of this study was to analyze the radiographic and functional outcomes of flexible intramedullary (IM) nailing in adolescent patients with forearm fractures at the diaphysis or at the metadiaphyseal junction (MDJ). Methods We retrospectively reviewed the results of 40 patients who underwent IM nailing for pediatric forearm fractures. Thirty males and 10 females were followed for an average of 16 months (range, 12 to 20 months). Their average age was 11 years (range, 10 to 16 years). The average duration from the onset of trauma to surgery was 3.8 days (range, 1 to 36 days). Fracture sites were located at the MDJ of the radius in 8 patients (MDJ group) while 32 patients had middle-third fractures (D group). We assessed the magnitude and location of the maximum radial bow and range of movements. Functional outcomes were evaluated using Daruwalla criteria. Results Open reduction was carried out in 8 cases. Union was achieved at an average of 8.3 weeks postoperatively. The results were classified as good in 38 and excellent in 2 according to Daruwalla criteria with restoration of forearm rotation. The mean angulation at the last follow-up was 1.8° on the anteroposterior radiograph and 3.3° on the lateral radiograph (MDJ group: 1.8° and 2.1°, respectively; D group: 1.9° and 2.8°, respectively). There was no significant difference in the mean angulation between the groups. The mean magnitude of maximal radial bow was 5.7% ± 1.8% (MDJ group, 5.2% ± 0.8%; D group, 5.9% ± 1.9%). The mean location of maximal radial bow was 58.0% ± 8.8% (MDJ group, 56.4% ± 8.9%; D group, 58.6% ± 8.9%). The differences in the mean magnitude and location of maximal radial bow with the normal contralateral arms (7.0% ± 1.2% and 50.9% ± 6.0%, respectively) were not significantly different between the groups. Complications included superficial infection (2), delayed union (1), and refracture (1). Conclusions IM nail fixation provided satisfactory results and

  6. Development of Proprioceptive Acuity in Typically Developing Children: Normative Data on Forearm Position Sense.

    PubMed

    Holst-Wolf, Jessica M; Yeh, I-Ling; Konczak, Jürgen

    2016-01-01

    This study mapped the development of proprioception in healthy, typically developing children by objectively measuring forearm position sense acuity. We assessed position sense acuity in a cross-sectional sample of 308 children (5-17 years old; M/F = 127/181) and a reference group of 26 healthy adults (18-25 years old; M/F = 12/14) using a body-scalable bimanual manipulandum that allowed forearm flexion/extension in the horizontal plane. The non-dominant forearm was passively displaced to one of three target positions. Then participants actively matched the target limb position with their dominant forearm. Each of three positions was matched five times. Position error (PE), calculated as the mean difference between the angular positions of the matching and reference arms, measured position sense bias or systematic error. The respective standard deviation of the differences between the match and reference arm angular positions (SDPdiff) indicated position sense precision or random error. The main results are as follows: First, systematic error, measured by PE, did not change significantly from early childhood to late adolescence (Median PE at 90° target: -2.85° in early childhood; -2.28° in adolescence; and 1.30° in adults). Second, response variability as measured by SDPdiff significantly decreased with age (Median SDPdiff at 90° target: 9.66° in early childhood; 5.30° in late adolescence; and 3.97° in adults). The data of this large cross-sectional sample of children document that proprioceptive development in typically developing children is characterized as an age-related improvement in precision, not as a development or change in bias. In other words, it is the reliability of the perceptual response that improves between early childhood and adulthood. This study provides normative data against which position sense acuity in pediatric patient populations can be compared. The underlying neurophysiological processes that could explain the observed

  7. The effect of heating rate on the cutaneous vasomotion responses of forearm and leg skin in humans.

    PubMed

    Del Pozzi, Andrew T; Miller, James T; Hodges, Gary J

    2016-05-01

    We examined skin blood flow (SkBF) and vasomotion in the forearm and leg using laser-Doppler fluxmetry (LDF) and spectral analysis to investigate endothelial, sympathetic, and myogenic activities in response to slow (0.1 °C·10 s(-1)) and fast (0.5 °C·10 s(-1)) local heating. At 33 °C (thermoneutral) endothelial activity was higher in the legs than the forearms (P ≤ 0.02). Fast-heating increased SkBF more than slow heating (P=0.037 forearm; P=0.002 leg). At onset of 42 °C, endothelial (P=0.043 forearm; P=0.48 leg) activity increased in both regions during the fast-heating protocol. Following prolonged heating (42 °C) endothelial activity was higher in both the forearm (P=0.002) and leg (P<0.001) following fast-heating. These results confirm regional differences in the response to local heating and suggest that the greater increase in SkBF in response to fast local heating is initially due to increased endothelial and sympathetic activity. Furthermore, with sustained local skin heating, greater vasodilatation was observed with fast heating compared to slow heating. These data indicate that this difference is due to greater endothelial activity following fast heating compared to slow heating, suggesting that the rate of skin heating may alter the mechanisms contributing to cutaneous vasodilatation.

  8. An electromyographic study of the effect of hand grip sizes on forearm muscle activity and golf performance.

    PubMed

    Sorbie, Graeme G; Hunter, Henry H; Grace, Fergal M; Gu, Yaodong; Baker, Julien S; Ugbolue, Ukadike Chris

    2016-01-01

    The study describes the differences in surface electromyography (EMG) activity of two forearm muscles in the lead and trail arm at specific phases of the golf swing using a 7-iron with three different grip sizes among amateur and professional golfers. Fifteen right-handed male golfers performed five golf swings using golf clubs with three different grip sizes. Surface EMG was used to measure muscle activity of the extensor carpi radialis brevis (ECRB) and flexor digitorum superficialis (FDS) on both forearms. There were no significant differences in forearm muscle activity when using the three golf grips within the group of 15 golfers (p > 0.05). When using the undersize grip, club head speed significantly increased (p = 0.044). During the backswing and downswing phases, amateurs produced significantly greater forearm muscle activity with all three grip sizes (p < 0.05). In conclusion, forearm muscle activity is not affected by grip sizes. However, club head speed increases when using undersize grips.

  9. Congenital Deficiency of Distal Ulna and Dislocation of the Radial Head Treated by Single Bone Forearm Procedure

    PubMed Central

    Dutta, Anshuman; Sipani, Arun Kumar; Daolagupu, Arup Kumar

    2014-01-01

    Congenital deficiency of part of distal ulna affecting the distal radio-ulnar joint is a rare disorder. It is even rarer to find the association of proximal radio-ulnar joint dislocation along with distal ulnar deficiency. This type of congenital forearm anomaly is difficult to treat. Conversion to a single bone forearm in the expense of pronation-supination movement is a viable option. By doing so the elbow and wrist can be stabilized; however movement is possible in only one plane. We are describing here a girl of 8 years having proximal radio-ulnar joint dislocation along with deficiency of distal ulna treated by converting into a single bone forearm. PMID:25254127

  10. Effect of the Mandibular Orthopedic Repositioning Appliance (MORA) on Forearm Muscle Activation and Grasping Power during Pinch and Hook Grip

    PubMed Central

    Lee, Sang-Yeol; Park, Yi-Jeong; Park, Hye-Min; Bae, Hae-Jin; Yu, Min-Ji; Choi, Hee-Won; Hwang, Na-Young

    2014-01-01

    [Purpose] This study verified the changes in muscle activities and grasping power during maximal isometric exercise of the forearm and masseter muscle with and without a mandibular orthopedic repositioning appliance (MORA). It also offers basic data for defining the correlation of function of hand with mouth. [Methods] EMG was used to measure masticatory muscle, flexor bundle and extensor bundle activities with or without MORA while subjects performed the hook grip and pinch grip. The measuring tool used for measuring grip strength was the same as that used for measuring pinch and hook strength. The subjects were 28 healthy young adults. [Result] Muscle activity and grasping power significantly increased when wearing the MORA. [Conclusion] The result indicates that wearing MORA can increase muscle activity and grasping power of forearm and masseter muscle. We think wearing MORA might help improve the function of the forearm because it activates the function of the masseter. PMID:24648630

  11. A simple ergometer for 31P NMR spectroscopy during dynamic forearm exercise in a whole body magnetic resonance imaging system.

