Severe Crush Research Articles

A Stepwise Algorithm for Surgical Treatment of Type II Displaced Pediatric Phalangeal Neck Fractures

To evaluate a stepwise reduction algorithm including closed, percutaneous, and open reduction techniques followed by percutaneous pin fixation for displaced pediatric phalangeal neck fractures. Sixty-one consecutive children (mean age, 9.4 y; range, 2-18 y) presenting with closed, type II displaced phalangeal neck fractures were treated using the following algorithm. If satisfactory reduction was achieved with closed reduction, percutaneous pinning (CRPP) was performed. If not achieved, then percutaneous reduction and pinning (PRPP) was performed using a temporary intrafocal joystick for reduction and for osteoclasis as needed. If percutaneous reduction failed, open reduction and percutaneous pinning (ORPP) was performed. Using the Al-Qattan system, radiographic and clinical outcomes were retrospectively graded for union, deformity, range of motion, and function. Satisfactory alignment was achieved in all 61 fractures, by CRPP in 49 and PRPP in 12. No fracture required open reduction. Mean number of days from injury to surgery was 8 days for CRPP and 17 days for PRPP. All fractures treated after 13 days required percutaneous pinning. Fifty-three patients were followed for at least 1 year or until full functional recovery was achieved, with 45 excellent, 4 good, 1 fair, and 3 poor results. Four complications accounted for the fair and poor results, including 1 flexion contracture, 1 nonunion following pin track infection, and 1 case of avascular necrosis following a severe crush injury in the CRPP group and 1 flexion contracture following PRPP. Our stepwise algorithm for surgical treatment of closed, type II displaced pediatric phalangeal neck fractures produced 92% good to excellent results while minimizing the need for open reduction even in late-presenting fractures. Therapeutic IV.

The MESS: is it must?

Background: Massive lower extremity trauma presents an immediate and complex decision making challenge. Significant advancements have made in the field of reconstructive surgery over the past 30 years. Severely traumatised limbs which would have been treated by primary amputation 20 years ago are beginning to be saved. On the contrary, such extensive reconstructive procedures may not always produce the best of results in terms of functional outcomes. Thus the management of a severely crushed extremity presents a therapeutic dilemma as whether to amputate or to attempt salvage. Methods: All Prospective study of 40 patients with severe crush injury to the lower extremities treated in Sri Ramachandra Medical College, Chennai between June 2012 and June 2014. The inclusion criteria were grade IIIb and grade IIIc open fractures of the lower extremity with a Mangled extremity severity score (MESS) of 7 and above with minimum of 12 months follow up. All the fractures were classified according to the Gustilo and Anderson classification system and Mangled extremity severity score. Out of the 40 patients 18 of them had their limbs salvaged and 22 underwent primary amputation. Results: The lowest MESS in this study was 7 and highest MESS was 12. The mean score in the limb salvage group was 8 and in the amputated group was 9.7. Complication rates in salvage group were higher. The mean SF score for amputated group for physical component summary was 40.15 and mental component summary was 44.30 while for limb salvage group score for physical component summary was 30.91 and mental component summary was 36.90. Conclusions: The MESS scheme provides excellent guidelines to the treating surgeon when faced with a dilemma of whether to attempt salvage or amputate a severely injured limb. The decision of whether to amputate or salvage an injured limb must be made very early in the course of treatment. This is because immediate amputation is most often viewed by the patient as a result of injury; whereas, delayed amputation is often considered as a failure of treatment.

Modelling of forefoot injuries caused by brake pedal loading – a finite element analysis case study

Lower extremity injuries, in particular the foot/ankle are one of the most common in automotive crashes.[1] Although not life threatening, they can lead to long term medical complications or permanent disability[²]. In most cases foot and/or ankle fractures are caused during frontal automotive crashes, while the driver attempts an emergency brake and the foot is subject to crash loading [³]. In these cases, fractures of the forefoot, in particular the metatarsals are very common [4] and range from simple fractures to severe crush injuries [5]. The location of metatarsal fractures in a car crash victim can be dictated by the loading pattern [5]. However, there is little information about whether the pedal has an effect on the mechanism or extent of injury. In order to evaluate the effect of brake pedal loading on the injury tolerance of the metatarsal, a computer based finite element analysis was performed to assess the regional capabilities in terms of loading transmission around the forefoot.

Surgical Reconstruction of a Severe Crush Injury of the Lateral Part of the Forefoot with Use of a Cross-Leg Osteocutaneous Pedicled Fibular Graft: A Case Report.

