Injuries Of Upper Limb Research Articles

A Retrospective Analysis of 5-Year Data of Training-Related Injuries in an Institutional Setting

Introduction:Musculoskeletal injuries sustained during training are not only the major cause of loss of training hours but also lead to attrition of precious workforce. Detailed knowledge of the pattern, type, mechanism of musculoskeletal injury, etc., helps in designing prevention strategies. Hence, the study was conducted to study the epidemiology of injuries sustained by trainees while undergoing training at an institutional training.Materials and Methods:The study is a record-based observational study. The data relating to training-related injuries sustained over 5 years (April 2014 to March 2019) were obtained from the record maintained in the medical facility of the training institute in India. The data were extracted using a case record form. The injury data (date of injury, unique identification number, trainee name, diagnosis, and type of treatment taken) were obtained from the medical record register maintained in the medical facility of the training institute. Anthropometric data (height and weight) were obtained from the record of initial medical screening done routinely on the day of joining the training institute. The descriptive analysis of the collected data was done.Results:A total of (n= 2946) trainees comprising 2584 male trainees and 362 female trainees underwent training during the period of the study. The total number of visits to the medical facility related to injury during the 5-year study period was 13,579. Most of the injuries are occurring in the 5th–20thweek in the first half of training period and 29–44 week in the second half of training period. Among male trainees, the lower limb injuries alone accounted for 72.8% of total injuries, followed by trunk and back injuries (11.97%) and upper limb injuries (11.95%). Among female trainees although lower limb injuries still account for the majority (79.66%) of injuries, among them, hip and groin injuries accounted for the highest percentage of injuries as compared to leg and knee injuries in male trainees. The twisting injuries of the knee, stress fractures, and acute traumatic fractures accounted for the majority (78.34%) of the injuries leading to repetition of the training by 24 weeks. The twisting injuries of the knee, acute traumatic fractures, traumatic shoulder instability, and head injuries accounted for the majority (83.2%) of the injuries leading to dropout from training institution (withdrawal).Conclusion:The analysis related to the injuries sustained by trainees during the 5 years found out the timings, severity, and location of injuries. The findings may be important for the formulation of preventive program in an institutional training institute.

Biomechanics of wheelchair turning manoeuvres: novel insights into wheelchair propulsion.

Wheelchair turning biomechanics is an under researched area despite its obvious relevance to functional mobility of wheelchair users. Wheelchair turns might be linked to a higher risk of upper limb injuries due to the increased forces and torques potentially associated with asymmetric movement. Our aim was to obtain a better theoretical understanding of wheelchair turning by biomechanically analyzing turns compared to steady-state straightforward propulsion (SSSFP). Ten able-bodied men received 12-min familiarization and 10 trials (in a random order) of SSSFP and multiple left and right turns around a rectangular course. A Smartwheel was mounted at the right wheel of a standard wheelchair to measure kinetic parameters during SSSFP and of the inner hand during right turns and the outer hand during left turns. A repeated measures ANOVA was used to detect differences across tasks. Two strategies were identified: 3% demonstrated roll turns and 97% spin turns. Spin turns consisted of three phases: approach, turning and depart phase. The turning phase was accomplished by increasing peak force (72.9 ± 25.1 N vs. 43.38 ± 15.9 N in SSSFP) of the inner hand, while maintaining high push frequency of the outer hand (1.09 ± 0.20 push/s vs. 0.95 ± 0.13 push/s in SSSFP). Peak negative force and force impulse during the turning phase were much higher than SSSFP, 15.3 ± 15.7 and 4.5 ± 1.7 times higher, respectively. The spin turn strategy might carry an increased risk of upper limb injuries due to higher braking force and requires particular attention by rehabilitation professionals to preserve upper limb function of long-term wheelchair users.