    PubMed

    Nishijima, H; Nishida, M; Anzai, T; Yonezawa, K; Fukuda, H; Sato, I; Yasuda, H

    1992-03-01

    The purpose of this study was to construct a simple ergometer for the 31P NMR spectroscopic study of dynamic forearm exercise in a whole body magnetic resonance imaging system and to evaluate the total system and the physiological response to this type of exercise using a multistage protocol. The system consisted of a completely nonmagnetic assembly including a rope, pulley and weights. The work of lifting weights was quantitated. The exercise protocol of 1-min increments in work load enabled subjects to reach maximal effort. Phosphocreatine decreased linearly with an increase in work load and was accompanied by a fall in pH and an increase in lactate level in the antecubital vein of the exercising forearm; concomitantly, there was a slight increase in whole body oxygen uptake and heart rate. Spectroscopy gave reproducible results using this exercise protocol. These results demonstrate that this system provides a reliable means for performing 31P magnetic resonance spectroscopy studies during forearm exercise.

  12. Bifurcated Bicipital Aponeurosis Giving Origin to Flexor and Extensor Muscles of the Forearm – A Case Report

    PubMed Central

    Nayak, Satheesha B; Shetty, Prakashchandra; Maloor, Prasad A; Dsouza, Melanie R

    2016-01-01

    Bicipital aponeurosis is usually attached to the antebrachial fascia on the medial side of forearm and to posterior border of ulna assisting in the supination of the forearm along with biceps brachii muscle. Variations in the bicipital aponeurosis may lead to neurovascular compression as reported earlier. In the present case, the bicipital aponeurosis had two slips i.e. medial and lateral. Medial slip gave origin to some fibers of pronator teres and flexor carpi radialis and the lateral slip gave origin to some fibers of brachioradialis. Such unusual slips of bicipital aponeurosis may distribute the stress concentration and may work in different directions affecting the supination of forearm by biceps brachii muscle and bicipital aponeurosis. PMID:27042440

  13. Experimental and Finite Element Analysis of Dynamic Loading of the Mouse Forearm

    PubMed Central

    Thiagarajan, Ganesh; Lu, Yunkai; Dallas, Mark; Johnson, Mark L.

    2015-01-01

    Bone formation is reported to initiate in osteocytes by mechanotransduction due to dynamic loading of bone. The first step towards this is to characterize the dynamic strain fields in the overall bone. Here, the previously developed mouse forearm ulna-radius model, subjected to static loading, has been further enhanced by incorporating a loading cap and applying a cyclic dynamic load to more closely approximate experimental biological conditions. This study also incorporates data obtained from strain gauging both the ulna and radius simultaneously. Based on separate experiments, the elastic modulus of the ulna and radius were determined to be 13.8 and 9.9 GPa, respectively. Another novel aspect of the numerical model is the inclusion of the interosseous membrane in the FE model with membrane stiffness ranging from 5–15 N/mm that have been found to give strain values closer to that from the experiments. Interestingly, the inclusion of the interosseous membrane helped to equalize the peak strain magnitudes in the ulna and radius (~1800 at 2 N load and ~3200 at 3.5 N), which was also observed experimentally. This model represents a significant advance towards being able to simulate through FE analysis the strain fields generated in vivo upon mechanical loading of the mouse forearm. PMID:25196694

  14. CASE REPORT Acute Compartment Syndrome of the Forearm Following Blood Gas Analysis Postthrombolysis for Pulmonary Embolism.

    PubMed

    Bisarya, Kamal; George, Samuel; El Sallakh, Sam

    2013-01-01

    Acute compartment syndrome is an important condition with potentially serious consequences if not diagnosed and treated promptly. This report highlights a case of acute compartment syndrome of the forearm after radial artery blood gas analysis in a patient who had been thrombolyzed for a pulmonary embolus. Methods/Case Report: We present a case of a 54-year-old lady, admitted and treated for a pulmonary embolism with tenecteplase for thrombolysis. As per routine management, she had taken an arterial blood gas sample, which caused hematoma in the wrist and a few hours later developed pain and a tense right forearm being diagnosed with compartment syndrome. She underwent fasciotomies and subsequent split skin grafting. We discuss the different etiologies of compartment syndrome, clinical signs, and available investigations as well as immediate and definitive management options including fasciotomy techniques. We present the latest literature on the subject and extract valuable learning points from this case. With the common use of thrombolysis for the management of a myocardial infarction or pulmonary embolus, compartment syndrome is an uncommon but potentially associated problem. Furthermore, with blood gas sampling being part of daily clinical practice and a potential cause of this condition, the compartment syndrome becomes iatrogenic and potentiates serious litigation. As many junior doctors are performing blood gas analysis postthrombolysis, they need to assess patients adequately and realize the risk of possible sequelae such as compartment syndrome in this group and inform patients of such complications.

  15. Andreas Vesalius' 500th anniversary: the initiation of hand and forearm myology.

    PubMed

    Brinkman, R J; Hage, J J

    2015-11-01

    Andreas Vesalius (1515-1564) was the first to market an illustrated text on the freshly dissected muscular anatomy of the human hand and forearm when he published his De Fabrica Corporis Humani Libri Septem, in 1543. To commemorate his 500th birthday, we searched the second of seven books composing De Fabrica, the annotated woodcut illustrations of De Fabrica, the Tabulae Sex, and Epitome, and an eyewitness report of a public dissection by Vesalius for references to the morphology and functions of these muscles. We found Vesalius to have recognized all currently distinguished muscles except the palmaris brevis and he noted occasional absence of some muscles. Generally, he limited the origin and insertion to bones, largely disregarding attachments to membranes and fascia. Functionally, he recorded the muscles as having a single vector and operating on only one joint. We conclude that Vesalius was nearly completely correct about the anatomy of the muscles of the forearm, but much less accurate about their function. 5. © The Author(s) 2015.

  16. Aging is associated with reduced prostacyclin-mediated dilation in the human forearm

    PubMed Central

    Nicholson, Wayne T.; Vaa, Brianna; Hesse, Christiane; Eisenach, John H.; Joyner, Michael J.