The lateral part of the forefoot serves as part of the transverse and lateral longitudinal arches and therefore plays a key role in foot function1,2. Foot injuries resulting from high-energy trauma are increasingly common. These injuries are usually accompanied by extensive damage to the soft tissues, severely comminuted fractures or bone defects, and even injuries to the nerves and the main vessels. Limb salvage and reconstruction in these cases present great challenges for orthopaedic and plastic surgeons3. After high-energy trauma, substantial defects of the lateral part of the forefoot are commonly encountered during surgery, especially with injuries involving the four lateral metatarsal bones and the corresponding soft tissues. Limited information has been published about limb salvage surgery techniques for this region. We describe a case of a severe crush injury of the four lateral metatarsal bones with corresponding soft-tissue damage that was treated effectively with a cross-leg osteocutaneous pedicled fibular graft. The patient and his family were informed that data concerning the case would be submitted for publication, and they provided consent. A twenty-four-year-old man was admitted to the hospital and treated for injuries to the left lower extremity, which had been sustained in a motorcycle crash. Initial examination revealed extensive soft-tissue injury of the left foot associated with a Gustilo-Anderson type-IIIC comminuted fracture of the metatarsal bones (Fig. 1-A). The metatarsal bone fractures were fixed with Kirschner wire, and the wound was covered with a vacuum-assisted closure device during emergency treatment. Necrosis of the four lateral metatarsal bones was considered to …

The legacy of Hillsborough: liberating truth, challenging power

In April 1989, ninety-six men, women and children, supporters of Liverpool Football Club, died in a severe crush at an FA Cup semi-final at Hillsborough Stadium, Sheffield. Hundreds were injured and thousands traumatised. Within hours, the causes and circumstances of the disaster were contested. While a judicial inquiry found serious institutional failures in the policing and management of the capacity crowd, no criminal prosecutions resulted, and the inquests returned ‘accidental death’ verdicts. Immediately, the authorities claimed that drunken, violent fans had caused the fatal crush. Denied legitimacy, survivors’ accounts revealed a different story criticising the parlous state of the stadium, inadequate stewarding, negligent policing, failures in the emergency response and flawed processes of inquiry and investigation. Reflecting on two decades of research and contemporaneous interviews with bereaved families and survivors, this article contrasts the official discourse with those alternative accounts – the ‘view from below’. It demonstrates the influence of powerful institutional interests on the inquiries and investigations. It maps the breakthrough to full documentary disclosure following the appointment of the Hillsborough Independent Panel, its research and key findings published in September 2012. The campaigns by families and survivors were vindicated and the fans, including those who died, were exonerated. The process is discussed as an alternative method for liberating truth, securing acknowledgement and pursuing justice.

Traumatic urethrocutaneous fistula: Case report and literature review

Penile injury is fortunately fairly uncommon as it represents only about 1% to 1.6% of all trauma cases. Severe penile trauma may be complicated by urethrocutaneous fistula. A 22 year old male patient presented with urethrocutaneous fistula following severe crush injury of his penis from the rollers of a baking machine. He had penile fasciocutaneous flap urethroplasty with satisfactory outcome. Wearing loose fitting clothing while operating industrial machinery could lead to entrapment and severe genital injury.

Transcorneal alternating current stimulation after severe axon damage in rats results in “long-term silent survivor” neurons

Transcorneal alternating current stimulation (tACS) was proposed to decrease acute death of retinal ganglion cells after optic nerve transection in rats, but it is not known if cell survival is long-term and associated with functional restoration. We therefore evaluated the effects of tACS in a rat model of optic nerve crush using anatomical, electrophysiological and behavioural measures. Rats were trained in a brightness discrimination visual task and the retinal ganglion cell number was quantified with in vivo confocal neuroimaging. Thereafter, severe optic nerve crush or sham crush was performed and rats were treated under anaesthesia either with tACS or sham stimulation immediately after the lesion and on day 3, 7, 11, 15, 19 and 23. Brightness discrimination was evaluated for 6 weeks and retinal ganglion cells were counted in vivo on post-crush days 7 and 28. In additional rats we studied the influence of tACS on bioelectrical activity. On post-lesion day 28, the tACS-treated group showed a neuronal survival of 28.2% which was significantly greater than in sham operates (8.6%). All animals with optic nerve crush were significantly impaired in brightness discrimination and did not recover performance, irrespective to which group they belonged. In accordance with this, there was no significant influence of the stimulation on EEG power spectra. In conclusion, tACS induced long-term neuronal protection from delayed retrograde cell death, but in this case of severe axonal damage tACS did not influence functional restoration and EEG signals recorded over the visual cortex.

