Obstacles to the Care of Patients With Multicomponent Volar Wrist Lacerations at a County Hospital

Vaughn, Carolyn J.; Raghavan, Shyam S; Hansen, Scott L.; Terry, M. C.

doi:10.1097/sap.0000000000000801

Cited by 6 publications

(3 citation statements)

References 11 publications

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“…These findings are similar to the study by Gibson et al [4]. The most frequently injured structures were the ulnar artery, ulnar nerve, and FCU, all of which were noted to be disproportionately more frequently injured structures in several prior studies assessing flexor zone 5 [1,9,11,14].…”

Section: Discussionsupporting

confidence: 88%

A Diagnostic Algorithm to Guide Operative Intervention of Zone 5 Flexor Injuries

Alluri

Vakhshori

Hill

et al. 2021

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Given the importance of the neurovascular structures in the volar forearm, accurate diagnosis of zone 5 flexor injuries is critical. Purpose: We sought to test the hypothesis that tendinous injury would be more likely in the distal 50% of the forearm and muscle belly injury would be more likely in the proximal 50% of the forearm. Methods: From December 2015 to December 2016, we conducted a prospective clinical study of patients 18 years and older with zone 5 flexor lacerations. We excluded those with concomitant ipsilateral injuries in flexor zones 1 to 4, multiple lacerations in flexor zone 5, prior neurovascular injuries, crush injuries, patients who underwent operative exploration prior to transfer to our facility, and patients who were unable or unwilling to provide consent. Neurovascular and musculotendinous injuries on physical examination were recorded. All patients underwent operative exploration. Physical examination accuracy and the incidence of musculotendinous and neurovascular injury in the distal 50% of the forearm were compared with the proximal 50% of the forearm. Results: The distal 50% of the forearm (group 1, n = 14) had higher probability of tendon injury (64%), whereas lacerations of the proximal 50% of the forearm (group 2, n = 5) did not result in any tendinous injuries. Rather, all patients in group 2 had muscle belly injuries. There was no difference in the rate of neurovascular injury between groups. Physical examination alone was highly accurate in diagnosing nerve injuries (93%–100%) but less accurate in diagnosing arterial injuries (79%–80%) regardless of the location of injury. Conclusions: Due to the lack of tendinous injuries in proximal zone 5 lacerations, along with the accuracy of physical examination in determining the presence of neurovascular injuries, patients with lacerations in the proximal half of the forearm, without evidence of nerve or arterial injury, can likely be observed in lieu of immediate operative exploration.

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Section: Discussionsupporting

confidence: 88%

A Diagnostic Algorithm to Guide Operative Intervention of Zone 5 Flexor Injuries

Alluri

Vakhshori

Hill

et al. 2021

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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“…A total of 1477 patients were included; 585 (49%) were male, and the mean age ranged from 16 to 57 years. Some studies specified their population, for example, self-inflicted stab wounds, 27 flexor zone 5 lacerations, 28 spaghetti wrist injuries, 29 , 30 upper extremity vascular injuries 22 and self-embedded foreign bodies. 26 Where psychiatric comorbidities were described, 325 (35%) patients had depression or low mood, 180 (19%) previous self-harm, 73 (8%) previous suicide attempt(s), 71 (8%) any substance misuse disorder, 61 (6%) bipolar disorder, 45 (5%) schizophrenia or psychotic spectrum disorder, 40 (4%) personality disorder and 11 (1%) anxiety disorder.…”

Section: Resultsmentioning

confidence: 99%

Management of Incisional Self-Harm of the Upper Limb: A Systematic Review

et al. 2023

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“…The most common combined injury pattern observed in this study was ulnar triad injuries in keeping with various studies. [10][11][12][13] This is due to the proximity of these anatomical structures, their superficial and ulna location in the wrist. In cases of assault, the ulnar side of the forearm is used for protection, hence more easily lacerated.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of preoperative clinical examination in zone V flexor injuries

Osei,

SathekgaI,

Ntombela

et al. 2023

SA orthop. j.

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BackgroundZone V flexor tendon injuries are devastating and may result in significant morbidity. There may be remarkable differences between preoperative clinical and the intraoperative findings of zone V flexor injuries. In this study, we assessed the demographics of patients presenting with zone V flexor injuries and the diagnostic accuracy of preoperative clinical examination. MethodsThis was a prospective study of patients who presented with zone V flexor injuries at an emergency department of a tertiary academic hospital for a period of one year. The demographic data were analysed and the preoperative clinical examination findings were compared to the definitive intraoperative findings to assess the accuracy of the former. The one-sample test for proportion was used to assess if the difference between the two findings was statistically significant. ResultsZone V flexor injuries occurred predominantly in males under 40 years of age. Assault was the leading cause of these injuries. Alcohol intake was a significant factor for the causes of these injuries. Almost one-third (33%) of lacerated anatomical structures were missed and 91% of partially lacerated anatomical structures were inaccurately diagnosed. The mean number of errors of the clinical examination was 3.55; only 9% of the clinical examination had no error and 42% had four or more errors. ConclusionThere was a significant difference between preoperative clinical examination and intraoperative findings and we recommend that all zone V flexor injuries extending beneath the subcutaneous tissue should be explored in theatre.

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Obstacles to the Care of Patients With Multicomponent Volar Wrist Lacerations at a County Hospital

Cited by 6 publications

References 11 publications

A Diagnostic Algorithm to Guide Operative Intervention of Zone 5 Flexor Injuries

A Diagnostic Algorithm to Guide Operative Intervention of Zone 5 Flexor Injuries

Management of Incisional Self-Harm of the Upper Limb: A Systematic Review

Diagnostic accuracy of preoperative clinical examination in zone V flexor injuries

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