High-velocity Accidents Research Articles

Obturator dislocation of the hip

Obturator dislocation of the hip is caused by high-velocity accidents as evidenced by its frequent association with other traumatic injuries and, seldom found. Its main complication remains femoral head avascular necrosis. We report on four cases of obturator dislocation of the hip. The mean age of patients was 30 years, and all their injuries followed a road traffic accident. Associated lesions were a contralateral femur fracture in two cases and an osteochondral fracture in one case. Reduction of dislocations was achieved orthopedically under general anaesthesia and the average waiting time before reduction was 20 hours. One patient had an intra-articular incarcerated frag- ment visible on X-ray, and another patient showed signs of early coxarthrosis 15 months later. The average follow-up time was 24 months.

Management of Aesthetic and Functional Deficits in Frontal Bone Trauma.

Frontal bone trauma has an increasing incidence and prevalence due to the wide-scale use of personal mobility devices such as motorcycles, electric bicycles, and scooters. Usually, the patients are involved in high-velocity accidents and the resulting lesions could be life-threatening. Moreover, there are immediate and long-term aesthetic and functional deficits resulting from such pathology. The immediate complications range from local infections in the frontal sinus to infections propagating inside the central nervous system, or the presence of cerebrospinal fluid leaks and vision impairment. We review current trends and available guidelines regarding the management of cases with frontal bone trauma. Treatment options taken into consideration are a conservative attitude towards minor lesions or aggressive surgical management of complex fractures involving the anterior and posterior frontal sinus walls. We illustrate and propose different approaches in the management of cases with long-term complications after frontal bone trauma. The team attending to these patients should unite otorhinolaryngologists, neurosurgeons, ophthalmologists, and maxillofacial surgeons. Take-home message: Only such complex interdisciplinary teams of trained specialists can provide a higher standard of care for complex trauma cases and limit the possible exposure to further legal actions or even malpractice.

Revisiting the epidemiology of mid shaft clavicle fracture-recent and emerging trends

<p><strong>Background: </strong>Clavicle fracture is a common injury involving upper limb. It accounts for 2.6-5% of injuries. Most common mechanism causing this injury is a fall on an outstretched hand. Clavicle fractures have a bimodal distribution with 1<sup>st</sup> peak in young active adult males less than 30 years of age. Second peak in elderly females with osteoporotic bones. The annual incidence is highest in male under 20 age group, decreasing with subsequent age groups. Road traffic accidents is another mode of injury which is becoming increasingly common for mid shaft clavicle fractures.</p><p><strong>Methods</strong>: A prospective study was carried out over 12 months. A total of 126 patients met the inclusion criteria. The epidemiological data was collected at the time of presentation using standard case sheet proforma. Radiographic assessment was done for fracture classification.</p><p><strong>Results</strong>: Mid Shaft clavicle fracture was most common in middle aged males (31-40 years) with right side being most commonly affected. Road traffic accidents was the most common cause of injury (62%). AO/OTA type 15B1 is the most common fracture morphology (45%). Most of the high energy road traffic accidents are associated with 15B3 type fractures while type 15B1 is more common in low energy mechanisms like ground level fall.<strong></strong></p><p><strong>Conclusions: </strong>Mid shaft clavicle fracture is a common injury in young population. It is increasingly being associated with road traffic accidents. The number of comminuted fractures, which represent high energy injury mechanism has been on the rise due to increase in high velocity accidents.<strong></strong></p>

The Demography of Traumatic Brachial Plexus Avulsion Injuries.

Background and objectiveBrachial plexus injuries more commonly affect the younger generation who constitute the productive workforce. The patients who sustain avulsion injuries of the brachial plexus are more often involved in high-velocity accidents. The avulsion injuries are surgically managed by nerve transfers. This study aimed to evaluate the demography of brachial plexus avulsion injuries.Materials and methodsThis retrospective study was conducted in January 2013 and included 21 patients treated from January 2007 to December 2011.ResultsOf the 21 patients, 20 were male and the most commonly affected patients were in the age group of 21-30 years. The mean age of the affected patients was 27.24 years. Six of the patients had pan palsy (C5-8 and T1), nine had C5-7 injury, and six had C5-6 injury. Twenty patients underwent spinal accessory to suprascapular nerve transfer, nine patients underwent ulnar nerve fascicle to nerve to biceps branch transfer, and one patient underwent intercostal nerve to musculocutaneous nerve transfer. Of note, 40% of the patients regained more than M3 power for abduction and external rotation of the shoulder, and 30% of the patients regained more than M3 power for elbow function.ConclusionsRoad traffic accidents are the most common cause of brachial plexus injuries. Nerve transfers for shoulder and elbow function play a significant role in improving the function of the upper extremity.