A contemporary analysis of the management of the mangled lower extremity

The management of a mangled lower extremity is complex and requires consideration of a patient's injury pattern, medical history, social context, and preference. The Lower Extremity Assessment Project provides the highest level of evidence guiding management; however, the Lower Extremity Assessment Project cohort was recruited 15 years ago and was restricted to Level I trauma centers. Furthermore, as our ability to salvage limbs has improved, the decision to amputate in the early period following injury remains particularly challenging. Given these considerations, our primary objective was to characterize the contemporary management of the mangled lower extremity across a range of trauma centers and identify which patient and injury characteristics are associated with early amputation. We used a retrospective cohort design and included adults in the National Trauma Databank (2007-2009) with a mangled lower extremity treated at Level I or II trauma centers. A mangle injury was defined as (1) a severe crush injury or (2) the combination of a severe fracture with selected severe injuries from at least two of three categories as follows: soft tissue, artery, or nerve. Logistic regression was used to evaluate the association of patient and injury characteristics with our primary outcome: amputation performed before the end of the first full calendar day following emergency department arrival (early amputation). A total of 1,354 patients were identified from 222 centers; 278 (21%) underwent amputation during their hospital course, with 124 (9%) undergoing early amputation. On multivariable analysis, only injury characteristic was associated with early amputation. The presence of severe head injury (Abbreviated Injury Scale [AIS] score ≥ 3), shock in the emergency department (systolic blood pressure < 90 mm Hg), limb injury type, and higher-energy mechanism were independently associated with early amputation. Nearly half of all in-hospital amputations for mangled lower extremities are performed early. The decision to amputate early may not be guided by age, comorbidity level, or insurance status but rather by systemic and local injury characteristics. Therapeutic study, level IV; prognostic/epidemiologic study, level IV.

Circumferential Strut Fracture as a Mechanism of “Crush” Bifurcation Restenosis

The "Crush" procedure is a 2-stent technique for the treatment of bifurcation lesions with greater rates of in-stent restenosis than the Culotte technique. In conclusion, we report a possible mechanism for this discrepancy in the case of severe Crush stent fracture with associated focal restenosis identified by postmortem microcomputed tomography and histologic examination.

Limb salvage surgery

The threat of lower limb loss is seen commonly in severe crush injury, cancer ablation, diabetes, peripheral vascular disease and neuropathy. The primary goal of limb salvage is to restore and maintain stability and ambulation. Reconstructive strategies differ in each condition such as: Meticulous debridement and early coverage in trauma, replacing lost functional units in cancer ablation, improving vascularity in ischaemic leg and providing stable walking surface for trophic ulcer. The decision to salvage the critically injured limb is multifactorial and should be individualised along with laid down definitive indications. Early cover remains the standard of care, delayed wound coverage not necessarily affect the final outcome. Limb salvage is more cost-effective than amputations in a long run. Limb salvage is the choice of procedure over amputation in 95% of limb sarcoma without affecting the survival. Compound flaps with different tissue components, skeletal reconstruction; tendon transfer/reconstruction helps to restore function. Adjuvant radiation alters tissue characters and calls for modification in reconstructive plan. Neuropathic ulcers are wide and deep often complicated by osteomyelitis. Free flap reconstruction aids in faster healing and provides superior surface for offloading. Diabetic wounds are primarily due to neuropathy and leads to six-fold increase in ulcerations. Control of infections, aggressive debridement and vascular cover are the mainstay of management. Endovascular procedures are gaining importance and have reduced extent of surgery and increased amputation free survival period. Though the standard approach remains utilising best option in the reconstruction ladder, the recent trend shows running down the ladder of reconstruction with newer reliable local flaps and negative wound pressure therapy.

