PURPOSE:Upper-extremity compartment syndrome can result in functional deficits, loss of limb, and loss of life. Although most commonly caused by trauma, in recent years, opioid and substance-related overdose has led to a rise in patients with "found down" compartment syndrome. Our purpose was to compare clinical presentations and outcomes in patients with upper-extremity compartment syndrome caused by a substance-related found down mechanism to those caused by an acute trauma mechanism. METHODS:A retrospective chart review was performed to confirm a diagnosis of upper-extremity compartment syndrome. Inclusion criteria consisted of patients 18 years and older who underwent treatment for upper-extremity compartment syndrome from a substance-related found down or acute trauma mechanism. Patient demographics, clinical presentations, comorbidities, laboratory values, and outcomes were collected and compared between the two groups. RESULTS:Over the 10-year study period, 51 patients were identified and included in our final cohort. The trauma group had 24 patients, and the found down group had 27 patients. The forearm was the most affected compartment in both groups, and the found down group had more patients with multiple affected compartments. On clinical examination, muscle weakness and skin blisters were seen more in the found down group. Hemoglobin, potassium, blood urea nitrogen, and creatine kinase levels were higher in the found down group. The patients in the found down group had a higher number of surgical procedures and length of stay. The found down group had more patients with rhabdomyolysis and kidney injury requiring hemodialysis. CONCLUSIONS:Upper-extremity compartment syndrome because of a substance-related found down mechanism most commonly affects the forearm compartment. Patients with a found down mechanism overall require more surgeries and muscle debridement in subsequent surgeries. They also have higher lengths of stay and higher rates of rhabdomyolysis and acute kidney injury requiring hemodialysis. TYPE OF STUDY/LEVEL OF EVIDENCE:Therapeutic IV.

Purpose Our institution has noted an increase in severe upper - extremity infections within the last 2 years. These patients have required transhumeral amputation. This case series demonstrates some of the catastrophic outcomes of these infections in people who inject drugs, which has been postulated to be related to the addition of xylazine to injectable drugs in our community. Methods The study included patients presenting with severe upper -extremity infections resulting from intravenous drug use and requiring upper -extremity amputation between January 1, 2020 and September 30, 2022 at a single, urban, level 1 trauma center. Patient information and clinical images were collected through retrospective chart review. Results Eight patients were identi fi ed at our institution with extensive necrosis of the skin and soft tissues in the forearm and hand, resulting in exposure of the radius and ulna. None of these patients had viable motor function in the hand and presented with a lack of sensation. All underwent transhumeral amputations, including bilaterally in one case. Conclusions The patients in this case series self -reported injection of tranquilizer -containing drugs, and xylazine has been reported to be present in 91% of heroin and fentanyl samples in our community. Although more studies are needed to con fi rm that xylazine is the de fi nitive cause of the extensive tissue necrosis seen in these patients, we have found the severity of these infections to be noteworthy, given the likely expansion of xylazine to drug samples beyond our region. (J Hand Surg Am. 2024;49(5):459 e 464. Copyright (c) 2024 by the American Society for Surgery of the Hand. All rights reserved.)

Background: Aberrant ectopic bone formation of the elbow is a common clinical presentation after neurologic, burn, and traumatic injuries to the joint. This represents a significant source of patient burden, delayed recovery times and increased medical costs. Although there is an abundance of literature on heterotopic ossification (HO) of the hip, there is little literature on HO of the elbow in comparison. Aims: This literature review seeks to summarize consensus regarding the appropriate system of classification, pathophysiology, clinical presentation, risk factors, and prophylactic treatment options associated with HO formation of the elbow. Clinicians may utilize this information to identify high risk patient populations for potential prophylactic therapy to prevent the occurrence/complications of HO at the elbow. Methods: A PubMed literature review was conducted using combinations of the key words “heterotopic ossification,” “elbow,” and “fracture/dislocation.” All study types were considered and relevant articles were utilized for this review. Results: Higher levels of injury, severe neurologic and burn injuries, delay to surgery, delay in fixation/stabilization of the elbow, multiple surgical treatments, and genetics were correlated with ectopic bone formation. Single dose pre/postoperative radiotherapy with 700cGy or preoperative NSAID regiments were found to be the main prophylactic treatments. Conclusion: Clinicians must consider the HO risk profile of their patients as well as the risk factors of treatment before deciding on prophylactic options. Surgical resection is reserved for the most severe cases.