Propulsion kinetics of recumbent handcycling during high and moderate intensity exercise

People with spinal cord injuries (PwSCI) are at high risk of developing cardiovascular disease (CVD). While regular exercise can reduce risk of CVD, PwSCI face various barriers to exercise, including high rates of upper limb injuries, especially in the shoulder. Handcycling high intensity interval training (HIIT), which consists of periods of high intensity exercise followed by rest, is a potential exercise solution, but the musculoskeletal safety of HIIT is still unknown. In this study, we characterized three-dimensional continuous applied forces at the handle during handcycling HIIT and moderate intensity continuous training (MICT). These applied forces can give an early indication of joint loading, and therefore injury risk, at the shoulder. In all three directions (tangential, radial, and lateral), the maximum applied forces during HIIT were larger than those in MICT at all timepoints, which may indicate higher contact forces and loads on the shoulder during HIIT compared to MICT. The tangential and radial forces peaked twice in a propulsion cycle, while the lateral forces peaked once. Throughout the exercises, the location of tangential peak 2 and radial peak 1 was later in HIIT compared to MICT. This difference in maximum force location could indicate either altered kinematics or muscular fatigue at the end of the exercise protocol. These changes in kinematics should be more closely examined using motion capture or other modeling techniques. If we combine this kinetic data with kinematic data during propulsion, we can create musculoskeletal models that more accurately predict contact forces and injury risk during handcycling HIIT in PwSCI.

Ultrasound-guided supraclavicular block versus Bier block for emergency reduction of upper limb injuries: a protocol for an open-label, non-inferiority, randomised controlled trial

BackgroundClosed reduction of upper limb fractures and/or dislocations are common in the emergency department (ED), which involves physically re-aligning the injured part prior to immobilisation. As this is painful, numerous techniques are available to provide regional anaesthesia to ensure patient tolerance. A Bier block (BB) is typically performed as part of routine care. An alternative technique gaining interest in the ED is ultrasound-guided supraclavicular block (UGSCB), which involves injecting local anaesthetic around the brachial plexus at the supraclavicular fossa under ultrasound guidance. It is unclear whether UGSCB is effective and safe when performed in the ED.MethodsSUPERB (SUPraclavicular block for Emergency Reduction versus Bier block) is a prospective open-label, non-inferiority randomised controlled trial that compares the effectiveness of UGSCB versus BB for closed reduction of upper limb fractures and/or dislocations. Adult patients presenting with an upper limb fracture and/or dislocation that requires emergent closed reduction in the ED will be eligible. After screening, participants will be randomised to either UGSCB or BB. Once regional anaesthesia is obtained, closed reduction of the injured part will be performed and appropriately immobilised. The primary outcome is maximal pain experienced during closed reduction measured via a visual analogue scale (VAS). Secondary outcomes include baseline and post-reduction pain, patient satisfaction, total opioid requirement in ED, ED length of stay, adverse events and regional anaesthesia failure.DiscussionExisting evidence suggests UGSCB is effective when performed in the operating theatre by trained anaesthetists. SUPERB will be the first randomised controlled trial to elucidate the effectiveness and safety of UGSCB in the ED. The findings have the potential to provide an alternative safe and effective option for the management of upper extremity emergencies in the ED.Trial registrationThis trial has been registered on 21 October 2022 with Australia and New Zealand Clinical Trials Registry (ACTRN12622001356752).

Descriptive and temporal trend analysis of LER/DORT Cases in Brazil from 2012 to 2021

The Repetitive Strain Injury (RSI) or Work-related Musculoskeletal Disorders (WMSDs) are labor misfortunes that affect thousands of workers in Brazil, capable of causing irreversible sequelae, depending on the severity of the accident and the conditions in which the work is performed. In this context, this research aims to conduct a quantitative descriptive study to evaluate the most incident cases of work-related musculoskeletal disorders in Brazil from 2012 to 2021. The proposed method was based on a descriptive analysis along with a linear regression model to capture the trend of major occupational ICDs over ten years. The cases of work-related musculoskeletal disorders analyzed showed a reduction throughout the period, and the most common pathologies are upper limb injuries, especially back pain, which resulted in an average of 24.7 thousand accidents per year. Thus, it is recommended to adopt more effective preventive measures in order to reduce the statistics of accidents caused by work-related musculoskeletal disorders in the country.

