Crushing Injury of the Left Hand/Wrist/Forearm/Upper Arm
This is an unfortunate 37-year-old man who sustained a significant crushing injury in a press machine. His left hand, arm and forearm were all crushed. He sustained severe friction burns and soft tissue avulsion injuries of the hand and forearm. He sustained a Galeazzi fracture with a distal radioulnar joint fracture dislocation associated with a radius shaft fracture. In addition, he also had a left biceps midsubstance soft tissue avulsion. He presented to Dr. Yevgeny Shuhatovich about 3 weeks from injury with severe stiffness of the elbow, digits, wrist and forearm. The patient was immediately taken to surgery for his Galeazzi fracture and debridement. After the surgical procedure, he was immediately started on an aggressive home exercise program and formal therapy regimen.
Press injuries are some of the worst mutilating injuries that we see in our practice. Generally, a combination of very extensive soft tissue reconstructive procedures is required. When these are performed, in our practice, we use microsurgical techniques, requiring use of an operating microscope. Tissues from all over the body can be used, including the person’s thigh, upper arm, forearm, scalp including many others. Bony reconstructions are equally difficult, requiring use of multiple plates and screws and oftentimes grafts from the patient’s hip, wrist or elbow. Success of these procedures is directly related to the skill of the surgeon, age of the patient, the type of injury and, very importantly, time elapsed from injury to the reconstructive procedure. The outcomes are then directly related to the aggressiveness of the rehabilitation programs. In hand surgery, use of a certified hand therapist has been associated with significantly improved functional outcomes.
This patient is very happy with his result, because his strength, range of motion and pain are all back to his pre-injury level. He is very excited to be able to return to work using his injured arm and loves picking up his kids and playing with them at home.