Physical Medicine Rehabilitation

Fractures of the Upper Extremity by by Bruce H. Ziran (Editor)

By by Bruce H. Ziran (Editor)

Addressing the zone of the higher extremity, this sensible reference good points contributions from 17 experts and provides cutting-edge descriptions of various fractures, therapy methods and surgical concepts. additionally it is a bankruptcy on nonunions of the higher extremity.

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5-mm cancellous screw placed down the shaft from the proximal piece. The wire loop is then placed to neutralize these constructs. The use of screws may offset some of the reported difficulties of the K wires backing out, causing discomfort and limited range of motion. Fractures of the Forearm 37 Some have advocated the use of a heavy nonabsorbable suture in place of wire to avoid the problem of wire breakage and pain on the subcutaneous border of the ulna. Even with these technique modifications, many patients will have hardware related issues that will require metal removal after fracture union.

Lister’s simple transposition flap is illustrated in Fig. 7, with subsequent modifications to improve mobility but minimize tension in Figure 6 A. Diagram of rotation flap. B. Back cut. C. Burrow’s triangle. 26 Goitz and Jurbala Figure 7 Diagram of a transposition flap. the flap. This flap can often be used to close moderate-sized defects in the arm or forearm of approximately 3 to 5 cm using nontraumatized adjacent tissue. F. Regional Flaps 1. Radial Forearm Flap A proximally based radial forearm flap is a versatile fasciocutaneous flap that can be used to cover large defects about the distal humerus, elbow, or proximal forearm (Fig.

The posterior interosseous artery (PIOA) is a branch of the ulnar artery that supplies dorsal skin via septal perforators between the extensor carpi ulnaris and extensor digiti minimi (18). The axis of the PIOA is centered on a line drawn from the lateral epicondyle to the dorsal radioulnar joint at the wrist. Flap elevation is similar to that of the radial artery flap but more demanding (Fig. 9). Figure 8 Radial forearm flap (elbow on the left with the radial artery inflow indicated by the solid line).

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