Effect of traumatic upper-limb injury on cognitive functions: A cross-sectional observational study

ObjectivesThere is growing evidence of cognitive impairment after traumatic peripheral lesions. The purpose of this study was to explore the association between cognitive function and traumatic upper-limb injury. We assessed difference in cognitive function between participants with and without upper-limb injury, and explored the association between cognitive function and certain variables in injured individuals: gender, age, body mass index (BMI), educational level, and occupation. We sought to identify the factors associated with cognitive function in injured subjects: time since injury, injury side, nerve injury, hand function, pain, and finger sensation. Material and methodsA cross-sectional observational study was conducted, with 2 groups: observational group (with traumatic upper-limb injury) and control group (uninjured). The 2 groups were matched for age, gender, BMI, educational level and occupation. Short-term memory and executive functions were assessed using the Rey Auditory and Verbal Learning Test (RAVLT) and Stroop Color and Word Test (SCWT), respectively. Results104 participants with traumatic upper-limb injury and 104 uninjured control subjects were included. There was a significant inter-group difference only in RAVLT (p < 0.01; Cohen d, of 0.38). Regression analysis demonstrated an association of pain on VAS (beta = −0.16, p < 0.01) and touch-test (beta = 1.09, p < 0.05) with total RAVLT score (short-term memory) in injured subjects (R2 = 0.19, F (2, 82) = 9.54, p < 0.001). ConclusionTraumatic upper-limb injury can impact short-term memory, which should be kept in mind during rehabilitation.

Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake.

The aim of this study was to evaluate the benefits of our triage system in acceleration of intervention for the musculoskeletal injuries and clinical follow-ups of trauma patients admitted to our center after the Kahramanmaras earthquake. Between February 6th, 2023 and February 20th, 2023, a total of 439 patients (207 males, 232 females; mean age: 37.1±19.1 years; range, 1 to 94 years) with earthquake-related musculoskeletal injuries after the Kahramanmaras earthquake were retrospectively analyzed. Data including age, sex, referral city information, removal time from the rubbles, physical examination findings, clinical photos, fasciotomy and amputation stumps and levels, and X-ray images and computed tomography images of all patients were shared and archived in the WhatsApp (Meta Platforms, Inc.® ATTN/CA, USA) group called 'Earthquake' created by orthopedic surgeons. To complete the patient interventions as soon as possible and to ensure order, the patients were distributed with the teams in order through this group by the consultant orthopedic surgeon. The treatments were applied and recorded according to the skin and soft tissue conditions, and fractures of the patients. All treatments were carried out with a multi-disciplinary approach. Of the patients, 16.2% were children. Lower limb injuries constituted 59.07% of musculoskeletal injuries. Upper limb, pelvic, and spinal cord injuries were observed in 21.9%, 12.7%, and 6.25%, respectively. Conservative treatment was applied to 183 (41.68%) patients. The most common surgical intervention was debridement (n=136, 53.1%). External fixation was applied in the first stage to 21 (8.2%) patients with open fractures. The mean removal time from the rubbles was 32.1±29.38 h. A total of 118 limb fasciotomy operations were applied to the patients. Fifty limb amputations were performed in 40 patients at the last follow-up due to vascular insufficiency and infection. Based on our study results, we believe that a triage system using a good communication and organization strategy is beneficial to prevent treatment delay and possible adverse events in future disasters.

Types of Injury Experienced by Rugby Athletes in Indonesia

Rugby is a popular sport categorized as a physical game with a high level of physical contact and significant injury risk. The purpose of this study was to find out and describe the type of injury suffered by Rugby athletes in Indonesia. This quantitative descriptive research was conducted by evaluating male rugby athletes (N = 62) experiencing injury using a questionnaire. The questionnaire questions focused on anthropometry, age when experiencing the injury, causes of injury, anatomical injury, and types of injury. The anthropometry analysis result of the Rugby athletes aged 16-30 years showed that they had an ideal body mass index (16-20 years = 21.0 ± 2.8 vs 21-25 years = 23.2 ± 1.3 vs 26-30 years = 25.9 ± 1.0). The common injuries found in Rugby athletes was acute injuries (56%) compared to overuse injuries (44%). The result also showed that 65% of 62 players suffered a lower limb injury, only 35% of the 62 players suffered an upper limb injury. In general, 53% of 62 players suffered ligament injury, where 31% of injury occurred in the Knee. The cause of injury suffered by Rugby players was physical contact with opponents. The data described that 50% of 62 players suffered injuries due to physical contact. This study indicates that physical contact is a common cause of injury to Rugby athletes, while the type of injury that often occurs is a ligament injury where the lower limb becomes the most common injury. As they get older, the risk of injury in Rugby athletes in Indonesia is increasing.

