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Ortop Traumatol Rehabil 2020 Apr;22(2):85-93

University Rehabilitation Institute, Linhartova Ljubljana, Slovenia.

Background: There is a lack of studies on adjustment to upper limb prosthesis with large representative samples that would compare different prosthesis types and use standardised outcome measures. Hence, we wanted to assess satisfaction with, and level of adjustment to, an upper-limb prosthesis among people after an upper limb amputation in our country.

Material And Methods: We conducted a cross-sectional descriptive study. Read More

Cureus 2020 Feb 1;12(2):e6842. Epub 2020 Feb 1.

Internal Medicine, Fatima Jinnah Medical University, Lahore, PAK.

Subclavian artery thrombosis is a rare cause of upper limb ischemia resulting from occlusion of the upper extremity blood supply. Symptomatic presentation is quite rare and therefore remains underdiagnosed by physicians. Possible catastrophic clinical consequences necessitate prompt rectification of the underlying disease and risk factors. Read More

Malawi Med J 2019 12;31(4):244-248

Department of Surgery, University of North Carolina at Chapel Hill, USA.

Introduction: Amputations in low- and middle-income countries (LMICs) represent an important cause of disability and economic hardship. LMIC patients are young and suffer from preventable causes, such as trauma and trauma-related infections. We herein studied the etiology in amputations in a Malawian tertiary care hospital over a 9-year period. Read More

J Clin Med 2019 Dec 20;9(1). Epub 2019 Dec 20.

Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.

Global brachial plexopathies including multiple nerve root avulsions may result in complete upper limb paralysis despite surgical treatment. Bionic reconstruction, which includes the elective amputation of the functionless hand and its replacement with a mechatronic device, has been described for the transradial level. Here, we present for the first time that patients with global brachial plexus avulsion injuries and lack of biological shoulder and elbow function benefit from above-elbow amputation and prosthetic rehabilitation. Read More

Ann Afr Med 2019 Oct-Dec;18(4):196-199

Department of Surgery, John F. Kennedy Memorial Hospital, Monrovia, Liberia.

Background: Amputation is one of the oldest known surgical procedures. It has been one of the modalities of applying judgment and treatment. Its method and indications has evolved over time. Read More

Plast Reconstr Surg 2019 12;144(6):1037e-1043e

Vienna, Austria; and North Bristol, United Kingdom From the Division of Plastic and Reconstructive Surgery and the Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Department of Physical Medicine and Rehabilitation, Medical University of Vienna; and the Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Trust.

Background: Although the distal targets have been lost in proximal upper limb amputees, the neural signals for intuitive hand and arm function are still available and thus can be incorporated into more useful prosthetic function using targeted muscle reinnervation technique. In this article, the authors present their outcomes and range of indications in addition to experiences and pitfalls after 30 targeted muscle reinnervation cases at above-elbow and shoulder disarticulation level of amputation.

Methods: Thirty patients with above-elbow or shoulder disarticulation amputations were enrolled between 2012 and 2017. Read More

Mil Med 2020 Mar;185(3-4):444-450

Extremity Trauma and Amputation Center of Excellence, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.

Introduction: Military Service Members (SMs) with upper limb (UL) amputation have unrestricted access to occupational therapy (OT) services. Identifying OT interventions used based on clinical rationale and patient needs can provide insight toward developing best practice guidelines. The purpose of this retrospective observational study was to identify preferred OT practice patterns for U. Read More

Cureus 2019 Sep 3;11(9):e5557. Epub 2019 Sep 3.

Diabetes and Endocrinology, Peterborough City Hospital, Peterborough, GBR.

Undifferentiated pleomorphic sarcoma (UPS) is a rare tumor of mesenchymal origin affecting the hand in less than 3% of cases. A 92-year-old male reported an enlarging, painless mass on his left hand of three months duration. Examination of the hand revealed a soft, non-tender, immobile mass over the wrist joint, just proximal to his thumb. Read More

Mil Med 2020 Feb;185(1-2):e244-e253

VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161.

Introduction: Little population-based research has described the transition from Department of Defense (DoD) to Department of Veterans Affairs (VA) healthcare following combat related amputations. The objectives were to describe (1) to what extent patients used either DoD only facilities, both DoD and VA facilities, or VA only facilities during the first 5 years postinjury, (2) which specific clinics were used and (3) clinic use among patients with different levels of amputation (upper versus lower), and among patients with early or late amputation.