    2009-01-01

    Aging is associated with reduced endothelial function. There is indirect evidence for reduced prostacyclin mediated vasodilation with aging, but it is unknown if this is due to reduced dilation to prostacyclin or altered production. Additionally, the contribution of endothelial nitric oxide to prostacyclin-mediated dilation is unknown. Using plethysmography to determine forearm blood flow, we studied the effect of prostacyclin in ten older (61–73 years) and ten younger (19–45 years) subjects using three escalating intra-arterial doses of prostacyclin (epoprostenol). Prostacyclin was also administered after nitric oxide synthase inhibition with NG-Monomethyl-L-arginine acetate. Percent change in forearm vascular conductance (mean ± standard error of the mean) from baseline after prostacyclin was significantly lower (p=0.002) in the aging individuals (52±11, 164±23, 221±27 vs. 115±20, 249±19, 370±35 percent). Additionally, the group-by-dose interaction was also significant (p=0.018). Following nitric oxide synthase inhibition, the dose response curve to prostacyclin was blunted in the young subjects but unchanged in the older subjects; the difference between the groups was no longer significant. Our data suggest that the reduced dilator effects of prostacyclin in older individuals are due to a reduction in the contribution of endothelial-derived nitric oxide vs. alterations in the direct effects of prostacyclin on vascular smooth muscle. PMID:19414649

  17. Coordination of human upper arm and forearm motion in rapid extensions

    NASA Technical Reports Server (NTRS)

    Nahvi, Mahmood

    1991-01-01

    In many movements of the upper limb such as reaching, positioning, and displacing the objects, the hand moves smoothly along a uni-directional planar trajectory with a bell-shaped speed profile. Because of variability of the load, gravitational and velocity interaction forces between its segments, the dynamics of the arm during the motion is very complex. Motion of the upper arm and the forearm are coordinated to produce smooth movements despite such complex dynamics. This coordination constitutes an important organizational feature of arm movement. The present paper describes some experimental results related to the above and interprets their role in producing smooth motion of the hand. Trajectories of the right upper limb in vertical plane and the simultaneous muscles' EMG activities were recorded for extensions of various amplitudes under four loads. The forearm trajectories are smooth with bell-shaped speed profiles. The upper arm trajectories may have bimodal speed profiles and three segments, resembling an inverted 'Z.' Segmentation is sharper for the points near the shoulder joint, and is accentuated by load. As one moves from the central points near the shoulder joint to the peripheral points near the hand, the three segments merge and result in smooth curves with single-peaked speed profiles. The three segments have a coherent time course and can be identified rather accurately and non-ambiguously. The observed trajectories and the EMG patterns reveal an effective coordination strategy which utilizes the structure and the dynamics of the moving arm to produce smooth movement.

  18. Spontaneous Bone Regeneration in an Open Segmental Fracture of the Forearm with Extruded Middle Segment

    PubMed Central

    Rai, Bibek K; Vaishya, Raju

    2016-01-01

    Open segmental fractures of both bones of the forearm with the loss of the middle segment of the radius is a rare injury in children. An eight-year-old boy presented to our clinic four days following a road traffic accident. The child’s mother was carrying a 12-cm long extruded and soiled segment of the radius bone. The extruded bone segment seemed necrotic, and we decided not to use it for replantation. The wound over the forearm fracture was infected. It was debrided and regularly dressed until it became healthy. We planned to use a fibular graft for the gap and to fix the graft with a Kirschner wire (K-wire). The operation was delayed due to the poor wound condition. At the four-week follow-up, we noticed unexpected signs of bone regeneration in the bone defect of the radius. After eight weeks, a complete spontaneous reconstruction of the bone was noted. This case highlights the excellent healing potential of the bones in children, where even if a long segment of the bone is lost, we can expect spontaneous complete regeneration of the bone if the periosteum is intact and continuous. PMID:27738571

  19. Objective assessment of plaster cast quality in pediatric distal forearm fractures: Is there an optimal index?

    PubMed

    Labronici, Pedro José; Ferreira, Leonardo Termis; Dos Santos Filho, Fernando Claudino; Pires, Robinson Esteves Santos; Gomes, Davi Coutinho Fonseca Fernandes; da Silva, Luiz Henrique Penteado; Gameiro, Vinicius Schott

    2017-02-01

    Several so-called casting indices are available for objective evaluation of plaster cast quality. The present study sought to investigate four of these indices (gap index, padding index, Canterbury index, and three-point index) as compared to a reference standard (cast index) for evaluation of plaster cast quality after closed reduction of pediatric displaced distal forearm fractures. Forty-three radiographs from patients with displaced distal forearm fractures requiring manipulation were reviewed. Accuracy, sensitivity, specificity, false-positive probability, false-negative probability, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were calculated for each of the tested indices. Comparison among indices revealed diagnostic agreement in only 4.7% of cases. The strongest correlation with the cast index was found for the gap index, with a Spearman correlation coefficient of 0.94. The gap index also displayed the best agreement with the cast index, with both indices yielding the same result in 79.1% of assessments. When seeking to assess plaster cast quality, the cast index and gap index should be calculated; if both indices agree, a decision on quality can be made. If the cast and gap indices disagree, the padding index can be calculated as a tiebreaker, and the decision based on the most frequent of the three results. Calculation of the three-point index and Canterbury index appears unnecessary. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Local inhibition of converting enzyme and vascular responses to angiotensin and bradykinin in the human forearm.

    PubMed Central

    Benjamin, N; Cockcroft, J R; Collier, J G; Dollery, C T; Ritter, J M; Webb, D J

    1989-01-01

    1. The function of angiotensin converting enzyme was investigated in twenty-four healthy men. Forearm blood flow was measured under basal conditions and during administration of enalaprilat (a converting enzyme inhibitor) and/or peptide substrates of converting enzyme into the left brachial artery. Blood flow was compared in the two arms. 2. Enalaprilat had no effect on basal blood flow. The concentration of enalaprilat in venous blood from the control arm was low, and plasma renin activity was not increased, indicating that systemic inhibition of converting enzyme did not occur. 3. Effects of angiotensin and of bradykinin, administered intra-arterially, were limited to the infused arm. Enalaprilat (13 nmol min-1) inhibited converting enzyme in the infused arm, in which it caused approximately a 100-fold reduction in sensitivity to angiotensin I, while having no effect on the vasoconstriction caused by angiotensin II. Enalaprilat increased vasodilatation caused by bradykinin. 4. Aspirin, an inhibitor of cyclo-oxygenase, did not inhibit vasodilatation caused by bradykinin whether infused alone or with enalaprilat, indicating that these responses are not mediated by prostaglandins. 5. We conclude that under basal conditions neither conversion of angiotensin I to angiotensin II nor degradation of bradykinin determines resistance vessel tone in the human forearm. Converting enzyme may affect vascular tone in situations in which intravascular concentrations of peptides are increased over those present under basal conditions. PMID:2557432

  1. On optimal electrode configuration to estimate hand movements from forearm surface electromyography.

    PubMed

    Paleari, Marco; Di Girolamo, Michela; Celadon, Nicoló; Favetto, Alain; Ariano, Paolo

    2015-01-01

    Understanding the movement of the hand from sEMG signals acquired on the forearm is key in the development of future prosthetics of the upper limb. Despite the technical advancement on this technique, state of the art of sEMG still relies strongly on optimal electrode placement which is typically performed by a specialist by mean of a heuristic search. Involving a specialist has few major disadvantages including high costs and relatively long schedules. This work searches an optimal electrode configuration which could reduce or avoid the intervention of a specialist. More than 200 different possible electrode configurations were assessed by means of the average recognition rate over 11 different movements of the hand, wrist, and fingers. It is shown that using two rows of 8 equally spaced electrodes around the circumference of the forearm could be an optimal trade-off solution to accomplish the task of recognizing hand movement (ARR = 92%) without the need for a specialist or very complex hardware.