Cross-cultural adaptation and validation of the Greek version of the Kerlan-Jobe orthopaedic clinic shoulder and elbow score in Greek overhead athletes.

Background: Overhead athletes frequently perform rapid and powerful throwing overhead strokes in positions at the extreme range of motion, increasing the risk of upper limb injury. The Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Score has shown to be a valid and reliable questionnaire that can be used for the assessment of the functional status of the upper limb of patients involved in highly demanding overhead sports. The KJOC has been translated into several other languages however, a Greek version of the KJOC is not available yet. Methods: The KJOC will be cross-culturally adapted into Greek following international guidelines. At least 100 overhead athletes with or without shoulder or elbow complaints will be recruited and asked to fill in the Greek version of the KJOC twice and the Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) once. The internal consistency and the test-retest reliability will be examined using Cronbach's alpha and the intraclass correlation coefficient (ICC), respectively. The standard error of measurement (SEM) and the minimum detectable change (MDC) will be calculated and possible ground or ceiling effects will be also examined. Convergent validity will be evaluated with the Greek DASH using Pearson's correlation. Results: The results of this study will be presented in an article to be published later. Conclusions: This report describes the process of translation and cross cultural adaptation of the Greek version of the KJOC. We believe a study protocol will assist researchers in the field to improve the reporting of similar studies and as a result improve the quality of their studies.

The Changing Landscape in Upper Limb Sports Rehabilitation and Injury Prevention

This editorial aims to feature authors who intend to submit their research to this Special Issue of Sports entitled "Clinical Advances in Upper Limb Sports Rehabilitation and Injury Prevention" in areas that need special consideration [...].

The impact of concussion on subsequent injury risk in elite junior Australian football athletes.

Concussion increases injury risk. However, this has not been investigated in junior Australian football and it is unknown whether the location, severity, and mechanism of subsequent injuries differ after concussion vs. non-concussion injury. Prospective cohort. 1455 elite adolescent male Australian footballers were tracked across seven seasons to determine whether subsequent injury risk was greater after concussion compared to non-concussion index injury using multilevel survival analysis. Mixed-effects logistic regression compared location and mechanism. Mixed-effects Poisson regression compared severity. Of 1455 athletes, 632 were injured and included in subsequent-injury analysis. There were no differences in injury incidence after a concussion compared to upper- (hazard ratio = 1.0, 0.6 to 1.9, P = 0.892; trivial effect) and lower (hazard ratio = 1.1, 0.6 to 1.9, P = 0.810; trivial effect) index injury, or in location. Subsequent injuries were more likely to be contact-based after a non-concussion injury than concussion (odds ratio = 4.6, 1.3 to 16.0; P = 0.017; large effect). There was no difference in subsequent injury severity after lower- (3.4 ± 3.0 missed matches; incidence rate ratio = 1.4, 0.9 to 2.1; P ≤ 0.117; small effect) and upper-limb injuries (3.4 ± 3.1 missed matches; incidence rate ratio = 1.4, 0.9 to 2.2; P = 0.189; small effect) compared to concussion (2.4 ± 2.0 missed matches). Subsequent injury risk, severity, and location in junior Australian football are similar following concussion compared to non-concussion index injuries, although contact injuries are less likely.

ORthopaedic trauma hospital outcomes - Patient operative delays (ORTHOPOD) Study: The management of day-case orthopaedic trauma in the United Kingdom