Materials And Methods: This was a retrospective analysis of health data extracted from the expeditionary medical encounter database (EMED) and national DoD and VA databases. Read More

Am Surg 2019 May;85(5):501-504

Amputations associated with trauma carry significant morbidity in addition to risk of limb loss due to tissue damage, contamination, and risk of infection. The timing of formal amputation closure in this situation varies among surgeons, with some allowing the wound to remain open for some time after debridement, whereas others perform formal amputation and closure at the index operation if debridement is adequate. The presence of infection after closure of an amputation has the potential to result in a higher amputation (, a below-knee amputation to an above-knee amputation). Read More

PM R 2019 06 29;11(6):577-589. Epub 2019 Mar 29.

Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA.

Background: Limited population-based research has described long-term health outcomes following combat-related upper limb amputation.

Objective: To compare health outcomes following upper limb amputation with outcomes following serious upper limb injury during the first 5 years postinjury.

Design: Retrospective cohort. Read More

Stem Cell Res Ther 2019 01 11;10(1):15. Epub 2019 Jan 11.

Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.

Background: Although the mononuclear cell (MNC) transplantation could theoretically induce therapeutic angiogenesis in the patients with no-option critical limb ischemia (NO-CLI), the clinical responses to this approach are inconsistent among different clinical trials. The purpose of this study was to identify the prognostic factors of responders and develop a predictive nomogram to guide patient selection.

Methods: We retrospectively reviewed a consecutive NO-CLI cohort who received peripheral blood-derived transplantation in our center. Read More

Ann Vasc Surg 2019 Apr 28;56:357.e1-357.e4. Epub 2018 Nov 28.

Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.

Angiosarcomas developing in nonfunctioning arteriovenous fistulas in renal transplant recipients are quite rare clinical entities with very poor prognosis. Herein we present a 60-year-old male who developed an angiosarcoma in a thrombosed radiocephalic fistula 6 years after renal transplantation. The patient presented with pain and swelling at the site of a previously asymptomatic fistula. Read More

Can J Surg 2018 12;61(6):S203-S207

From the Royal Canadian Medical Service, Ottawa, Ont. (Smith, DaCambra, McAlister); and the Division of General Surgery, Western University, London, Ont. (Smith, McAlister).

Background: We have previously reported a higher than expected rate of upper-extremity amputation (UEA) in victims of an antipersonnel improvised explosive device (AP-IED) compared with a similar cohort injured by antipersonnel mines (APM). The goal of this study was to describe the rate, severity and impact of UAE caused by an AP-IED.

Methods: We analyzed a prospective database of 100 consecutive dismounted AP-IED victims with pattern 1 injuries to compare the outcomes of the cohort with UEA to that without. Read More

J Burn Care Res 2019 01;40(1):107-111

Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas.

Electrical injuries induce substantial morbidity and mortality. Amputations are often necessary to enable survival and based on tissue nonviability, development of life-threatening infection, or expected nonfunctional outcome. They analyzed occurrence and type of amputations in their institution for electrical and nonelectrical pediatric burns and the number of reconstructive operations. Read More

Sci Rep 2018 10 18;8(1):15459. Epub 2018 Oct 18.

Aix Marseille Univ, CNRS, ISM, Marseille, France.

There is an increasing need to extend the control possibilities of upper limb amputees over their prosthetics, especially given the development of devices with numerous active joints. One way of feeding pattern recognition myoelectric control is to rely on the myoelectric activities of the residual limb associated with phantom limb movements (PLM). This study aimed to describe the types, characteristics, potential influencing factors and trainability of upper limb PLM. Read More

J Vasc Surg 2019 01 29;69(1):120-128.e2. Epub 2018 Jul 29.

Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, Tex; South Texas Center for Vascular Care, South Texas Medical Center, San Antonio, Tex. Electronic address:

Background: Critical hand ischemia owing to below-the-elbow atherosclerotic occlusive disease is relatively uncommon. The aim of this study was to examine the outcomes in patients presenting with critical ischemia owing to below-the-elbow arterial atherosclerotic disease who underwent nonoperative and operative management.

Methods: A database of patients undergoing operative and nonoperative management for symptomatic below-the-elbow atherosclerotic disease between 2006 and 2016 was retrospectively queried. Read More

Rev Port Cir Cardiotorac Vasc 2017 Jul-Dec;24(3-4):179

Hospital de Santa Marta, Portugal.