Role of Gentamicin Loaded Collagen on Compound Fracture Internal Fixation

Introduction: In the today’s world with faster ways of transportation high velocity accidents and the compound fracture are increasing day by day producing a challenge preventing post operative wound infections after internal fixation of fracture.
 Materials and Methods: 50 patients of compound fractures were included in the study and were randomly divided in 2 groups of 25 each . Both the groups undergone internal fixation with stainless steel implant and one group wound is closed with gentamicin loaded collagen in it and other group without it
 Method: In both the groups same process of and lavage is used and fractures were fixed internally fixed . A group has 25 patients in which after internal fixation the gentamicin loaded collagen is placed inside and in B group after internal fixation wound is closed without gentamicin loaded collagen.
 Results: In group A where Gentamicin loaded collagen was placed wound infection was there in 2 patients . In Group B were no gentamicin loaded collagen was used 9 patietns has infections. P value 0.0275
 Discussion: After surgery wound is assessed for post operative infection on 2 nd post op day 14 day at 4 weeks 6 weeks 3 months and 6 months
 Conclusion: The Author believe that use of gentamicin loaded collagen significantly reducing the chance of infection in compound fractures surgeries.
 Keywords: compound fracture, gentamicin loaded collagen, post operative infection

Functional outcome of tibial plateau fractures treated with locking and non locking plate fixation: A retrospective study

Tibial plateau fracture have been a challenge to treat as these fractures are associated with severe damage to the soft tissue envelope and significant communition and bone loss. This may be due to high speed velocity accidents or fall from height. There exist no gold standard approach in treating these fractures, each case may vary in terms of soft tissue injury, communition and association of neurovascular status. This study was conducted by department of orthopaedics at Government Medical College Ernakulam from February 2018 to January 2020, during this period 30 patients managed by internal fixation was evaluated for their functional outcome. The patients were assigned into two groups; those treated with locking plate and another being the Non locking group. Follow up range was 10-24 months, average being 17.4.This study revealed locking plates to be superior in terms of knee scores, radiological outcomes and post-operative pain.

Surgical outcome of proximal tibial fractures treated with locking compression plate: A prospective study

Background: The knee joint is one of the major weight bearing joints in the lower extremity. Generally, these injuries fall into two broad categories, high energy fractures and low energy fractures. Fractures of the proximal tibia are the result of high energy injuries and because of lack of soft tissue coverage in this region. The majority of tibial plateau fractures are secondary to high speed velocity accidents and fall from height. Fractures result from direct axial compression usually with a valgus or varus moment and indirect shear forces. Materials and Methods: The study was conducted between the period of November 2017 to April 2019 includes at Department of Orthopaedics, Bowring hospital,Bangalore.20 patients with diagnosis of proximal tibial fractures were treated with locking compression plate. All Schatzker’s classification type 1-6 proximal tibial fractures in adults aged 18 years and above of either sex were included in the study. All patients were followed up. With each follow up, clinical and radiological examinations were performed at 6 weeks, 3 months and 6 months. Results: The study included 20 patients, 18 males and 2 female aged from 21-80 years with mean age of 40.02 years. The average time for fracture union in our series was 15.52 weeks. In present study, knee stiffness was observed in 2 patients. Our study yielded excellent to good results in 80% of cases. Conclusion: Displaced tibial plateau fractures are best managed operatively. Optimal knee function is achieved by accurate anatomical reduction and secure fixation followed by early mobilization to attain functional arc of motion. For minimally-displaced fractures with minimal bone defects percutaneous fixation suffices, whereas for comminuted fractures, open reduction and internal fixation is mandatory. In our study, we found that proximal tibial locking plate provides complete union and early mobilization to attain better functional outcome.

Contemporary insight into diffuse axonal injury.