IntroductionORTHOPOD: Day Case Trauma is a multicentre prospective service evaluation of day-case trauma surgery across four countries. It is an epidemiological assessment of injury burden, patient pathways, theatre capacity, time to surgery and cancellation. It is the first evaluation of day-case trauma processes and system performance at nationwide scale. MethodsData was prospectively recorded through a collaborative approach. Arm one captured weekly caseload burden and operating theatre capacity. Arm two detailed patient and injury demographics, and time to surgery for specific injury groups. Patients scheduled for surgery between 22/08/22 and 16/10/22 and operated on before 31/10/22, were included. For this analysis, hand and spine injuries were excluded. ResultsData was obtained from 86 Data Access Groups (70 in England, 2 in Wales, 10 in Scotland and 4 in Northern Ireland). After exclusions, 709 weeks worth of data representing 23,138 operative cases were analysed. Day-case trauma patients (DCTP) accounted for 29.1% of overall trauma burden and utilised 25.7% of general trauma list capacity. They were predominantly adults aged 18 to 59 (56.7%) with upper limb Injuries (65.7%). Across the four nations, the median number of day-case trauma lists (DCTL) available per week was 0 (IQR 1). 6 of 84 (7.1%) hospitals had at least five DCTLs per week. Rates of cancellation (13.2% day-case; 11.9% inpatient) and escalation to elective operating lists (9.1% day-case; 3.4% inpatient) were higher in DCTPs. For equivalent injuries, DCTPs waited longer for surgery. Distal radius and ankle fractures had median times to surgery within national recommendations: 3 days and 6 days respectively. Outpatient route to surgery was varied. Dominant pathways (>50% patients listed at that episode) in England and Wales were uncommon but the most frequently seen was listing patients in the emergency department, 16 of 80 hospitals (20%). ConclusionThere is significant mismatch in DCTP management and resource availability. There is also considerable variation in DCTP route to surgery. Suitable DCTL patients are often managed as inpatients. Improving day-case trauma services reduces the burden on general trauma lists and this study demonstrates there is considerable scope for service and pathway development and improved patient experience.

The association between size and symmetry of the lumbar multifidus muscle, and injuries in adolescent rugby union players

ObjectivesThis study aimed to investigate the association between size and symmetry of the lumbar multifidus muscle, and season injuries in adolescent rugby union players. DesignProspective longitudinal cohort study. SettingPre-season assessment of the size (cross-sectional area) of the lumbar multifidus (L2-5) muscles using ultrasound imaging. ParticipantsSeventy-one adolescent rugby union players (aged 15–18 years). Main outcome measures“Time-loss” injuries were recorded during the season and divided into four injury regions (head and neck, upper limb, trunk and lower limb). ResultsThirty-nine injuries were recorded during the season. Players who sustained an upper limb injury during the season had smaller lumbar multifidus muscles at the L5 vertebral level (effect size = 0.7, p = 0.03) and asymmetry in muscle size at the L2 (p = 0.05) and L5 (p = 0.04) in the pre-season. There was no association between size of the lumbar multifidus muscle and other injuries (p > 0.05). ConclusionLumbar multifidus muscle size and symmetry may impact lumbopelvic control which may increase the risk of sustaining an upper limb injury during rugby union. Future research should aim to identify whether lumbar multifidus muscle size is a modifiable risk factor for rugby union injuries to guide future intervention programs.

A cross-sectional retrospective survey of injury situation and prevalence in female recreational netball players with a focus on knee injuries

ObjectivesTo examine situations of injury and injury prevalence in female adult recreational netball players with a focus on knee injuries. DesignCross sectional retrospective online survey. Participants193 female adult recreational netball players. Main outcome measuresAny injury sustained in the previous 12 months, situation of injury, any knee injuries sustained in the previous five years, the length of time unable to play netball, and knee injury management. ResultsIn the previous 12 months, 61% of respondents sustained injury to the lower limb, and 27% to the upper limb. Lower limb injury situations were mostly landings (46%). Upper limb injury situations were mostly collisions with an opponent (27%). 46% reported sustaining a knee injury in the previous five years. Following knee injury, players were unable to play netball for 6.8 ± 7.0 months (training); and 8.2 ± 7.4 months (matches) respectively. ConclusionsLower limb injury is more common than upper limb injury in recreational adult female adult netball players. Landing was the most common situation of injury for the lower limb including knee injuries. In the previous five years, nearly half of the players had sustained a knee injury resulting in more than six months out of the game.

