The authors performed a retrospective review of the anterior cubital approach, an alternative exposure for displaced pediatric supracondylar fractures. Anatomic structures that hinder reduction, such as the brachialis muscle or joint capsule, and neurovascular tissues can be identified easily with this approach. Sixty-one children with displaced supracondylar humeral fractures were treated surgically with Kirschner wires using the anterior cubital approach between January 1996 and August 2002. The cohort comprised 35 boys and 26 girls with a mean age of 8.7 years (range 3-13 years). Mean follow-up was 3.5 years (range 1-6 years). Preoperatively 13 children (21.3%) had a neurovascular insufficiency that required an exploration during the operation. All patients were reduced completely with full anatomic position. On follow-up, no patient had any scar formation or deformity or experienced any restricted motion. The authors conclude that the anterior cubital approach is very effective and is an option for the treatment of pediatric supracondylar humerus fractures without serious complications.

To understand the lesion of the terminal branches of posterior interosseous nerve (PIN), an anatomic study was carried out. Thirty adult cadaver arms were dissected and the anatomic pattern of the nerve was documented. The distance between the point at which the nerve divides into branches and the distal edge of the supinator were measured, as well as the length of each nerve branch to its muscle-entering sites. The number of branches innervating each muscle was recorded. It was found that the PIN was branching to multiple short branches and a single deep long branch after leaving the supinator muscle with great morphometric and schematic variances.

No abstract

Lateral arm flaps are versatile in the use of upper extremity moderate-sized defects with little morbidity and with acceptable cosmesis. The conditions are outlined in a series of 74 lateral arm flaps performed on 72 patients and the results are given. Five patients were operated on as emergencies, 12 were operated within the first 72 hours of injury and 57 patients were treated electively. Skin defects were between 6 x 4 cm and 20 x 9 cm. Five (7%) flaps were lost due to venous thrombosis, three that sustained a high-voltage electric burn. Two other patients that were treated for a high-voltage electric burn had a successful revision of the anastomosis site in the early post-operative duration. One flap was abandoned due to very thin pedicle and obesity of the patient. A higher failure rate is encountered most frequently with the cases of high-voltage electric burn. To deal with this problem, a modified approach such as an extended approach and/or including the forearm skin to the flap is recommended during the flap harvest. For a longer pedicle to be anatomized more proximally, perforator flaps with longer pedicles may be used as an alternative.

No abstract