Introduction: With increasing use of percutaneous vascular procedures, access complications that present to a vascular surgeon increase. The most limb-threatening condition is acute limb ischaemia. Acute limb ischaemia is the most common vascular surgical emergency. Read More

Plast Reconstr Surg 2018 06;141(6):1447-1458

Toronto, Ontario, Canada From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Institute of Biomaterials and Biomedical Engineering, University of Toronto; the Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children; and Orthotics and Prosthetics, Holland Bloorview Kids Rehabilitation Hospital.

Prosthetic options for patients with proximal upper limb absence are limited. Current above-elbow prostheses may restore basic motor functions for crucial activities, but they are cumbersome to operate, lack sensory feedback, and are often abandoned. Targeted muscle reinnervation is a novel surgical procedure that enhances the ability of patients with above-elbow amputations to intuitively control a myoelectric prosthesis. Read More

Brain 2017 Dec;140(12):3166-3178

Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

Denervation due to amputation is known to induce cortical reorganization in the sensorimotor cortex. Although there is evidence that reorganization does not lead to a complete loss of the representation of the phantom limb, it is unclear to what extent detailed, finger-specific activation patterns are preserved in motor cortex, an issue that is also relevant for development of brain-computer interface solutions for paralysed people. We applied machine learning to obtain a quantitative measure for the functional organization within the motor and adjacent cortices in amputees, using high resolution functional MRI and attempted hand gestures. Read More

JAMA 2017 Oct;318(16):1581-1591

Joint Trauma System, Defense Center of Excellence for Trauma, Fort Sam Houston, San Antonio, Texas.

Importance: Prehospital blood product transfusion in trauma care remains controversial due to poor-quality evidence and cost. Sequential expansion of blood transfusion capability after 2012 to deployed military medical evacuation (MEDEVAC) units enabled a concurrent cohort study to focus on the timing as well as the location of the initial transfusion.

Objective: To examine the association of prehospital transfusion and time to initial transfusion with injury survival. Read More

IEEE Int Conf Rehabil Robot 2017 07;2017:1457-1464

Prosthetic arms should restore and extend the capabilities of someone with an amputation. They should move naturally and be able to perform elegant, coordinated movements that approximate those of a biological arm. Despite these objectives, the control of modern-day prostheses is often nonintuitive and taxing. Read More

J Orthop Case Rep 2017 Jan-Feb;7(1):3-8

Department of Orthopaedics, Preethi Hospitals Pvt. Ltd., Madurai, Tamil Nadu, India.

Introduction: Mangled upper limb injuries are at surge because of industrialization, modernization, and severe motor vehicle accidents. The utility of various scoring systems are meant for decision making in mangled lower limb injuries, and the same have been extrapolated for mangled upper limb injuries to make a decision of salvage or amputation for the lack of separate scoring system.

Materials And Methods: We applied mangled extremity severity score (MESS) and mangled extremity syndrome index (MESI) scoring systems to 10 cases of mangled upper limb injuries during the period of November 2010 to September 2012 presented at our tertiary trauma care center. Read More

J Am Acad Orthop Surg 2017 May;25(5):339-347

From the Department of Orthopaedic Surgery, University of Texas Health Science Center, Houston, TX (Dr. Choo and Dr. Burgess), and the Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, Burlington, VT (Dr. Schottel).

Scapulothoracic dissociation is a rare, potentially limb- and life-threatening injury of the shoulder girdle. The injury is characterized by lateral displacement of the scapula resulting from traumatic disruption of the scapulothoracic articulation. The typical physical examination findings consist of substantial swelling of the shoulder girdle, along with weakness, numbness, and pulselessness in the ipsilateral upper extremity. Read More

J Occup Rehabil 2018 03;28(1):158-169

Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, PO BOX 30001, 9700 RB, Groningen, The Netherlands.

Purpose To develop and pilot test a functional capacity evaluation (FCE) for individuals with upper limb absence (ULA) due to reduction deficiency or amputation, and to examine the relationship between FCE results and presence of musculoskeletal complaints (MSC). Method Five tests (overhead lifting, overhead working, repetitive reaching, fingertip dexterity, and handgrip strength) were selected and adapted if necessary. The newly developed FCE, called FCE-One-Handed (FCE-OH), was pilot tested in 20 adults individuals with ULA, and 20 matched controls. Read More

J Neuroeng Rehabil 2017 Jan 7;14(1). Epub 2017 Jan 7.

Chinese Academy of Sciences (CAS) Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Shenzhen, 518055, China.