Background: Hand infections frequently involve the dorsal aspect of the hand and often develop secondary to some traumatic mechanism. Although Staphylococcus aureus is most commonly isolated, anaerobic and polymicrobial infections are not uncommon. To date, treatment is largely anecdotal, with some surgeons preferring a formal debridement in the operating room, while others opt for an initial debridement at the bedside. The goals of this study were to compare outcomes between treatment modalities and to identify the most common causative organisms. Methods: A 10-year retrospective chart review was conducted to identify adult patients who presented with a dorsal hand infection to a single, level 1, urban trauma center. Demographic data were collected as well as the abscess size, location, duration of symptoms, treatment administered, number of formal debridements, length of hospital stay, and complications. Results: The number of formal debridements was significantly less in the initial bedside debridement group (P < .01), as was the hospital length of stay (P < .01). There was no significant difference in hospital readmissions, complications, or infection due to methicillin-resistant Staphylococcus aureus. There was also no significant difference in abscess size, duration of symptoms, or demographic data including age, sex, comorbidities, intravenous drug use status, and immunocompromised status. Conclusions: An initial debridement of dorsal hand infections at the bedside is at least as effective as formal debridement in the operating room. This decreases number of formal debridements and days in the hospital, without any increase in complications. This permits safe, expeditious, and cost-effective treatment for this common condition.

Twenty-six patients with scaphoid fractures were treated with internal fixation using a cannulated differential pitch compression screw. Sixteen patients underwent a dorsal approach (group 1) and 10 patients a volar approach (group 2). Average time from injury to surgery was 6.6 months (range: 0.3-19 months) for group 1 and 8.3 months (range: 0.3-24 months) for group 2. The rate of union, determined by radiographs and clinical examination, was 81% in group 1 and 80% in group 2. No significant differences were noted between the groups for dorsiflexion/palmar flexion, radial deviation, grip strength, and pain level.

Residual limb shortening is common after obstetric brachial plexus palsy. The exact limb-length discrepancy remains undetermined, and the purpose of this paper is to determine the resultant discrepancy. Twenty-two skeletally immature patients with obstetric brachial plexus palsies were examined. Radiographs of both the involved and uninvolved humerii and forearms were obtained with a radiographic ruler placed adjacent to the extremity. Each limb segment was measured and the discrepancy calculated as a percentage compared with the normal side. Twenty-one of the 22 children had some shortening of the limb at both the humerus and forearm level. The involved limb averaged 92% of the uninvolved limb. The humeral length averaged 93% and the forearm length averaged 90%. Children with upper brachial plexus lesions had significantly less forearm and total limb shortening compared with those with global lesions. There was no correlation between age and percentage difference of the humeral, forearm, and total length.

This article discusses nerve loss treatment options. The role of cable graft versus early tendon transfers are delineated. Vascularized grafts and the timing of nerve grafting also are discussed.

Penetrating trauma is an endemic urban disease. The initial assessment requires a comprehensive examination and assessment of wound morphology. Preliminary splinting and radiographs of the injured extremity are necessary to plan fracture fixation. The surgical approach must appreciate the zone of injury and respect the soft tissues. Open or indirect reduction and internal fixation are the preferred techniques to stabilize the fracture.

Profound deficiencies occur in the intrinsic minus hand with loss of the interossei, thenar, hypothenar, and adductor pollicis muscles. The purpose of this study was to define the load-generating deficiencies of grip and pinch after simulated low median and/or low ulnar nerve lesions. Twenty-one healthy volunteers underwent median and ulnar nerve blocks at the wrist level with mepivacaine HCl injection. Key pinch and grip data were recorded before injection and after each nerve block was determined to be effective. A computerized dyna-mometer that simultaneously recorded individual force data from each digit and cumulative grip was used to record grip strength. Grip strength data showed a significant decrease in total grasp at all 3 handle sizes after initial median or ulnar nerve block. The average decrease in grip strength was 38% after ulnar nerve block and 32% after median nerve block. The total grip loss after both injections averaged 49% compared with the preinjection strength. After ulnar or median nerve block there was a significant decrease in the force production of the long, ring, and small fingers but not the index finger. Pinch data revealed a significant decrease in key pinch of 77% after ulnar block and 60% after median block with a further significant change after combined block to decrease pinch 85%. (J Hand Surg 1999;24A:64–72. Copyright © 1999 by the American Society for Surgery of the Hand.)

Web creep is a common complication following surgical release of syndactyly. Currently, normal web height has not been objectively determined, which prevents accurate analysis of the degree of web creep after surgery. The purpose of this study was to design a technique to reproducibly measure web height and to define the standard web height in a control population. Four hundred thirty-seven standard left posteroanterior hand x-rays of children without any upper extremity pathology were evaluated. Web height was measured as a relative ratio to digital length using standard landmarks. All measurements were tabulated according to gender, age, and web space. Statistical analysis was performed to determine the reliability of this technique and to delineate any differences between web space, gender, and age. There was no significant intraobserver or interobserver difference and web height was similar in males and females. There was a significant difference between web height with respect to web location and age. Normal ranges of web height with regard to age and web position were determined and plotted as graphs. Using this measurement method, web creep can be evaluated and comparison studies of different surgical techniques performed. (J Hand Surg 1998;23A:1071-1076. Copyright (C) 1998 by the American Society for Surgery of the Hand.).