Factors Associated with Lost Time Injury among Paramedics in Victoria, Australia

Background The dynamic and uncontrolled nature of paramedic work frequently exposes these workers to physical and psychological injury. Often paramedic injury rates are estimated based on national injury surveillance data or compensation databases. These data sources tend to only capture cases of a more serious nature and overlook the broader factors that contribute to injury. This limits our understanding of the true burden of paramedic injury and the characteristics associated with increased injury severity. Objectives To describe the incidence and proportions of paramedic occupational injury in Victoria, Australia, and to determine the injury-related characteristics associated with lost time from work. Methods A retrospective analysis of paramedic injury report data from the single state-wide ambulance service in Victoria, Australia – Ambulance Victoria. Injuries reported between 1 January 2015 and 30 June 2020 were included. Chi-square tests of independence were used to explore shift and injury characteristic variables that may be associated with time lost from work. Results Over the study period, 7,591 paramedic injuries were reported that met the inclusion criteria, of which 2,124 (28%) resulted in lost time from work. The cumulative incidence of paramedic injury was 333.8 injuries per 1,000 FTE workers per year, and the rate of lost time injury was 93.0 per 1,000 FTE workers per year. Musculoskeletal injuries were the most frequently reported injury type irrespective of lost time status. Manual handling followed by psychological stressors were the two leading mechanisms of injury based on incidence. Psychological injury was associated with lost time from work (X2= 384.2, p < 0.001). Conversely, injury to the head and neck (X2= 7.5, p = 0.006), and upper limb injuries (X2= 104.5, p < 0.001), were more strongly associated with no lost time from work. Conclusions Paramedics working in Victoria have a higher rate of work-related injury than other Australian workers. Injury-related factors that are often overlooked, such as time, shift type, location, and injury characteristics, all contribute to an increased risk of lost time injury. An understanding of the factors that contribute to an increase in injury severity may facilitate the development and targeting of appropriate interventions.

Baseball injuries in adolescent athletes with ADHD.

At the intersection of injury-prone sports such as baseball and conditions like ADHD that affect all aspects of life, there is a lack of research. This limits the availability of preventive care programs designed to target potential risks and promote a safe experience. In this retrospective cohort study, we assess the frequency of injury in youth baseball players with and without ADHD, along with further investigation into how treatment with stimulant medication may modify risk factors. The data for this study were obtained in deidentified, aggregate format from the TriNetX research database. We identified all patients under 25 years of age with a designation of baseball activity. Within this population, we separated patients by presence or absence of ADHD diagnosis, and then by stimulant usage. The studied outcomes were injuries commonly occurring in baseball, including fractures, sprains, and specific injury patterns. We identified 17,710 patients under 25 years old with designated baseball activity, 1,183 of which had a diagnosis of ADHD. Of these, 511 had a history of stimulant medication and 470 had no history of stimulant use. For most events (i.e., injuries), there were no statistical differences between cohorts. The overall ADHD cohort significantly differed from the Not ADHD cohort in 3 events: "thorax, abdomen, pelvis injuries," "ankle sprain," and "concussion." When athletes with ADHD received treatment, this trend reversed for select injuries: "any fracture", "head or neck injuries", "upper limb injuries", and "lower limb injuries" were less likely in ADHD athletes on stimulants. Given the ongoing debate around stimulant use in athletics, our study is relevant to many patients, providers, and the baseball community.

Traumatic divergent dislocation of the elbow in the adults

PurposeThis retrospective study aimed to investigate the clinical outcomes of DDE in adults.MethodsFrom September 2010 to March 2020, adult patients with traumatic DDEs admitted to Beijing Chaoyang Hospital and Beijing Jishuitan Hospital were included in this study. Each patient underwent operative or conservative treatment during hospitalization. The clinical and radiological examinations were followed up. The primary outcomes included the Mayo Modified Wrist Score (MMWS), the Mayo Elbow Performance Score (MEPS), the Broberg and Morrey functional index, the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the Visual Analogue Scale (VAS) score that were performed. Post-operative complications and secondary surgery details were also collected.ResultsOf the fourteen patients, clinical and radiographic results were reviewed at a mean of 53.2 months (18 to 110 months) postoperatively. There were 11 men and three women with an average age of 31.5 years (17 to 51 years). At the final follow-up, the average MMWS, MEPS, Broberg and Morrey functional index, and DASH scores were 91.4 points, 93.4 points, 92.6 points, and 10.7 points. The mean VAS at rest and during activities was 0.4 and 1.7 points. Two patients required a secondary procedure due to radial malalignment and elbow contracture, respectively. In addition, two patients were found degeneration.ConclusionsWithin the context of high-energy DDE combined with simultaneous upper limb injuries, our study recommended obtaining the mechanical benefit of the forearm ring with concentric elbow stability. Despite the various and complicated traumatic patterns of DDE, great clinical results could be acquired based on adequate surgical treatments and early rehabilitation training.

