Team approach to managing upper extremity trauma following work accident

Mangled upper extremity case study

A 34 year old man was injured during a roll-over truck accident. His arm was pinned under the vehicle for about 10 minutes and he sustained severe fractures and soft tissue injuries to his arm. He was taken to a trauma center and after it was determined he had no life-threatening injuries he was transferred to Presbyterian/St. Luke's Medical Center for care by the Extremities at Risk team.

When he arrived he was taken immediately to surgery because of an acute compartment syndrome. The initial surgery was a compartment release and placement of an external fixator to stabilize the fractures. Antibiotic beads have been placed in the wound near the wrist to minimize risk of infection.


Picture of the patient's arm before release of the compartment syndrome.	X-ray of the patient's arm showing fractures of the bones of the forearm.	External fixator in-place to stabilize the fracture. Soft tissue is opened to relieve compartment pressure.

He was taken back to surgery 5 days later to wash out the area and remove any dead tissue.

7 days later he returned to surgery for a soft tissue reconstruction of the open area. A rectus-abdominus free tissue transfer was completed where one of the muscles along his stomach was moved to cover the open area of his arm. This live muscle was placed in the area and blood supply was achieved by vein grafting.


The abdominus rectus muscle flap covering the soft tissue deficit.	Picture of the patient's arm 9 months after the injury.

He was able to begin moving his fingers and hand about 6 weeks after the surgeries. He had a mild infection that was managed with oral antibiotics. His fractures healed well and he was able to return to work in construction about 12 months after this injury.

Last Updated ( Tuesday, 30 June 2009 )