Acute compartment syndrome of the upper extremity.

Acute compartment syndrome occurs when pressure within a fibro-osseous space increases to a level that results in a decreased perfusion gradient across tissue capillary beds. Compartment syndromes of the hand, forearm, and upper arm can result in tissue necrosis, which can lead to devastating loss of function. The etiology of acute compartment syndrome in the upper extremity is diverse, and a high index of suspicion must be maintained. Pain out of proportion to injury is the most reliable early symptom of impending compartment syndrome. Diagnosis is particularly difficult in obtunded patients and in young children. Early recognition and expeditious surgical treatment are essential to obtain a good clinical outcome and prevent permanent disability.

The Injury Distress Index: development and validation.

OBJECTIVE: To develop and validate a new measurement tool designed to assess self-reported distress responses after traumatic physical injury. DESIGN: A mixed-methods study design was used. Development of the Injury Distress Index (IDI) included input from patients and experts and a comprehensive literature review. The IDI and validity measures were administered by a trained research assistant at bedside within 1 week of admission. The internal structure (exploratory factor analyses [EFAs]), reliability (internal consistency), and associations with other variables (construct and criterion validity) were examined. SETTING: Hand, multiple trauma, and burn services at a large southeastern level-1 trauma center. PARTICIPANTS: Multicultural cohort of 169 traumatically injured adults (31% hand, 21% burn, 48% multiple trauma). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: IDI, Trauma Symptom Checklist-40, Short-Form McGill Pain Questionnaire, Perceived Stress Scale-10, Life Orientation Test-Revised, General Perceived Self-Efficacy Scale, Drug Abuse Screening Test-10, Brief Michigan Alcoholism Screening Test, Abbreviated Injury Scale, hospital length of stay (LOS), postdischarge emergency department visits, and days readmitted to hospital postdischarge. RESULTS: An item pool was developed from patient, expert, and literature review data. EFAs extracted 3 separate factors for posttraumatic stress (avoidance and numbing, re-experience, and hyperarousal: coefficient range, .31-.98), which is consistent with conceptual and diagnostic criteria. EFAs also produced single factors of depression (coefficient range, .44-.72), anxiety (coefficient range, .50-.75), and pain (coefficient range, .57-.79). Most IDI scales (except anxiety) could be differentiated between different levels of injury severity. IDI scales and subscales correlated highly and in a convergent pattern with validity measures of posttraumatic stress (r range, .18-.50), depression (r range, .24-.52), anxiety (r range, .30-.57), and pain (r range, .10-.42), as well as theoretically related variables, such as general distress (r range, .32-.56), self-efficacy (r range, -.15 to -.39), and optimism (r range, -.21 to -.45). IDI scales correlated in a discriminant pattern with measures of drug and alcohol abuse (r range, .02-.07; r range, .09-.21, respectfully). Concurrent and predictive validity evidence was also supported with small associations with injury severity (r range, .16-.30), hospital LOS (r range, .05-.21), number of emergency department visits postdischarge (r range, -.05 to .27), and number of days readmitted to the hospital postdischarge (r range, .05-.21). Cronbach alpha coefficients were within the acceptable range (alpha range, .75-.92). CONCLUSIONS: A new tool to examine injury-related distress after traumatic physical injury has been developed. Results suggest that IDI scores showed acceptable reliability and validity coefficients with this multicultural sample. Additional validation studies are recommended with larger sample sizes using similar populations to confirm these findings.

Multimodality Approach to a Stener Lesion: Radiographic, Ultrasound, Magnetic Resonance Imaging, and Surgical Correlation.

The ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint is a static stabilizer that may rupture from a hyperabduction injury. Although some UCL tears may heal with immobilization, outcomes are worse for Stener lesions, in which the proximal ligament stump slips out from beneath the adductor pollicis aponeurosis and is entrapped proximal and superficial to the aponeurosis, preventing primary healing. We report the case of a patient with a Stener lesion with radiographic, ultrasound, and magnetic resonance imaging correlation, subsequently confirmed with intraoperative photographs. Physicians must be familiar with the regional anatomy to understand the injury pathogenesis and the need for surgical intervention to optimize patient outcomes.

Imaging of athletic wrist and hand injuries.

Sports-related injuries of the wrist and hand are commonly encountered in clinical practice. Athletic injuries create special challenges for the orthopedic surgeon and radiologist, as these patients expect to recover quickly and return to the same athletic endeavors that caused their original injuries. A thorough understanding of the mechanism of injury and imaging findings are necessary for accurate diagnosis and effective therapy. This knowledge allows the clinician to effectively educate the athlete concerning the risks, complications, and prognosis of the injury and its treatment. This article will review mechanisms of injury, imaging findings, and some therapeutic options of common sports-related injuries to the wrist and hand.