  2. Mental practice maintains range of motion despite forearm immobilization: a pilot study in healthy persons.

    PubMed

    Frenkel, Marie O; Herzig, Daniela S; Gebhard, Florian; Mayer, Jan; Becker, Clemens; Einsiedel, Thomas

    2014-03-01

    To determine whether mental practice of wrist movements during forearm immobilization maintains range of motion. Randomized controlled trial. Eighteen healthy young men aged between 20 and 30 years were assigned to either a control or a mental practice group. Both groups were immobilized with a circular forearm cast for 3 weeks to simulate a distal radial fracture. The mental practice group received 1 × 60-min, followed by 3 × 30-min, sessions of supervised mental practice. Consecutively, they were asked to perform 15 min/day of self-guided imagery sessions, during which they mentally exercised motion sequences of the immobilized joint. The training program followed the Mental Gait Training procedure. The control group did no training. Wrist movement was measured with a goniometer before and after immobilization. Mental practice preserved dorsal extension and ulnar abduction. The sedentary control group showed due to this variables a significant decrease after cast removal. There was no significant change in palmar flexion and radial abduction in either group. Despite the study limitations, these results suggest that mental practice may be useful in preventing loss of hand function associated with mid-term immobilization. Because of the expected clinical benefits, the low cost and simple application of the intervention, the effects of mental practice in orthopedic rehabilitation of the upper extremity warrant further study.

  3. Effect of lower limb exercise on forearm vascular function: contribution of nitric oxide.

    PubMed

    Green, Daniel; Cheetham, Craig; Mavaddat, Louise; Watts, Katie; Best, Matthew; Taylor, Roger; O'Driscoll, Gerard

    2002-09-01

    We examined vascular function in an inactive muscle bed, the forearm, during lower limb exercise and determined the contribution of endothelium-derived nitric oxide (NO) to the hyperemic response. Eight young males were randomized to participate in two studies, each consisting of two bouts of lower limb exercise, separated by a 30-min recovery. Peak forearm blood flow (PFBF) and mean blood flow (MFBF) were continuously recorded at baseline and during exercise using continuous high-resolution vascular ultrasound and Doppler flow velocity measurement. During one session, the brachial artery was cannulated to allow continuous infusion of saline or N(G)-monomethyl-L-arginine (L-NMMA), an inhibitor of NO synthase. The alternate session was performed to control for possible effects of repeated exercise. At 60, 100, and 160 W, L-NMMA significantly decreased both PFBF and MFBF compared with the saline infusion. These results suggest that systemic production of NO occurs during exercise in resting vessel beds, which do not feed metabolically active tissue. This finding provides a plausible explanation for the antiatherogenic benefits of exercise.

  4. Activation of forearm muscles for wrist extension in patients affected by lateral epicondylitis.

    PubMed

    Rojas, Monica; Mañanas, Miquel A; Muller, Bertram; Chaler, Joaquim

    2007-01-01

    Work related upper extremity disorders are associated with cumulative trauma resulting from the continuous use of forearm muscles rather than from a specific incident. The aim of this work is to compare wrist extensor muscles activation between patients with lateral epicondylitis and healthy subjects. Differences can be used in the design of rehabilitation or injury prevention programs according to biomechanical deficits. Surface EMG signals from three forearm extensor muscles (Carpi Radialis-ECR, Digitorum Communis-EDC and Carpi Ulnaris-ECU) were recorded by linear electrode arrays in wrist extension as well as during selective contractions. Average Rectified Values (ARV) were calculated in order to identify the contribution of each muscle to different tasks. On the other hand, Muscle Fiber Conduction Velocity, Mean and Median Frequencies and also ARV were studied to obtain fatigue indexes related to metabolic changes in the muscles during a high force sustained contraction. Results showed muscular imbalance with lower ECR activity compensated by higher ECU activation, and higher fatigue indexes in patients with lateral epicondylitis.

  5. Functional assessment: Free thin anterolateral thigh flap versus free radial forearm reconstruction for hemiglossectomy defects

    PubMed Central

    Lu, Mingxing; Hu, Qingang; Tang, Enyi; Wang, Yujia

    2015-01-01

    Background To compare free thin anterolateral thigh (ALT) flap with free radial forearm (FRF) flap in the reconstruction of hemiglossectomy defects, and to introduce our methods and experience in the tongue reconstruction with free thin ALT flap. Material and Methods The clinicopathologic data of 46 tongue carcinoma cases hospitalized from December 2009 to April 2014 were obtained from Nangjing Stomatological Hospital, Medical School of Nanjing University. All the subjects were evaluated for the articulation and the swallowing function 3 months after the surgery. Results Among these 46 patients, 12 patients underwent tongue reconstruction after hemiglossectomy with ALT flap; 34 patients underwent tongue reconstruction with FRF flap. The differences in the incidence of vascular crisis, the speech and the swallowing function between two groups were not significant (P>0.05). Conclusions Thin ALT flap could be one of the ideal flaps for hemiglossectomy defect reconstruction with its versatility in design, long pedicle with a suitable vessel diameter, and the neglectable donor site morbidity. Key words:Free thin anterolateral thigh flap, free radial forearm flap, hemiglossectomy, reconstruction, morbidity. PMID:26449437

  6. Tracheoesophageal voice following tubed free radial forearm flap reconstruction of the neopharynx.

    PubMed

    Deschler, D G; Doherty, E T; Reed, C G; Anthony, J P; Singer, M I

    1994-12-01

    Tracheoesophageal voice restoration after laryngectomy is possible with a variety of neopharyngeal reconstructions. We have used the tubed radial forearm free flap for neopharyngeal reconstruction since 1991. Six patients have undergone voice restoration with the Blom-Singer prosthesis and were available for quantitative and qualitative speech analysis. These patients were compared to five laryngectomy patients with standard pharyngeal closures and similar voice restorations. The free flap patients produced similar loudness levels compared to the standards with soft speech (52.06 dB and 47.19 dB, respectively) and loud speech (62.66 dB and 60.91 dB, respectively). The free flap patients demonstrated adequate intelligibility, with fundamental frequencies comparable to standards (124.82 Hz and 135.66 Hz, respectively), although with increased jitter (5.00% versus 1.96%). No differences were statistically significant, but evaluation by trained and naive listeners demonstrated significant differences in voice quality. This quantitative and qualitative and qualitative analysis of tracheoesophageal speech after radial forearm free flap reconstruction of the neopharynx demonstrates that acceptable voice can be achieved, but with limitations.

  7. [Reconstruction of the oral cavity: the free radial forearm flap versus the free jejunal flap].

    PubMed

    Belli, E; Cicconetti, A; Matteini, C

    1995-05-01

    The concentration in a restricted area such as the oral cavity of the essential anatomic structures for mastication, deglutition, speech, salivary drainage and respiration makes it indispensable to ensure not only the structural reconstruction of the region but also, and above all, a functional reconstruction of the anatomic unit affected by resection. The use of revascularised flaps has extended both the quantity and quality of reconstructive methods available. In the context of the oral cavity the most widely used flaps are the radial forearm free flap and jejunum free flap. In this paper the authors report their personal experience in a group of 13 patients (6 radial forearm and 7 jejunum) undergoing oral cavity reconstruction using free flap. For each flap the authors describe the microsurgical procedure, the clinical characteristics of the post-operative period, the locoregional complications, the donor site and lastly the long-term clinical, anatomopathological and functional modifications 6-12 months after primary treatment. Moreover, they highlight the varying characteristics of the two flaps and make a critical assessment of the advantages and disadvantages of using one or other method. Lastly, in the light of their experience and a review of international literature, the authors underline the importance of making a careful choice and personalized reconstruction, and finally outline their own criteria of choice.

  8. Use of the radial forearm fasciocutaneous free flap and montgomery salivary bypass tube for pharyngoesophageal reconstruction.