Background: Most of the modern motorized prostheses are controlled with the surface electromyography (sEMG) recorded on the residual muscles of amputated limbs. However, the residual muscles are usually limited, especially after above-elbow amputations, which would not provide enough sEMG for the control of prostheses with multiple degrees of freedom. Signal fusion is a possible approach to solve the problem of insufficient control commands, where some non-EMG signals are combined with sEMG signals to provide sufficient information for motion intension decoding. Read More

Mil Med 2016 08;181(8):773-6

Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234.

Introduction: Upper extremity amputation is associated with significant disability. Elbow arthrodesis (EA) is a rarely indicated salvage procedure with a narrow set of indications. The purpose of this case series is to describe the clinical course of those patients undergoing an EA following severe combat-related, upper extremity trauma. Read More

J Plast Reconstr Aesthet Surg 2016 Mar 26;69(3):311-7. Epub 2015 Oct 26.

Mayo Clinic, Department of Orthopedic Surgery, Division of Hand Surgery, 200 1st Street South West, Rochester, MN 55905, USA. Electronic address:

Background And Aim: Despite undergoing complex brachial plexus, surgical reconstructions, and rehabilitation, some patients request an elective amputation. This study evaluates the role of elective amputation after brachial plexus injury.

Methods: A retrospective chart review was performed for all the 2140 patients with brachial plexus injuries treated with elective amputation between 1999 and 2012 at a single institution. Read More

Anesth Pain Med 2015 Dec 30;5(6):e24025. Epub 2015 Nov 30.

Tameside Hospital, Ashton-Under-Lyne, UK.

Introduction: The brachial plexus block is a commonly performed procedure in the anesthetic practice today. It is performed for analgesia as well as anesthesia for upper limb procedures. It has been used for amputation and replantation surgeries of the upper limb. Read More

Lymphat Res Biol 2016 Mar 19;14(1):35-9. Epub 2015 Nov 19.

1 Division of Plastic Surgery, Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medical Centre , Göttingen, Germany .

Background: Stewart-Treves syndrome is a rare complication of breast cancer treatment, representing a lymphangiosarcoma commonly associated with lymphedema and severely impacting patient's outcome. The tumor typically develops in the atrophic, pachydermatous, hyperkeratotic skin of limbs affected by long-standing lymphedema. Clinical data associated with Stewart-Treves syndrome and lymphedema management have rarely been published. Read More

J Shoulder Elbow Surg 2015 Nov;24(11):1757-63

Department of Orthopedic Surgery and Traumatology, Niguarda Hospital, Milan, Italy.

Background: Surgical arthrodesis of the elbow joint is frequently unsuccessful and rarely performed. It is the purpose of this article to evaluate tactics and different constructs to achieve elbow arthrodesis (EA) using the Ilizarov apparatus in patients with post-traumatic nonreconstructable elbow sequelae.

Methods: A consecutive series of 4 patients were treated between 2009 and 2013 (3 men and 1 woman; mean age, 46. Read More

J Pain Res 2015 24;8:641-5. Epub 2015 Sep 24.

Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA ; Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH, USA.

Tumor progression during end-of-life care can lead to significant pain, which at times may be refractory to routine analgesic techniques. Although regional anesthesia is commonly used for postoperative pain care, there is limited experience with its use during home hospice care. We present a 24-year-old male with end-stage metastatic osteosarcoma who required anesthetic care for a right-sided above-the-elbow amputation. Read More

PLoS One 2015 4;10(9):e0137729. Epub 2015 Sep 4.

Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

Background: Traumatic arm amputations can be treated with replantation or surgical formalization of the stump with or without subsequent prosthetic fitting. In the literature, many authors suggest the superiority of replantation. This systematic review compared available literature to analyze whether replantation is functionally and psychologically more profitable than formalization and prosthetic fitting in patients with traumatic arm amputation. Read More

Int J Surg Pathol 2015 Dec 27;23(8):649-51. Epub 2015 Jul 27.