Diffuse axonal injury (DAI) is present in approximately 50% of the cases with severe traumatic brain injury. It is one of the leading causes of morbidity and mortality among children and young individuals worldwide. Generally, DAI occurs as a result of high-velocity accidents. Typically, it presents with loss of consciousness for at least 6 hours and neurological deficit dependent on the brain area that is affected by the injury. The final diagnosis is confirmed by neuroimaging studies such as computed tomography and magnetic resonance imaging. According to the injured brain site, DAI is classified into three grades: Grade I-DAI with axonal lesions in the cerebral hemispheres; Grade II-DAI with focal axonal lesions in the corpus callosum; Grade III-DAI with focal or multiple axonal lesions in the brainstem. Each of the three grades is associated with different outcome.Due to the high disability and mortality rate, DAI represents an important medical, personal and social problem. The aim of the current review is to address the unsolved issues connected with the pathogenesis, diagnostics, treatment and outcome of the diffuse axonal injury.

Functional outcome of surgical management in cases of fracture patella in a tertiary care hospital in Salem

<p><strong>Background: </strong>Fractures of the patella are serious injuries with a broad range of subtypes. These injuries account for about 1% of all skeletal injuries and are most prevalent within the age group of 20-50 years. The underlying mechanisms of open fractures are mostly high-velocity accidents. To assess the functional outcome of various surgical procedures done for fracture patella.</p><p><strong>Methods: </strong>A longitudinal study was conducted from the department of orthopedics, Vinayaka missions Kirupananda Variyar medical college and hospital, Salem for one year in August 2019 and July 2020. All the adult patients admitted with the diagnosis of patellar fracture were included in the study. A complete local examination was conducted and an X-ray of AP and the lateral view was taken for all the patients.</p><p><strong>Results: </strong>Transverse patella fracture is being the most common fracture and for that modified tension band wiring (TBW) was the most common procedure performed and for comminuted fracture partial patellectomy was the most common procedure and for 1 patient total patellectomy was performed.</p><p><strong>Conclusions:</strong><strong> </strong>The study shows that the treatment of patella fractures with modified tension band wiring is a definitive treatment with minimal complications and excellent functional outcomes.</p>

Functional outcome of locking compression plate in the management of proximal tibia fracture

Background: The proximal tibia fractures are one of the commonest intra-articular fractures. These injuries fall into two broad categories, high energy fractures and low energy fractures. The majority of tibial plateau fractures are secondary to high velocity accidents and fall from height where fractures result from direct axial compression, usually with a valgus (more common) or varus movement and indirect shear forces. Proximal tibial fractures present a spectrum of soft tissue and bony injuries that can produce permanent disabilities.Objective: This study evaluates the effectiveness of LCP (locking compression plate) in the management of proximal tibia fractures based on clinio-radiological assessment.Methods: It is a prospective observational study with sample size of 30 and all patients having intraarticular and or juxtaarticular fracture of proximal part of tibia, using AO classification system. Post operatively patients were followed up after 2 weeks, 6 weeks and at 3 month then monthly till union.Results: Fair to good functional results were correlated with associated injury whereas excellent results were obtained with those who did not sustained other associated injury.Conclusion: locking compression plate offers a good treatment option for intraarticular and juxtaarticular fractures of proximal part of tibia without the need for additional medial stabilization.Level of evidence: prospective level III follow up study.

Surgical management of fracture shaft of femur in children aged between 5 to 16 years using elastic stable intramedullary nailing

Femoral shaft fractures including subtrochanteric and supracondylar fractures, represent approximately 1.6% of all bony injuries in children. Most fractures in children are the result of high velocity accidents. Most of the injuries in children were due to fall from swings on a play ground. More recently a variety of therapeutic alternatives such as external fixation, compression plating and flexible or locked intramedullary nailing have become available, to help decrease impairment, increase convenience and decrease the cost of treatment. In this study 20 patients aged between 5 to16 years, with fracture shaft of femur were treated with flexible intramedullary nail. Upon evaluation by the FLYNN criteria, we had 45% (n=9) excellent results, 40% (n=8) of successful results and 15% (n=3) of poor results.