    PubMed

    Varvares, M A; Cheney, M L; Gliklich, R E; Boyd, J M; Goldsmith, T; Lazor, J; Baron, J C; Montgomery, W W

    2000-08-01

    Head and neck reconstructive surgeons involved in pharyngoesophageal reconstruction have several options available to repair the defect after partial or total laryngopharyngectomy. There is no uniform agreement among head and neck surgeons as to which of the most frequently used techniques offers the best results. A retrospective study was performed on 20 consecutive patients who had undergone reconstruction of the hypopharynx and cervical esophagus using a radial forearm free flap with Montgomery salivary bypass tube at the Massachusetts Eye and Ear Infirmary in Boston, Massachusetts, and St. Louis University, Department of Otolaryngology-Head and Neck Surgery between 1992 and 1996. This reconstruction was used for primary reconstruction after total or partial laryngopharyngectomy with cervical esophagectomy, partial pharyngectomy sparing the larynx, and for reconstruction of the stenotic neopharynx after laryngectomy. The overall rate of pharyngocutaneous fistula was 20%, and the rate of postoperative stricture was 10%. Of patients reconstructed with this technique, 85% were able to resume oral alimentation, whereas 15% remained G-tube dependent. Of the 18 patients who did not have their larynges remain intact, 6 were able to develop useful tracheoesophageal speech. The results of this study show that the radial forearm fasciocutaneous free flap in combination with the Montgomery salivary bypass tube is extremely useful for reconstruction of partial and circumferential defects of the hypopharynx and cervical esophagus.

  9. Double bilobed radial forearm free flap for anterior tongue and floor-of-mouth reconstruction.

    PubMed

    Ko, Alvin B; Lavertu, Pierre; Rezaee, Rod P

    2010-04-01

    We describe what is, to the best of our knowledge, the first use of a double bilobed radial forearm free flap in reconstructive surgery of the tongue and floor of the mouth following bilateral tumor resection. Our patient was a 78-year-old man who had experienced tumor recurrence in the anterior floor of the mouth after previous resection and radiotherapy. Eleven weeks postoperatively, the patient could extend his tongue to his hard palate and past his mandibular alveolus anteriorly. Within 6 months, he was able to tolerate an oral diet of soft food and exhibited understandable speech quality. Although the use of a single bilobed radial forearm flap is widely used after hemiglossectomy, our double bilobed modification extends this technique to anterior tongue and floor-of-mouth defects. This technique provides adequate bulk while allowing for depth of a ventral sulcus that will minimize tethering of the tongue and reduce oral incompetence. We recommend that this technique be included in the armamentarium of any reconstructive head and neck cancer surgeon.

  10. Whole body and forearm substrate metabolism in hyperthyroidism: evidence of increased basal muscle protein breakdown.

    PubMed

    Riis, Anne Lene Dalkjaer; Jørgensen, Jens Otto Lunde; Gjedde, Signe; Nørrelund, Helene; Jurik, Anne Grethe; Nair, K S; Ivarsen, Per; Weeke, Jørgen; Møller, Niels

    2005-06-01

    Thyroid hormones have significant metabolic effects, and muscle wasting and weakness are prominent clinical features of chronic hyperthyroidism. To assess the underlying mechanisms, we examined seven hyperthyroid women with Graves' disease before (Ht) and after (Eut) medical treatment and seven control subjects (Ctr). All subjects underwent a 3-h study in the postabsorptive state. After regional catheterization, protein dynamics of the whole body and of the forearm muscles were measured by amino acid tracer dilution technique using [15N]phenylalanine and [2H4]tyrosine. Before treatment, triiodothyronine was elevated (6.6 nmol/l) and whole body protein breakdown was increased 40%. The net forearm release of phenylalanine was increased in hyperthyroidism (microg.100 ml(-1).min(-1)): -7.0 +/- 1.2 Ht vs. -3.8 +/- 0.8 Eut (P = 0.04), -4.2 +/- 0.3 Ctr (P = 0.048). Muscle protein breakdown, assessed by phenylalanine rate of appearance, was increased (microg.100 ml(-1).min(-1)): 15.5 +/- 2.0 Ht vs. 9.6 +/- 1.4 Eut (P = 0.03), 9.9 +/- 0.6 Ctr (P = 0.02). Muscle protein synthesis rate did not differ significantly. Muscle mass and muscle function were decreased 10-20% before treatment. All abnormalities were normalized after therapy. In conclusion, our results show that hyperthyroidism is associated with increased muscle amino acid release resulting from increased muscle protein breakdown. These abnormalities can explain the clinical manifestations of sarcopenia and myopathy.

  11. Peripheral Intravenous Catheterisation in Obstetric Patients in the Hand or Forearm Vein: A Randomised Trial.

    PubMed

    Tan, Peng Chiong; Mackeen, Anjana; Khong, Su Yen; Omar, Siti Zawiah; Noor Azmi, M A

    2016-03-18

    A peripheral intravenous catheter is often inserted as part of care during labour. The catheter is inserted into the back of the hand or lower forearm vein in usual practice. There is no trial data to guide the care provider on which is the better insertion site in any clinical setting. 307 women admitted to the labour ward who required insertion of intravenous catheter were randomised to back of hand or lower forearm vein catheter insertion. Catheter insertion is by junior to mid-grade providers. We evaluated insertion success at the first attempt, pain during insertion and catheter replacement due to malfunction as main outcomes. After catheter removal, we recorded patient satisfaction with site, future site preference and insertion site swelling, bruising, tenderness, vein thrombosis and pain. Insertion of a catheter into back of hand vein is more likely to be successful at the first attempt. Insertion pain score, catheter replacement rate, patient satisfaction, patient fidelity to site in a future insertion and insertion site complications rate are not different between trial arms. In conclusion, both insertion sites are suitable; the back of the hand vein maybe easier to cannulate and seems to be preferred by our frontline providers.

  12. A Compact Forearm Crutch Based on Force Sensors for Aided Gait: Reliability and Validity

    PubMed Central

    Chamorro-Moriana, Gema; Sevillano, José Luis; Ridao-Fernández, Carmen

    2016-01-01

    Frequently, patients who suffer injuries in some lower member require forearm crutches in order to partially unload weight-bearing. These lesions cause pain in lower limb unloading and their progression should be controlled objectively to avoid significant errors in accuracy and, consequently, complications and after effects in lesions. The design of a new and feasible tool that allows us to control and improve the accuracy of loads exerted on crutches during aided gait is necessary, so as to unburden the lower limbs. In this paper, we describe such a system based on a force sensor, which we have named the GCH System 2.0. Furthermore, we determine the validity and reliability of measurements obtained using this tool via a comparison with the validated AMTI (Advanced Mechanical Technology, Inc., Watertown, MA, USA) OR6-7-2000 Platform. An intra-class correlation coefficient demonstrated excellent agreement between the AMTI Platform and the GCH System. A regression line to determine the predictive ability of the GCH system towards the AMTI Platform was found, which obtained a precision of 99.3%. A detailed statistical analysis is presented for all the measurements and also segregated for several requested loads on the crutches (10%, 25% and 50% of body weight). Our results show that our system, designed for assessing loads exerted by patients on forearm crutches during assisted gait, provides valid and reliable measurements of loads. PMID:27338396

  13. The effects of forearm fatigue on baseball fastball pitching, with implications about elbow injury.

    PubMed

    Wang, Lin-Hwa; Lo, Kuo-Cheng; Jou, I-Ming; Kuo, Li-Chieh; Tai, Ta-Wei; Su, Fong-Chin

