Therapeutic principles in upper limb trauma

Andreea Grosu-Bularda,Razvan Teodoreanu,Alexandru Stoian,Serban Arghir Popescu,Flavia-Francesca Lita,Ioan Lascar,Florin-Vlad Hodea,Liviu-Petre Cojocaru

doi:10.37897/rmj.2021.3.2

Abstract

Upper limb trauma cases vary from simple to high energy impactful injuries, with different etiologies; situations which frequently require unique, demanding and challenging endeavors in order to obtain the most favorable outcome. Experience, good decision-making and knowledge of functional goals are mandatory in order to elaborate a therapeutic plan and execute it accordingly. Although cases differ in nature and prognosis, respecting a set of therapeutic principles whilst dealing with either simple or complex cases, will enhance patient outcome and give the surgeon the confidence to tackle any kind of upper limb trauma. After clearing out vital threat, the emergency surgery represents the first threshold in achieving and restoring normal function and biomechanics, mostly in young and labor active patients, with the mindset to salvage as much tissue as possible, with a thorough debridement and step-by-step approach to different types of tissues. Secondary surgery and reconstructive surgery can be planned timely, with prior discussion with both the therapist and the patient in order to enhance patient’s upper limb function and aesthetic and ensure social reintegration.

Highlights

Upper limb trauma still presents to date, a demanding therapeutic challenge, due to the variability of the case with multiple external factors such as traumatic mechanism, duration of injury, anatomical site, previous functional status, time of ischemia, all-in-all generating cases ranging from simple to complex, such as the mutilated hand
The importance of prompt intervention in such cases is once again enhanced by the fact that these types of injuries occur in young and labor active patients, with both individual social and functional impact, as well as public health and economy impact given by the burden of upper limb sequelae [1,2]
Upper extremity injuries can be challenging, time-saving decisions can be and immediately taken, in order to generate favorable outcomes, should the surgeon keep a therapeutic algorithm in mind

Summary

INTRODUCTION

Upper limb trauma still presents to date, a demanding therapeutic challenge, due to the variability of the case with multiple external factors such as traumatic mechanism, duration of injury, anatomical site, previous functional status, time of ischemia, all-in-all generating cases ranging from simple to complex, such as the mutilated hand. The importance of prompt intervention in such cases is once again enhanced by the fact that these types of injuries occur in young and labor active patients, with both individual social and functional impact, as well as public health and economy impact given by the burden of upper limb sequelae [1,2]. When planning for reconstruction, the surgeon must take into consideration patient factors such as general status, age, domination of hand, profession and socio-economic status. Other factors that need to be considered are ischemia time, injury mechanism, wound contamination status, and history of limb trauma [4,5]

General principles

Surgical principles

Rehabilitation principles

CONCLUSIONS