Influence of the trauma mechanism on cervical spine injuries

The influence of trauma-related kinematics on the injury pattern of the cervical spine is currently not considered in the available classification systems, only the force vector. Whether the strength of the trauma has an additional influence on the number and complexity of the injuries and whether this can be classified, has not yet been finally investigated. What influence do different kinematics apart from the traumatic force vector have on injuries of the cervical spine? Based on the AOSpine classification system for the upper and subaxial cervical spine, data from 134 trauma patients from afirst level trauma center were retrospectively analyzed. Analogue to the S3 guidelines on polytrauma, patients were assigned to six trauma groups and the injuries were classified on the basis of computed tomography (CT) cross-sectional imaging. A higher trauma energy had a significant impact on the number of cervical spine injuries (p = 0.005). In low velocity accidents C2 was the most frequently injured vertebra (51%; p = 0.022) and high velocity accidents showed more C7 fractures (37%; p = 0.017). Furthermore, upper cervical spine injuries occurred more often in low energy trauma and older female patients (e.g. falling from a standing position). Subaxial cervical spine involvement was found significantly more often in high velocity accidents and younger male patients (p = 0.012). Exact knowledge of the trauma mechanism is helpful in the primary treatment of an injured person. Injury patterns can be better estimated and the appropriate diagnostics can be initiated. The results underline the importance of immediate cervical spine immobilization even after minor trauma. In high velocity trauma, patients more often suffer from lower cervical spine injuries, especially C7. Due to the accumulation of multilevel spinal injuries in high velocity trauma, radiographic imaging of the whole spine is advisable.

22THE PSYCHIATRIC RISK GENE NT5C2 REGULATES PROTEIN TRANSLATION IN HUMAN NEURAL PROGENITOR CELLS, AND IS INVOLVED IN LOCOMOTOR BEHAVIOUR IN DROSOPHILA MELANOGASTER

Diaphragmatic rupture following blunt trauma occurs rarely. Classically described after high-velocity accidents, ruptures are often associated with multiple organ injuries. The diagnosis is sometimes difficult. The goal of this study was to analyze and to discuss the modalities of early radiologic diagnosis and management of these injuries.This multicenter retrospective study included patients seen between 2009 and 2017 within the Northern Alpine Emergency Network [REseau Nord Alpin des Urgences (RENAU)]. Clinical, radiologic and surgical data from all patients sustaining blunt diaphragmatic rupture were studied.Thirty-one patients (18 men and 13 women), median age 44, were included. The principle mechanism of injury was road or traffic accidents for 22 patients. Diaphragmatic rupture occurred on the left side in 23 patients. Diagnosis was delayed in two patients, at 11 days and three months after the initial accident. Chest X-rays were diagnostic in 18 of 29 patients. CT scan was the reference investigation since it was performed in all patients and confirmed the diagnosis in 26 instances. Repair was surgical via a midline laparotomy in 27 patients, via laparoscopy in three, and via thoracoscopy in one. Three patients died.At urgent surgical exploration in the unstable blunt trauma patient, the surgeon should keep in mind the relatively poor diagnostic performance of chest X-rays. Accurate diagnosis relies on routine inspection of the diaphragmatic cupolas. In the stable trauma victim, contrast-enhanced abdomino-thoracic CT with reconstruction can lead to early diagnosis, which allows for repair under optimal conditions, whether by laparotomy, laparoscopy or thoracoscopy, according to local conditions and expertise.

Relevance of early CT scan diagnosis of blunt diaphragmatic injury: A retrospective analysis from the Northern French Alps Emergency Network

Diaphragmatic rupture following blunt trauma occurs rarely. Classically described after high-velocity accidents, ruptures are often associated with multiple organ injuries. The diagnosis is sometimes difficult. The goal of this study was to analyze and to discuss the modalities of early radiologic diagnosis and management of these injuries. This multicenter retrospective study included patients seen between 2009 and 2017 within the Northern Alpine Emergency Network [REseau Nord Alpin des Urgences (RENAU)]. Clinical, radiologic and surgical data from all patients sustaining blunt diaphragmatic rupture were studied. Thirty-one patients (18 men and 13 women), median age 44, were included. The principle mechanism of injury was road or traffic accidents for 22 patients. Diaphragmatic rupture occurred on the left side in 23 patients. Diagnosis was delayed in two patients, at 11 days and three months after the initial accident. Chest X-rays were diagnostic in 18 of 29 patients. CT scan was the reference investigation since it was performed in all patients and confirmed the diagnosis in 26 instances. Repair was surgical via a midline laparotomy in 27 patients, via laparoscopy in three, and via thoracoscopy in one. Three patients died. At urgent surgical exploration in the unstable blunt trauma patient, the surgeon should keep in mind the relatively poor diagnostic performance of chest X-rays. Accurate diagnosis relies on routine inspection of the diaphragmatic cupolas. In the stable trauma victim, contrast-enhanced abdomino-thoracic CT with reconstruction can lead to early diagnosis, which allows for repair under optimal conditions, whether by laparotomy, laparoscopy or thoracoscopy, according to local conditions and expertise.