    2016-01-01

    This study investigated the contribution of flexor muscles to the forearm through fatigue; therefore, the differences in forearm mechanisms on the pitching motion in fastball were analysed. Fifteen baseball pitchers were included in this study. Ultrasonographical examination of participants' ulnar nerve in the cubital tunnel with the elbow extended and at 45°, 90° and 120° of flexion was carried. A three-dimensional motion analysis system with 14 reflective markers attached on participants was used for motion data collection. The electromyography system was applied over the flexor carpi ulnaris, flexor carpi radialis and extensor carpi radialis muscles of the dominant arm. Flexor carpi ulnaris muscle activity showed a significant difference during the acceleration phase, with a peak value during fastball post-fatigue (P = 0.02). Significant differences in the distance between ulnar nerve and medial condyle on throwing arm and non-throwing arm were observed as the distance increased with the elbow movement from 0° to 120° of flexion (P = 0.01). The significant increase of the flexor carpi ulnaris muscle activity might be responsible for maintaining the stability of the wrist joint. The increased diameter might compress the ulnar nerve and cause several pathological changes. Therefore, fatigue in baseball pitchers still poses a threat to the ulnar nerve because the flexor carpi ulnaris and flexor carpi radialis all originate from the medial side of the elbow, and the swelling tendons after fatigue might be a key point.

  14. Effect of upper arm brachial basilic and prosthetic forearm arteriovenous fistula on left ventricular hypertrophy.

    PubMed

    Keuter, X H A; Kooman, J P; Habets, J; Van Der Sande, F M; Kessels, A G H; Cheriex, E C; Tordoir, J H M

    2007-01-01

    Creation of an arteriovenous fistula (AVF) may increase left ventricular hypertrophy in the hemodialysis population. Aim of this study was to compare the effects of a brachial-basilic (BB) AVF and the prosthetic brachial-antecubital forearm loop access (PTFE) on cardiac performance. Patients were randomized to receive BB-AVF or prosthetic brachial-antecubital forearm loop access. Before and three months after AVF creation patients underwent an echocardiographic examination. Mann-Whitney U-test was used to compare relative increase between the measured cardiac parameters for the two groups. Twenty-seven patients participated in the study. The relative increase in left ventricular parameters was not significantly different between the two groups. Only left ventricular end-diastolic diameter tended to be of significance. Mean blood flow through the brachial artery was 1680+/-156 and 1450+/-221 mL/min three months after surgery for the PTFE and the BB-AVF group, respectively. After three months of follow-up, changes in cardiac structure were comparable between patients with BB and PTFE AVFs. Also access flow was comparable at this time. In general, the effects of creation of a fistula on LV structure were limited. Longer follow up time may be needed to explore the long term effects of different vascular accesses on cardiac function.

  15. Surgical Outcomes of Forearm Loop Arteriovenous Fistula Formation Using Tapered versus Non-Tapered Polytetrafluoroethylene Grafts

    PubMed Central

    Han, Sun; Seo, Pil Won; Ryu, Jae-Wook

    2017-01-01

    Background Tapered grafts, which have a smaller diameter on the arterial side, have been increasingly used for arteriovenous fistula (AVF) formation. We compared the outcomes of 4–6-mm tapered and 6-mm straight forearm loop arteriovenous grafts. Methods A total of 103 patients receiving forearm loop arteriovenous grafts between March 2005 and March 2015 were retrospectively analyzed and separated into 2 groups (group A, 4- to 6-mm tapered grafts, n=78; group B, 6-mm straight grafts, n=25). In each group, complications and patency rates after surgery were assessed. Results Clinical characteristics and laboratory results, except for cerebrovascular disease history (group A, 7.7%; group B, 28.0%; p=0.014), were similar between the groups. No significant differences were found for individual complications. Kaplan-Meier survival analysis revealed no significant differences in 1-year, 3-year, and 5-year patency rates between groups (61.8%, 44.9%, and 38.5% vs. 62.7%, 41.1%, and 35.3%, respectively). Conclusion We found no significant differences in complication and patency rates between the tapered and straight graft groups. If there are no differences in complication and patency between the two graft types, tapered grafts may be a valuable option for AVF formation in light of their other advantages. PMID:28180100

  16. The role of fabricated chimeric free flaps in reconstruction of devastating hand and forearm injuries.

    PubMed

    Giessler, Goetz A; Schmidt, Andreas B; Germann, Guenter; Pelzer, Michael

    2011-11-01

    Devastating hand and forearm injuries almost exclusively need free flap transfer if reconstruction is attempted. Early active and passive motion is only possible with aggressive, early, and comprehensive reconstruction. Despite recent advances in compound flaps, in selected cases it might be wise to harvest several smaller flaps and microsurgically combine them to one "chain-linked" flap "system." Four microsurgically fabricated chimeric free flaps were used in four patients for complex hand and forearm injuries. The combinations were sensate anterolateral thigh (ALT) flap plus sensate extended lateral arm flap (2x), ALT plus free fibula, and ALT plus functional musculocutaneous gracilis muscle. All flaps survived completely. Functional rehabilitation was possible immediately after flap transfer. There were no donor-site complications except two widened scars. The microsurgical fabrication of chimeric free flaps, as well established in head and neck reconstruction, can be successfully adapted to massive hand injuries as well. Individual placement of selected tissue components, early comprehensive reconstruction, and reduction of the number of operations are beneficial in cases that need more than one free flap.

  17. Valve or No Valve: A Prospective Randomized Controlled Trial of Casting Options for Pediatric Forearm Fractures.

    PubMed

    Baldwin, Paul C; Han, Eric; Parrino, Anthony; Solomito, Matthew J; Lee, Mark C

    2017-08-03

    The purpose of this study was to determine the rate of cast-related complications when using split or intact casts. A total of 60 patients aged 3 to 13 years with closed shaft or distal third radius and ulna fractures requiring reduction were recruited for this study. Patients underwent closed reduction under sedation and were placed into a long-arm fiberglass cast with 1 of 3 modifications: no valve, univalve, or bivalve. Patients were followed to 6 weeks after reduction or surgical treatment if required. The frequency of neurovascular injury, cast saw injury, unplanned office visits, and cast modifications, the need for operative intervention, and pain levels through the follow-up period were recorded. The results showed no incidents of compartment syndrome or neurovascular injury. Additionally, there were no differences between complications associated with cast type (P=.266), frequency of cast modifications (P=.185), or subsequent need for surgical stabilization (P=.361). Therefore, cast splitting following closed reduction of low-energy pediatric forearm fractures does not change clinical outcomes with respect to neurovascular complications, cast modifications, pain levels, or the need for repeat reduction. Consideration should be given to minimizing cast splitting after reduction of low-energy pediatric forearm fractures for practice efficiency and to potentially decrease saw-related injury. [Orthopedics. 201x; xx(x):xx-xx.]. Copyright 2017, SLACK Incorporated.

  18. [Dislocation fractures of the forearm. Galeazzi, Monteggia, and Essex-Lopresti injuries].