АНАЛИЗ ОСЛОЖНЕНИЙ ПОСЛЕ АУТОТРАНСПЛАНТАЦИИ ПРИ ПОСЛЕДСТВИЯХ ТЯЖЁЛОЙ ТРАВМЫ ВЕРХНЕЙ КОНЕЧНОСТИ

Objective: To analyze the complications after transplantation of vascularized autografts in upper limb injuries and develop a set of measures to eliminate them. Methods: Surgical treatment outcomes of 159 patients with severe upper limb injury sequelae were analyzed. The study population comprised 102 (64.1%) males, 57 (35.8%) females, and 49.6% of the patients were under 18. In forearm and hand injuries sequelae, 159 vascularized skin fascia and skin-bone composite autograft flaps were used. Of the 159 grafts, free flaps grafting and pedicled flaps grafting were performed in 30 (18.8%) and 129 (81.2%), respectively. Results: Of 30 free flaps, circulatory compromise was observed in 4 (13.3%) cases in the early postoperative period. Out of the total 159 grafts used, the percentage was 2.5%. In evaluating complications, it was revealed that the flap circulatory compromise of 4 patients was noted in the following grafting types: radial osseocutaneous (1), radial fasciocutaneous (1), fibula transplant (1), and inguinal fasciocutaneous (1). Of the 129 reverse and transposition flaps, a circulatory compromise was noted in 10 (7.7%) cases. Out of the total 159 flaps, the percentage of circulatory compromise was 6.3%. Of the total 159 free and pedicled flaps, necrosis with flap loss was observed in 6.9%. Conclusion: Timely diagnosis of complications based on clinical and axillary investigations data facilitated conducting appropriate conservative measures or surgical revision, which helped to achieve engraftment of transplanted autografts in 93.1% of cases. Keywords: Upper limb injury, injury sequelae, autotransplantation, flap engraftment, flap necrosis.

Medical rehabilitation period in women after an upper limb injury with different recovery methods

Medical rehabilitation period in women after an upper limb injury with different recovery methods

ОКИСЛИТЕЛЬНЫЙ СТРЕСС И АНТИОКСИДАНТНАЯ СИСТЕМА ПРИ ТЯЖЁЛЫХ ТРАВМАХ ВЕРХНЕЙ КОНЕЧНОСТИ

Objective: To evaluate lipid peroxidation (LPO) and antioxidant defense (AOD) system in severe upper limb injury (SULI) with skin defects covered with autografts Methods: LPO and AOD system were evaluated in 32 patients after urgent surgical intervention for SULI. The patients were divided into two groups: Group I (main) included 16 patients who underwent reconstructive surgery and antioxidant therapy, and Group II included 16 operated patients who did not receive antioxidant treatment. There were 22 men and 10 women enrolled in the study; the age of the patients varied between 19-51 years, and the average age was 29.2 years. Patients of both groups underwent reconstructive surgery with soft tissue traumatic defects covered with autografts. In both groups, malondialdehyde (MDA) and superoxide dismutase (SOD) were tested in the blood serum before surgery and on the 7th day after surgery. In the main group, patients received a course of antioxidant treatment immediately in the postoperative period for 7 days, while the control group patients did not receive this therapy. Results: The MDA values before surgery in Groups I and II were similar comprising 3.23±0.41 and 3.35±0.37 µmol/l, respectively. After surgery, there was a considerable decrease in the level of MDA in both groups (p 0.001), however, in Group I this decrease was more significant compared to Group II (1.86±0.32 µmol/l vs. 2.78±0 .43 µmol/l, p 0.001). Initially, the level of SOD in both clinical groups had no statistical differences (p 0.05), amounting to 10.6±2.4 u/ml and 10.2±1.8 u/ml, respectively. The level of SOD on the 7th day after the operation tended to increase in both groups, however, its more significant increase was noted in the main group compared with the control group (15.8±1.3 u/ml and 12.2±1.9 u/ml, respectively, p 0.001). Conclusion: SULI with skin defects is accompanied by oxidative stress and antioxidants depletion. The use of antioxidant therapy in the postoperative period largely eliminates the disbalance in the LPO-AOD system and improves the results of reconstructive surgeries in SULI. Keywords: LPO, AOD, MDA, SOD, upper limb injury, autotransplantation, antioxidant therapy.