Racial disparities in outcomes of operatively treated lower extremity fractures.

Whether racial differences are associated with function in the long term following surgical repair of lower extremity fractures has not been investigated. The purpose of this study is to compare how race affects function at 3, 6 and 12months post-surgery following certain lower extremity fractures. Four hundred and eighteen patients treated operatively for a lower extremity fracture (199 tibial plateau, 39 tibial shaft, and 180 rotational ankle fractures) were prospectively followed for 1year. Race was stratified into four groups: Caucasian, African-American, Hispanic origin, and other. Long-term outcomes were evaluated using the short musculoskeletal function assessment (SMFA) and pain scores were assessed at 3, 6months and 1year. There were 223 (53.3%) Caucasians, 72 (17.2%) African-Americans, 53 (12.4%) Hispanics, and 71 (17.0%) patients from other ethnic groups, included in our study population. Minority patients (African-American, Hispanics, etc.) were more likely to be involved in high velocity mechanisms of injury and tended to have a greater percentage of open fractures. Although there were no differences in the rate of wound complications or reoperations, long-term functional outcomes were worse in minority patients as assessed by pain scores at 6months and functional outcome scores at 3, 6 and 12months. Multivariate analysis revealed that only African-American and Hispanic race continued to be independent predictors of worse functional outcomes at 12months. Racial minorities and those on medicaid had poorer long-term function following fractures of the lower extremity. While minority patients were involved in more high velocity accidents, this was not an independent predictor of worse outcomes. These disparities may result from multifactorial socioeconomic factors, including socioeconomic status and education levels that were not controlled in our study. Prognostic Level III.

Management of intra-articular fractures of distal end radius in adults

<p class="abstract"><strong>Background:</strong> Incidence of intra articular fracture L/3rd radius is significantly on rise due to high velocity accidents in young and adults. Painless wrist function is of vital importance for functioning of upper extremity in almost all activities of daily living and precise function of hand. Intra articular fracture of L/3rd radius has generally gross comminution and so also small articular fragments. Orthopaedic community differ about specific implants to fix this complex injury. The present study was undertaken to know efficacy of different modalities of treatment for different fracture pattern. Comminuted intra articular fracture geometry varies widely, to fix these small fragments to achieve stable anatomical reduction is a challenging task. </p><p class="abstract"><strong>Methods:</strong> It is a combined i.e. retrospective and prospective study conducted at Hardikar Hospital, Pune, India from 1999 to December 2000. Patients of intra-articular fracture of distal end radius by different modes of treatment are included in the study. 1 patient with unilateral fracture was lost for follow-up. Thus 50 fractures, in 49 patients. were included in study. Clinico-radiological assessment was carried out by Lidstrom's (1959) criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> Satisfactory early functional end results with plaster treatment is 72.2% whereas with other modality of treatment it rises to 87.5%, indicating superiority of other modalities of treatment as far as early functional end results are concerned.</p><strong>Conclusions:</strong> Manipulation and plaster cast method continues to be the treatment of choice in the stable intra articular distal radial fractures. Hence there is a need for a "differentiated therapy for distal radial fractures". The treatment plan for patients must be based not only on fracture pattern identified on plain radiographs but also on factors such as bone quality, bone comminution, energy of injury and associated soft tissue damage. Additional factors to be considered in individual patient are-life style associated medical conditions and compliance.

An Algorithm for the Management of Concomitant Maxillofacial, Laryngeal, and Cervical Spine Trauma.