    PubMed

    Lendemans, S; Taeger, G; Nast-Kolb, D

    2008-12-01

    Combined forearm fractures are identified according to their location as Galeazzi, Monteggia, or Essex-Lopresti injuries. The feature common to these three forms is the combination of a forearm fracture with instability of the distal or proximal radioulnar joint. Appropriate management of the injury at an early stage is indispensable to achieve good functional results. Galeazzi fractures should initially be treated by open reduction and correct anatomy restored by plate osteosynthesis. Fixation of the distal radioulnar joint with Kirschner wires should be performed in cases of persistent dislocation or instability and limited to 6 weeks. Monteggia fractures should be surgically approached, taking care not to overlook possible additional injuries (radial head, coronoid process). Essex-Lopresti injuries are treated by surgical reconstruction of the radial head, and in cases of comminuted fractures by implanting a radial head prosthesis. Subsequent treatment entails at least 14 days immobilization in a supinated position using an upper arm cast. Early functional therapy should follow when all three forms of injuries have been treated.

  19. Head-down-tilt bed rest alters forearm vasodilator and vasoconstrictor responses

    NASA Technical Reports Server (NTRS)

    Shoemaker, J. K.; Hogeman, C. S.; Silber, D. H.; Gray, K.; Herr, M.; Sinoway, L. I.

    1998-01-01

    To test the hypothesis that head-down-tilt bed rest (HDBR) for 14 days alters vascular reactivity to vasodilatory and vasoconstrictor stimuli, the reactive hyperemic forearm blood flow (RHBF, measured by venous occlusion plethysmography) and mean arterial pressure (MAP, measured by Finapres) responses after 10 min of circulatory arrest were measured in a control trial (n = 20) and when sympathetic discharge was increased by a cold pressor test (RHBF + cold pressor test; n = 10). Vascular conductance (VC) was calculated (VC = RHBF/MAP). In the control trial, peak RHBF at 5 s after circulatory arrest (34.1 +/- 2.5 vs. 48.9 +/- 4.3 ml . 100 ml-1 . min-1) and VC (0.34 +/- 0.02 vs. 0.53 +/- 0.05 ml . 100 ml-1 . min-1 . mmHg-1) were reduced in the post- compared with the pre-HDBR tests (P < 0. 05). Total excess RHBF over 3 min was diminished in the post- compared with the pre-HDBR trial (84.8 vs. 117 ml/100 ml, P < 0.002). The ability of the cold pressor test to lower forearm blood flow was less in the post- than in the pre-HDBR test (P < 0.05), despite similar increases in MAP. These data suggest that regulation of vascular dilation and the interaction between dilatory and constrictor influences were altered with bed rest.

  20. The effect of repetitive passive and active movements on proprioception ability in forearm supination.

    PubMed

    Kwon, Ohsung; Lee, Seungwon; Lee, Youngwoo; Seo, Dongkwon; Jung, Sangwoo; Chol, Wonjae

    2013-05-01

    [Purpose] This study was conducted in order to investigate the effect of repetitive passive movement and repetitive active movement on proprioception in forearm supination. [Subjects] This study had a cross-sectional design. Twenty-three right-handed healthy subjects were recruited. All subjects randomly received both repetitive passive movement and repetitive active movement (repetitive passive/active movement at 120°/s with 60 repetitions over a 0-80° range). Active and passive joint repositioning of all subjects was measured using the error score for position sense, both before and after repositioning intervention. [Results] In the repetitive passive movement test, there was a statistically significant decrease in the pre- versus post-repositioning error scores in the active and passive angle examinations. In the repetitive active movement test, there was a statistically significant increase in pre- versus post-repositioning error scores in the active and passive angle examinations. In the comparison of position sense, there was a statistically significant decrease in both active and passive angle repositioning error scores in repetitive passive movement versus repetitive active movement. [Conclusion] Repetitive passive movement improved the proprioception results for forearm supination, compared to repetitive active movement. Results of this study indicate that repetitive passive movement can be recommended to clinicians for rehabilitation therapy as it provides greater proprioception benefits.

  1. Analysis of the forearm rotational efficiency in extant hominoids: new insights into the functional implications of upper limb skeletal structure.

    PubMed

    Ibáñez-Gimeno, Pere; Galtés, Ignasi; Manyosa, Joan; Malgosa, Assumpció; Jordana, Xavier

    2014-11-01

    The greatly diversified locomotor behaviors in the Hominoidea impose different mechanical requirements in the upper limb of each species. As forearm rotation has a major role in locomotion, the skeletal structures involved in this movement may display differences among taxa that reflect functional adaptations. To test this, we use a biomechanical model that quantifies the rotatory capacity of pronator teres (rotational efficiency) from skeletal measurements. Using a large sample of hominoids, we aim to identify the morphological adaptations that confer differences in the mechanics of forearm motion and to assess the functional advantage of these adaptations. Forearm positions along the pronation-supination range where rotational efficiency is maximal depend on the orientation of the humeral medial epicondyle and differ among taxa. Our results indicate that these are related to locomotor mode. Knuckle-walkers exhibit a medial epicondyle more posteriorly directed, which, in elbow angles close to extension, causes rotational efficiency to be maximal in pronated positions of the forearm. Species with a significant amount of arboreal locomotion, such as vertical climbing, i.e., Pongo spp., Pan troglodytes and Gorilla gorilla, display more proximally oriented epicondyles, which, in elbow flexion, leads to maximum rotational efficiencies in supinated positions of the forearm. Hylobatidae, with the less posteriorly and proximally oriented epicondyle, show their maximum rotational efficiencies closer to the forearm neutral position throughout most of the flexion-extension range, which may be linked to brachiation in this taxon. In humans, the epicondylar orientation and thus the positions of the maximum rotational efficiencies fall between arboreal and terrestrial hominoids. This may be related to the enhanced manipulative skills of the upper limb. In conclusion, the current analysis indicates that the orientation of the humeral medial epicondyle is linked to the locomotor

  2. Can forearm bone mineral density be measured with dxa in the supine position? A study in Chinese population.

    PubMed

    Zhao, Jinhua; Xing, Yan; Zhou, Qi; Jin, Wenya; Wacker, Wynn; Barden, Howard S

    2010-01-01

    The purpose of our study was to confirm that forearm bone mineral density (BMD) results obtained with the patient in the supine position are equivalent to results obtained with patient in the sitting position. The subjects were a Chinese sample of 82 healthy adults (35 males and 47 females; age: 22.5-59.8 yr; body mass index: 17.6-32.4). Forearm BMD was measured by dual-energy X-ray absorptiometry, with the forearm positioned in the sitting and supine positions. Repeated measurements were available for some subjects, and the average of the repeats for those subjects were used in the analysis. The standard enCORE software (GE Lunar, Madison, WI) adjustment for supine position was applied to the BMD values obtained in the supine position for 33% radius, ultradistal (UD) radius, and radius total regions of interest (ROIs) to give sitting-equivalent values. The supine sitting-equivalent results were regressed on the sitting values through the origin. There were statistically significant differences in the UD and total-radius forearm results between supine sitting-equivalent BMD and sitting BMD. The correlation coefficients of UD and total radius were 0.967 and 0.976, respectively. There was no significant difference between supine sitting-equivalent BMD and sitting BMD in the 33% radius forearm BMD. The correlation coefficient of 33% radius was 0.956. For Chinese subjects, there was no significant difference in BMD for the 33% radius, the only ROI recommended for diagnosis by ISCD. Forearm scans could be accomplished with the patient suitably positioned for the routine lumbar spine and proximal femur scans.