Sivelestat Improves Outcome of Crush Injury by Inhibiting High-Mobility Group Box 1 in Rats

Severe crush injury is associated with high mortality because of resulting hyperkalemia in early phase and multiorgan dysfunction in later phase. In this study, we investigated the effects of sivelestat administration 1 h before reperfusion on the outcome of crush injury. Crush injury was induced by 6 h of direct compression to both hindlimbs of anesthetized rats with blocks weighing 3.5 kg each side, followed by 3 h of reperfusion. Rats were randomly assigned to three groups. In the control group, rats were infused with normal saline at 1 mL/kg per hour throughout the experiment without compression. Rats in the positive control group were compressed for 6 h, followed by fluid resuscitation initiated 1 h before release with normal saline. The infusion rate was increased from 1 to 10 mL/kg per hour and continued for 4 h. Rats in the treated group underwent the same procedures as in the positive control group, but sivelestat was added to normal saline (concentration was adjusted to infuse 10 mg/kg per hour) during fluid resuscitation (for 4 h). Treatment with sivelestat significantly improved survival rate with P = 0.032. This was accompanied by lower serum high-mobility group box 1 (HMGB1) levels after 3-h reperfusion, attenuated lung injury (assessed using hematoxylin-eosin stain), and suppression of HMGB1 expression in the lung and the liver. These results suggest that treatment with sivelestat improves the outcome of crush injury, likely by inhibiting HMGB1 in rats.

Benefits of extracorporeal membrane oxygenation for major blunt tracheobronchial trauma in the paediatric age group

Tracheobronchial rupture due to blunt chest trauma is a rare but life-threatening injury among children. The severity of this condition ranges from death before hospital admission to clinical stability resulting in delayed management. Diagnosis is difficult because there is sometimes no evidence of external trauma, in spite of severe chest crush injury and consecutive rupture of airways. Here, we report the case of a 32-month-old girl whose torso was crushed by a van, resulting in bilateral bronchi disconnection. She was admitted to our hospital with cardiac and respiratory arrest. After prompt resuscitation, flexible bronchoscopy permitted the accurate visualization of the rupture and its extent. The life-saving procedure consisted of surgical repair using extracorporeal membrane oxygenation (ECMO) as ventilatory support. This provided rapid relief from the injury, which was previously expected to result in death. These data suggest that ECMO could be beneficial as supportive therapy for selected paediatric patients with major tracheobronchial traumas.

A Case of Gastric Perforation due to Large Lap-Band Erosion Presenting with Severe Crushing Chest Pain

Purpose: Gastric lap band surgery is a common procedure done for the treatment of morbid obesity. We present a case of large lap band erosion with gastric perforation presenting to the emergency room as severe crushing chest pain. A very pleasant 67-year-old Caucasian female with hx of hypertension, coronary artery disease, diabetes mellitus, hx of right nephrectomy for renal cancer, hx of lap band surgery 2 years ago for the treatment of morbid obesity presented to the emergency room with severe crushing chest pain. Chest X ray, electrocardiogram and cardiac enzymes were ordered and were found to be within normal limits. A gastroenterology consultation was requested and an upper endoscopy was performed which revealed a large gastric erosion in the gastric cardiac with almost half of the lap-band eroding into the stomach creating a contained perforation in the gastric wall. Surgical consultation was requested immediately and patient underwent laproscopic surgery with removal of the lap band and closure of the perforated site with figure of -8 Vicryl sutures. Follow-up gastroffin study 24 hours later did not reveal extravasation of contrast. Patient felt much better and had resolution of symptoms. Conclusion: In patients who have had lap band surgery, complications from lap band placement should be considered in the differential diagnosis of acute chest pain syndromes.Figure: Large lap-band erosion, just beneath the esophagogastric junction.Figure: Retroflexed view of the esophagogastric junction.Figure: No Caption available.

Transcorneal alternating current stimulation induces EEG “aftereffects” only in rats with an intact visual system but not after severe optic nerve damage

Noninvasive alternating current stimulation can induce vision restoration in patients with chronic optic nerve damage and results in electroencephalogram (EEG) aftereffects. To better understand the mechanisms of action, we studied such EEG "aftereffects" of transcorneal alternating current stimulation (tACS) at the chronic posttraumatic state in rats. EEG baseline was recorded from visual cortex under ketamine/xylazine narcosis of healthy rats and rats with chronic severe optic nerve crush. One week later, both groups were again anesthetized and stimulated transcorneally twice for 12 min each time. tACS-induced changes were compared with baseline EEG. Over the course of 65 min narcosis baseline EEG revealed a shift from a dominant delta power to theta. This shift was significantly delayed in lesioned animals compared with healthy controls. tACS applied during the late narcosis stage in normal rats led to significantly increased theta power with a parallel shift of the dominating peak to higher frequency which outlasted the stimulation period by 15 min (aftereffects). EEG in lesioned rats was not significantly changed. In rodents, tACS can induce neuroplasticity as shown by EEG aftereffects that outlast the stimulation period. But this requires a minimal level of brain activation because aftereffects are not seen when tACS is applied during deep anesthesia and not when applied to animals after severe optic nerve damage. We conclude that tACS is only effective to induce cortical plasticity when the the retina can be excited.