Concomitant maxillofacial, laryngeal and cervical spine injuries may occur after high-energy accidents. Although this presentation is uncommon, the multiple injuries may compromise airway, breathing, circulation, and neurologic function. We identified 8 adult trauma patients admitted to the National University Hospital with the concomitant injuries. We reviewed the patient data and existing literature to identify the important factors that must be considered for management. Seven resulted from high velocity accidents, whereas 1 was assaulted. An algorithm that prioritizes in-tandem diagnosis and acute management of the adult trauma patient with maxillofacial, laryngeal, and cervical spine trauma was developed. The first priority is to assess airway, breathing, and circulation with cervical spine immobilization. Early diagnosis of patients with severe laryngeal injury, confirmation by video endoscopy, and establishing a surgical airway prevents airway obstruction or even a laryngotracheal dissociation. Urgent computed tomography scans of the head and neck are essential for definitive diagnosis and surgical planning for the 3 injuries. Prudent sequencing of surgery is important to avoid complications and to achieve better functional outcomes.

Obturator Dislocation of the Hip at Yopougon/Abidjan Teaching Hospital

Obturator dislocation of the hip is caused by high-velocity accidents as evidenced by its frequent association with other traumatic injuries and, seldom found. Its main complication remains femoral head avascular necrosis. We report on four cases of obturator dislocation of the hip. The mean age of patients was 30 years, and all their injuries followed a road traffic accident. Associated lesions were a contralateral femur fracture in two cases and an osteochondral fracture in one case. Reduction of dislocations was achieved orthopedically under general anaesthesia and the average waiting time before reduction was 20 hours. One patient had an intra-articular incarcerated fragment visible on X-ray, and another patient showed signs of early coxarthrosis 15 months later. The average follow-up time was 24 months.

The sterno-vertebral instability - a new classification and therapeutic options

Sternal fractures in the context of high velocity trauma are commonly referred to as impact injuries. In general, these are considered to be treated conservatively. In the literature, there are only a few studies and a small number of cases. We know that not only high velocity accidents cause combined trauma of sternum and spine, but also low velocity traumas in the elderly are relatively common. How should such combinations of injuries be treated? Based on 11 patients from the years 2005 to 2013 with different combinations of sternal and spinal injuries, we distinguish the therapeutic approach of ventral, dorsal or combined stabilisation, with the help of a four-column classification of these injuries. We classify sternovertebral injury into 4 types. First the descendant type with an injury from C I to C VII and sternum, second the horizontal type (T I to T XII and sternum), third the ascendant type (L I to L V and sternum) and fourth a dissociative type. The recommended therapy of the descendant type is dorsoventral stabilisation of the spinal column plus stabilisation of the sternum. The horizontal type should be treated with dorsal stabilisation of the spine and stabilisation of the sternum. The ascendant type should be supplied with dorsoventral stabilisation of the spinal column and conservative therapy of the sternum. In case of the dissociative type one should supply each injury independently. The literature on sternal injuries and their treatment is low. Combinations of sternum and spine injuries have not yet been processed systematically in literature. Thus, there is no concerted standard of therapeutic options. The very rare occurrence of this injury combination often leads to this injury type being forgotten in the primary evaluation of casualties.

Ulnar nerve injury after a comminuted fracture of the humeral shaft from a high-velocity accident: a case report

IntroductionInjury to the ulnar nerve following humerus shaft fracture is a very rare entity because the ulnar nerve is well protected from the bone by muscle and soft tissue, and thus remains unaffected in these fractures. We report what is, to the best of our knowledge, the first case of ulnar nerve injury due to a comminuted humeral shaft fracture. The injury manifested and was diagnosed the day after a high-velocity accident. The paucity of related literature and the necessity for early diagnosis and subsequent treatment of such injuries in high-velocity accidents urged us to document this case.Case presentationA 30-year-old Indian man presented to our Emergency Department after a road traffic accident. Our patient complained of right arm pain and the inability to move his extremity. The following morning he developed clawing. Nerve conduction studies on the peripheral nerves of his arm in addition to an X-ray confirmed the diagnosis of a possible injury to the ulnar nerve. Our patient was taken to our Operating Room for surgery, during which a fragment of bone was found abutting the ulnar nerve after penetrating his triceps. This fragment of bone was replaced and the fracture was reduced by open reduction and internal fixation using a dynamic compression plate and screws. Postoperatively, our patient received physical therapy and was discharged two weeks after surgery with no neurological deficit.ConclusionsThis case emphasizes the urgency and importance of careful neurological examination of all the peripheral nerves supplying the arm in patients with a fracture of the shaft of the humerus. In the setting of injury to the arm in high-velocity accidents, a differential diagnosis of ulnar nerve injury should always be considered.