  3. The effect of topically applied tissue expanders on radial forearm skin pliability: a prospective self-controlled study

    PubMed Central

    2014-01-01

    Background The use of pre-operatively applied topical tissue expansion tapes have previously demonstrated increased rates of primary closure of radial forearm free flap donor sites. This is associated with a reduced cost of care as well as improved cosmetic appearance of the donor site. Unfortunately, little is known about the biomechanical changes these tapes cause in the forearm skin. This study tested the hypothesis that the use of topically applied tissue expansion tapes will result in an increase in forearm skin pliability in patients undergoing radial forearm free flap surgery. Methods Twenty-four patients scheduled for head and neck surgery requiring a radial forearm free flap were enrolled in this prospective self-controlled observational study. DynaClose tissue expansion tapes (registered Canica Design Inc, Almonte, Canada) were applied across the forearm one week pre-operatively. Immediately prior to surgery, the skin pliability of the dorsal and volar forearm sites were measured with the Cutometer MPA 580 (registered Courage-Khazaka Electronic GmbH, Cologne, Germany) on both the treatment and contralateral (control) arms. Paired t-tests were used to compare treatment to control at both sites, with p < 0.025 defined as statistically significant. Results There was a statistically significant increase in pliability by a mean of 0.05 mm (SD = 0.09 mm) between treatment and control arms on the dorsal site (95% CI [0.01, 0.08], p = 0.018). This corresponded to an 8% increase in pliability. In contrast, the volar site did not show a statistically significant difference between treatment and control (mean difference = 0.04 mm, SD = 0.20 mm, 95% CI [−0.04, 0.12], p = 0.30). Conclusions This result provides evidence that the pre-operative application of topical tissue expansion tapes produces measurable changes in skin biomechanical properties. The location of this change on the dorsal forearm is consistent with the method of tape

  4. Dorsalis Pedis Free Flap: The Salvage Option following Failure of the Radial Forearm Flap in Total Lower Lip Reconstruction

    PubMed Central

    Stathas, Theodoros; Tsiliboti, Dimitra; Tsiros, Aris; Mastronikolis, Nicholas; Goumas, Panos

    2014-01-01

    Reconstruction after resection of large tumors of the lower lip requires the use of free flaps in order to restore the shape and the function of the lip, with the free radial forearm flap being the most popular. In this study we describe our experience in using the dorsalis pedis free flap as a salvage option in reconstruction of total lower lip defect in a patient with an extended lower lip carcinoma after failure of the radial forearm free flap, that was initially used. The flap was integrated excellently and on the followup the patient was free of disease and fully satisfied with the aesthetic and functional result. PMID:24803937

  5. Fracture Diaphyseal Femur in a Case of Ipsilateral Excision Arthroplasty of Hip: Report of Two Cases with Description of an Unusual Injury Pattern, Mechanism, and Clinical Decision-making in Management

    PubMed Central

    Shah, Kunal; Ubale, Tushar; Abdul, Rahematullah; Kasodekar, Vaibhav; Assudani, Ashish; Makwana, Kiran

    2016-01-01

    Introduction: Although fracture diaphyseal femur is commonly seen in orthopedic practice, its association with ipsilateral resection arthroplasty of hip/pseudarthrosis of neck is rare. The technique of excision arthroplasty has undergone modification with emphasis on preserving as much bone as possible. However, it is not always possible to preserve bone while removing the earlier prosthesis and cement. This often leads to extensive proximal bone loss. Associated ipsilateral fracture femur presents a unique scenario. Till date, only one case report is published highlighting its surgical management. Case Report: We report two cases of diaphyseal fracture femur associated with resection arthroplasty of hip at subtrochanteric level with greater trochanter as a separate fragment (Case 1) and other with pseudarthrosis of the neck of femur with intact greater trochanter (Case 2). The first case was operated with surface fixation, whereas the second was operated with closed antegrade intramedullary nail. Conclusion: Decision-making and formulating treatment plan includes taking various factors into account such as level of resection arthroplasty of hip/pseudarthrosis of neck, status of greater trochanter (intact or separate fragment), osteoporosis, and post-operative ambulation and rehabilitation. In this report, we highlight the unusual occurrence, probable mechanism of injury, risk factors for fracture, and decision-making in the surgical management of such a condition. PMID:28164068

  6. Human ability in identification of location and pulse number for electrocutaneous stimulation applied on the forearm

    PubMed Central

    2014-01-01

    Background The need of a sensory feedback system that would improve users’ acceptance in prostheses is generally recognized. Feedback of hand opening and position are among the most important concerns of prosthetic users. To address the two concerns, this study investigated the human capability to identify pulse number and location when electrical stimulation applied on the forearm skin. The pulse number may potentially be used to encode the opening of prosthetic hands and stimulation location to encode finger position. Methods Ten able-bodied subjects participated in the study. Three electrodes were placed transversely across the ventral forearm spatially encoding three fingers (i.e., thumb, index, and middle finger). Five different pulse numbers (1, 4, 8, 12, and 20) encoded five levels of hand opening. The study consisted of three experiments. In the three experiments, each after a training session, the subjects were required to identify among: (a) five stimulation locations, (b) five pulse numbers, or (c) ten paired combinations of location and pulse number, respectively. The subjects’ performance in the three identification tasks was evaluated. Results The main results included: 1) the overall identification rate for stimulation location was 92.2 ± 6.2%, while the success rate in two-site stimulation was lower than one-site stimulation; 2) the overall identification rate for pulse number was 90.8 ± 6.0%, and the subjects showed different performance in identification of the five pulse numbers; 3) the overall identification rate decreased to 80.2 ± 11.7% when the subjects were identifying paired parameters. Conclusions The results indicated that the spatial (location) and temporal (pulse number) identification performance are promising in electrocutaneous stimulation on the forearm. The performance degraded when both parameters had to be identified likely due to increased cognitive load resulting from multiple tasks. Utilizing the proposed

  7. Monosynaptic Ia projections from intrinsic hand muscles to forearm motoneurones in humans

    PubMed Central

    Marchand-Pauvert, V; Nicolas, G; Pierrot-Deseilligny, E

    2000-01-01

    Heteronymous Ia excitatory projections from intrinsic hand muscles to human forearm motoneurones (MNs) were investigated. Changes in firing probability of single motor units (MUs) in the flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), extensor carpi radialis (ECR), extensor carpi ulnaris (ECU) and extensor digitorum communis (EDC) were studied after electrical stimuli were applied to the median and ulnar nerve at wrist level and to the corresponding homonymous nerve at elbow level.Homonymous facilitation, occurring at the same latency as the H reflex, and therefore attributed to monosynaptic Ia EPSPs, was found in all the sampled units. In many MUs an early facilitation was also evoked by heteronymous low-threshold afferents from intrinsic hand muscles. The low threshold (between 0.5 and 0.6 times motor threshold (MT)) and the inability of a pure cutaneous stimulation to reproduce this effect indicate that it is due to stimulation of group I muscle afferents.Evidence for a similar central delay (monosynaptic) in heteronymous as in homonymous pathways was accepted when the difference in latencies of the homonymous and heteronymous peaks did not differ from the estimated supplementary afferent conduction time from wrist to elbow level by more than 0.5 ms (conduction velocity in the fastest Ia afferents between wrist and elbow levels being equal to 69 m s−1).A statistically significant heteronymous monosynaptic Ia excitation from intrinsic hand muscles supplied by both median and ulnar nerves was found in MUs belonging to all forearm motor nuclei tested (although not in ECU MUs after ulnar stimulation). It was, however, more often found in flexors than in extensors, in wrist than in finger muscles and in muscles operating in the radial than in the ulnar side.It is argued that the connections of Ia afferents from intrinsic hand muscles to forearm MNs, which are stronger and more widely distributed than in the cat, might