Evaluation of a partial optic nerve crush model in rats

This study was performed to determine whether a partial optic nerve crush (PONC) model in rats is effective and reliable for the study of optic nerve protection and regeneration. Bilateral superior colliculus (SC) retrograde 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate (DiI) labeling of retinal ganglion cells (RGCs; n=3) and unilateral SC retrograde labeling of RGCs (n=3) were performed in adult Sprague-Dawley (SD) rats and the results were compared with the bilateral and unilateral SC retrograde-labeled RGCs. Another 40 adult SD rats, three days after bilateral SC retrograde DiI labeling of RGCs underwent crushing with a non-invasive vascular clip (40 gram power) 1 mm behind the right optic nerve head for 5, 10 and 30 sec (n=10 each), and a sham-operated control group (n=10) was used as a control. The retinas of all 40 rats were flattened by four radial cuts, mounted vitreal side-up on gelatin-coated slides, and the number of labeled RGCs was counted in four distinct regions per retinal quadrant at three different eccentricities of 1/6, 3/6 and 5/6 of the retinal radius three days later. Bilateral SC retrograde DiI injection labeled the majority of normal RGCs, while unilateral SC injections only labeled a small part of the RGCs; the majority of RGCs were not labeled. In the mild crush (5 sec) injury group, the bilateral SC retrograde DiI injection labeled the majority of RGCs. The RGC densities at 1/6, 3/6 and 5/6 of the retinal radius showed no significant difference compared with the RGC densities at the corresponding region of the retinal radius in the sham-operated control group (P=0.734, 0.461, 0.273, respectively). In the moderate crush injury (10 sec) group, the number of labeled RGCs was significantly lower compared to that of the sham-operated control group, and the RGC densities at 1/6, 3/6, 5/6 of the retinal radius were significantly lower compared to the RGC densities at the corresponding retinal radius in the sham-operated control group (P<0.001). In the severe crush injury (30 sec) group the number of labeled RGCs was significantly decreased, and the labeled RGCs were not observed in the region at 5/6 of the retinal radius. The RGC densities at 1/6 and 3/6 of the retinal radius were significantly lower compared to the RGC densities at the corresponding retinal radius region in the sham-operated control group (P<0.001). Compared with the mild and severe optic nerve crush injury models, the moderate crush injury model is more suitable for the study of optic nerve damage and regeneration.

Compression fatigue behavior of Ti–6Al–4V mesh arrays fabricated by electron beam melting

This paper focuses on the compression fatigue behavior of Ti–6Al–4V mesh arrays with high porosities of ∼60–85%, which were fabricated by an additive manufacturing technique using electron beam melting. The results show that their fatigue lives are mainly determined by uniform deformation through the entire specimens, while their failures are characterized by rapid strain accumulation and a severe crush band at an angle of 45° to the cyclic loading direction. The relation between the relative fatigue strength and relative density can be evaluated by the well-known Gibson–Ashby model with the exponential factor n being 2.7, which is higher than the reported data for aluminum and nickel foams, and almost double the idealized value (n=1.5) of a stochastic open cellular foam. The underlying mechanism of fatigue failure appears to be interaction between cyclic ratcheting and fatigue crack initiation and propagation, while the former plays a dominant role in fatigue life. TEM observations found that dislocations are generated along the interface of the α′ phase and their generation becomes more evident with an increase in the relative density. This would contribute to the retardation of cyclic ratcheting and an improvement in the fatigue strength.

Surgical Reconstruction of a Crush Injury of the Talar Body

Fractures of the talar body can have devastating results despite treatment. While talar body fractures are uncommon, they have worse outcomes than do other fractures of the talus, including more osteonecrosis and posttraumatic arthritis1,2. Crush injuries are the most difficult to treat as a result of a very constrained anatomy, the comminution of the fracture fragments, and articular cartilage damage. These fractures are challenging to reconstruct and stabilize and often have poor outcomes3. Conservative treatment does not appear to be better than operative treatment for talar body fractures4. For crush injuries, very aggressive techniques such as primary fusion of the talocrural joint, primary tibiotalar arthrodesis and subtalar arthrodesis, and salvage ankle fusion techniques with structural bone blocks are usually used3,5,6. There have been isolated reports of surgical treatment for crush injuries of the talar body with open reduction and internal fixation; however, these procedures either have had unsatisfactory outcomes2 or were used when there was comminution of only part of the talar dome7. It is generally accepted that severe crush fractures cannot be treated satisfactorily with open reduction and fixation5,8. We describe a case of a severely comminuted talar body and neck fracture treated effectively with surgical reconstruction with a satisfactory result. The patient gave permission for this information to be submitted for publication. A twenty-three-year-old man injured the right ankle in a high-speed motorcycle accident. At the time of admission, the patient had local swelling and varus deformity of the ankle, severe pain, and an inability to actively and passively move the ankle and subtalar joints. He had no neurovascular deficit, tension of the surrounding soft tissue was noted, and there was no open skin lesion. Anteroposterior and …

