Trends in Upper Extremity Injuries Presenting to US Emergency Departments

Wenzinger, Eric; Rivera-Barrios, Angel E.; Gonzalez, Gilberto; Herrera, Fernando

doi:10.1177/1558944717735943

Cited by 27 publications

(32 citation statements)

References 15 publications

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“…Pichard et al report that the proximal or distal location of upper extremity problem did not differ between 2019 and 2020 [14] . Similar trends for the type of hand and wrist injuries have been demonstrated in several studies [ 6 , 7 , 15 , 16 ], with the exception of a study focusing on the effect of the recent pandemic on hand and wrist injuries, with skeletal injuries being the second reason for ED visits, following lacerations [14] . Due to surgical treatment and prolonged rehabilitation, over 75% of health care costs are attributed to fractures [7] .…”

Section: Discussionsupporting

confidence: 80%

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Upper extremity emergencies during SARS-COV-2 pandemic: Turnout trends

Fyllos

Varitimidis

Papageorgiou³

et al. 2021

Injury

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Highlights During the pandemic the number of patients with orthopaedic, and upper extremity problems decreased by 57.09% and 49.77% (p<0.001) compared to 2019. The turnout of patients with upper extremity & hand-wrist emergencies increased in the private, and significantly decreased in the public sector. The ratio of upper extremity to total orthopaedic emergencies increased during the pandemic from 37.17% to 43.32% (p=0.006) compared to 2019. The ratio of hand-wrist to total orthopaedic emergencies increased during the pandemic from 25.07% to 29.15% (p<0.001) compared to 2019. The increased ratio of hand-wrist to total orthopaedic emergencies reflects the new hobbies uptake and increase of domestic accidents during lockdown.

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Section: Discussionsupporting

confidence: 80%

“…Due to surgical treatment and prolonged rehabilitation, over 75% of health care costs are attributed to fractures [7] . Infection rates remained low and very similar between 2019 and 2020 in our study, although they have been reported to be as high as 17% [16] .…”

Section: Discussionsupporting

confidence: 73%

Upper extremity emergencies during SARS-COV-2 pandemic: Turnout trends

Fyllos

Varitimidis

Papageorgiou³

et al. 2021

Injury

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“…Traumatic peripheral nerve injuries are common and caused by factors ranging from acts of violence, motor vehicle accidents, and recreational activities, to iatrogenic injuries during surgery. The majority of nerve injuries occur in the upper extremity . It is estimated that 1‐3% of all upper extremity trauma patients are diagnosed with nerve injuries during the first few months after trauma .…”

Section: Introductionmentioning

confidence: 99%

Advances in the repair of segmental nerve injuries and trends in reconstruction

2020

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Despite advances in surgery, the reconstruction of segmental nerve injuries continues to pose challenges. In this review, current neurobiology regarding regeneration across a nerve defect is discussed in detail. Recent findings include the complex roles of nonneuronal cells in nerve defect regeneration, such as the role of the innate immune system in angiogenesis and how Schwann cells migrate within the defect. Clinically, the repair of nerve defects is still best served by using nerve autografts with the exception of small, noncritical sensory nerve defects, which can be repaired using autograft alternatives, such as processed or acellular nerve allografts. Given current clinical limits for when alternatives can be used, advanced solutions to repair nerve defects demonstrated in animals are highlighted. These highlights include alternatives designed with novel topology and materials, delivery of drugs specifically known to accelerate axon growth, and greater attention to the role of the immune system. K E Y W O R D S acellular nerve allograft, autograft, nerve gap, nerve guidance conduit, peripheral nerve 2 | BIOLOGY OF NERVE REGENERATION ACROSS A DEFECT Peripheral nerve is capable of robust regeneration following injury. The molecular and cellular mechanisms have primarily been studied in rodent models. Following injury, neurons and their axons and the nonneuronal cellular environment distal to the injury undergo immediate morphological and molecular changes. Within the axon, there is a rapid influx of ions, principally calcium, as well as a disruption of transport proteins signaling a disruption to homeostasis with its end-organ. This multifactorial injury response from axon damage is rapidly transported to the neuron cell Abbreviations: ANA, acellular nerve allograft; ECM, extracellular matrix; FDA, Food and Drug Administration; FK506, tacrolimus; GDNF, glial cell line-derived neurotrophic factor; GFRα1, glial cell line-derived neurotrophic factor family receptor alpha-1; MRC, Medical Research

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“…The majority of human nerve injuries, resulting from vehicle accidents, recreational activities and iatrogenic injuries during surgeries, occur in the upper extremity ( Figure 3 A) [ 42 ]. Seminal studies in rodents in the Gordon and Brushart laboratories with Canadian and German collaborators [ 29 , 43 , 44 , 45 , 46 , 47 ] (reviews [ 33 , 48 , 49 , 50 , 51 , 52 ]), and in human patients in the Chan laboratory in Canada [ 53 , 54 , 55 ] (reviews [ 33 , 48 , 52 , 56 ]), demonstrated that brief low frequency, electrical stimulation of the nerve proximal to the site of transection and surgical repair, accelerated motor and sensory nerve regeneration.…”

Section: Introductionmentioning

confidence: 99%

Peripheral Nerve Regeneration and Muscle Reinnervation

Gordon

2020

IJMS

223

144

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Injured peripheral nerves but not central nerves have the capacity to regenerate and reinnervate their target organs. After the two most severe peripheral nerve injuries of six types, crush and transection injuries, nerve fibers distal to the injury site undergo Wallerian degeneration. The denervated Schwann cells (SCs) proliferate, elongate and line the endoneurial tubes to guide and support regenerating axons. The axons emerge from the stump of the viable nerve attached to the neuronal soma. The SCs downregulate myelin-associated genes and concurrently, upregulate growth-associated genes that include neurotrophic factors as do the injured neurons. However, the gene expression is transient and progressively fails to support axon regeneration within the SC-containing endoneurial tubes. Moreover, despite some preference of regenerating motor and sensory axons to “find” their appropriate pathways, the axons fail to enter their original endoneurial tubes and to reinnervate original target organs, obstacles to functional recovery that confront nerve surgeons. Several surgical manipulations in clinical use, including nerve and tendon transfers, the potential for brief low-frequency electrical stimulation proximal to nerve repair, and local FK506 application to accelerate axon outgrowth, are encouraging as is the continuing research to elucidate the molecular basis of nerve regeneration.

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Trends in Upper Extremity Injuries Presenting to US Emergency Departments

Cited by 27 publications

References 15 publications

Upper extremity emergencies during SARS-COV-2 pandemic: Turnout trends

Upper extremity emergencies during SARS-COV-2 pandemic: Turnout trends

Advances in the repair of segmental nerve injuries and trends in reconstruction

Peripheral Nerve Regeneration and Muscle Reinnervation

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