Thumb salvage with skin grafted medial femoral corticoperiosteal free flap

A 23-year-old man suffered a severe crush injury with fracture of his left thumb base phalanx and destruction of his extensor pollicis longus tendon. Immediate plate stabilisation and soft tissue coverage was performed; however, a recalcitrant pseudarthrosis developed in this compliant non-smoker despite three revisions with avascular iliac crest grafts for interphalangeal joint arthrodesis, corticocancellous bone application and hardware exchange. An attempt to improve thumb vascularity and soft tissue cover with a pedicled Foucher flap as well as through extracorporeal shock wave therapy failed. Bone healing and subsequent thumb salvage were finally achieved with a free vascularised medial femoral condyle (MFC) bone flap, which was covered directly with a full-thickness skin graft. Both bony and soft tissue healing went well and after 3 months the patient returned to work. This case demonstrates that skin grafting the periosteal surface of the MFC flap is safe and results in a thin skin-bone compositae transplant which also might be very useful for indications other than hand surgery.

Neuroprotective role of nerve growth factor in hypoxicischemic injury. From brain to skin.

Hypoxic-ischemic injuries (HII) of the brain, optic pathways, and skin are frequently associated with poor neurological and clinical outcome. Unfortunately, no new therapeutic approaches have been proposed for these conditions. Recently, experimental and clinical studies showed that nerve growth factor (NGF) can improve neurological deficits, visual loss and skin damage after HII. Based on these studies, we report the effects of NGF administration in different lesions of the brain, optic pathways and skin. 2.5S NGF purified and lyophilized from male mouse submaxillary glands was utilized for the treatment. NGF administration was started in absence of recovery after conventional and standardized treatment. One mg NGF was administered via the external catheter into the brain, by drop administration in the eye, and by subcutaneous administration in the skin. We treated 4 patients: 2 children with hypoxic-ischemic brain damage, an adult patient with an optic glioma-induced visual loss and a child with a severe crush syndrome of the lower left limb. After NGF treatment, we observed an amelioration of both neurological and electrophysiological function of the brain, a subjective and objective improvement of visual function, and a gradual improvement of ischemic skin lesion. No side effects were related to NGF treatment in all patients studied. Our observation shows that NGF administration may be an effective and safe adjunct therapy in patients with severe HII. The beneficial and prolonged effect on nerve function suggests a neuroprotective mechanism exerted by NGF on the residual viable neurological pathways of these patients.

The cause and management of ulnar club-hand secondary to crush injury in the palm

Objective To investigate the cause and management of ulnar club-hand secondary to crush injury of the palm. Methods Forty eadaver hands were dissected to measure the relative position between extensor aponeurosis and phalanges, the weight and cross-sectional area of intrinsic muscles to provide anatomical basis of the causes of ulnar club-hand. From March 2007 to February 2010, six patients with ulnar club-hand secondary to severe crush injury underwent intrinsic muscle reconstruction. The causes of ulnar club-hand were investigated in these cases. Results Anatomical dissection revealed that the extensor aponeurosis and extensor tendon of the finger tend to deviate the metacarpophalangeal joint ulnarly, while the intrinsic muscles work antagonistically to pull the joint radially. In the normal hand, these two kinds of acting forces are balanced. In the absence of intrinsic muscles after severe crush injury of the hand, this balance is broken, and the hand tends to deviate ulnarly. Intrinsic muscle reconstruction in six patients with ulnar club-hand secondary to palm crush injury restored the balance and corrected the ulnar deviation deformity after 8.5 months follow-up. Thumb opposition was also improved. Conclusion The absence of hand intrinsic muscles was the main cause of ulnar club-hand in severe crush injury. In the emergency operation, ruptured intrinsic muscles should be repaired whenever possible to prevent ulnar club-hand. For established ulnar club-hand, intrinsic muscle reconstruction should be done to correct the deformity. Key words: Hand injuries; Abnormalities; Treatment outcome