Royal Marsden Hospital, London, UK

Intraneural extension of soft tissue sarcomas is uncommon; it is most frequently seen in malignant peripheral nerve sheath tumor, but its occurrence is exceptional in synovial sarcoma. We describe a case arising extraneurally within the deep soft tissues of the forearm, which recurred and resulted in above-elbow amputation, revealing an unexpected finding of diffuse intraneural extension of tumor within a macroscopically normal major nerve. Despite macroscopic and microscopically clear soft tissue margins, the neoplasm had "traveled" a significant distance intraneurally to involve the neural resection margin. Read More

J Perioper Pract 2014 Dec;24(12):286-7

The loss of Horatio Nelson's right arm is undoubtedly the best known amputation in this country's history and the story is well worth the telling. In 1797, the 38 year old Nelson, then a Rear Admiral, devised a plan for a surprise night attack to seize treasure ships, which he believed were sheltering at Santa Cruz on Tenerife, (one of the Canary Islands). On the night of July 24th, Nelson led an armada of rowing boats from his fleet, anchored below the horizon. Read More

Am J Phys Med Rehabil 2015 Dec;94(12):1052-7

From the Departments of Physical Medicine and Rehabilitation (MRB, MJT, SWD, KLA, CCP) and Pediatric and Adolescent Medicine (SWD, DBS), Mayo Clinic and Foundation, Rochester, Minnesota.

Objective: The objective of this study was to determine if wrestling is a safe, positive athletic option for limb-deficient individuals.

Design: This descriptive study consisted of an opportunity sample of limb-deficient wrestlers, aged 5 yrs and older with at least 1 yr of experience. Participants completed a questionnaire regarding health, satisfaction, and achievements. Read More

Australas J Dermatol 2016 May 5;57(2):e53-6. Epub 2015 Mar 5.

Department of Radiation Oncology and Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, New South Wales, Australia.

We report an unusual case of Merkel cell carcinoma in a 70-year-old woman with the rapid development of left upper limb in-transit and hepatic metastases. The patient had a preceding history of left-sided breast cancer. Palliative chemotherapy with carboplatin and etoposide produced a minimal response. Read More

J Rural Med 2014 10;9(1):37-9. Epub 2014 Apr 10.

Department of Cardiovascular Surgery, Yuri-Kumiai General Hospital, Japan.

Objective: The aim of the present study was to consider the importance of medical information obtained via the Internet for difficult cases in hospitals, especially in those located in rural areas. We report here a case of congenital arteriovenous fistula (AVF) in the upper extremities.

Patient: A 30-year-old lady was transported to our hospital by ambulance due to massive bleeding in her left hand. Read More

Int J Surg Case Rep 2015 12;6C:280-4. Epub 2014 Dec 12.

University Orthopaedics, Buffalo General Hospital, 100 High Street, Buffalo, NY 14203, USA. Electronic address:

Introduction: The prognosis of patients with metastatic breast cancer is very poor. Because of this, treatment of skeletal metastasis is often palliative with limited goals rather than cure. However, there are those patients, such as presented here, who survive for an extended time. Read More

J Med Biogr 2016 Aug 15;24(3):363-71. Epub 2014 May 15.

Surgeon Commander, Royal Naval Medical Service, and Consultant Orthopaedic Surgeon, MDHU, Derriford Hospital, Plymouth, UK.

Horatio Nelson is an icon of British naval history. His above-elbow amputation by Thomas Eshelby remains one of the most famous surgical procedures ever performed. Yet the surgeon himself remains relatively obscure and uncelebrated. Read More

Phys Med Rehabil Clin N Am 2014 Feb;25(1):199-212

Amputee Services of America, 1601 East 19th Avenue, Suite 3200, Denver, CO 80218, USA. Electronic address:

This article provides a generalized overview of amputation classifications and the idealized outcomes for upper and lower amputations at their respective levels. The following levels are discussed: above knee/transfemoral, below knee/transtibial, above elbow/transhumeral, below elbow/transradial, and bilateral for upper and lower extremities. This classification defines a framework for clinicians to share with patients so that they understand the potential for their expected functional outcomes regarding mobility and activities of daily living, both with and without a prosthesis. Read More

Tech Hand Up Extrem Surg 2013 Dec;17(4):221-7

*Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine †Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.

Vascularized composite allotransplantation, also known as "Reconstructive Transplantation" is becoming more commonplace worldwide. Hand and upper extremity transplantation make up the majority of clinical vascularized composite allotransplantation cases performed so far. As success with reconstructive transplantation becomes more common, more challenging examples of limb loss are being addressed, including above-elbow, or "supracondylar" upper extremity transplants. Read More

Hepat Mon 2013 11;13(8):e10858. Epub 2013 Aug 11.

Department of Liver Transplantation, King Faisal Specialist Hospital and RC, Riyadh, Saudi Arabia.

Introduction: Cutaneous Mucormycosis is a rare opportunistic infection caused by Zygomycetes class of fungi that is often fatal, requiring aggressive local control as well as systemic therapy. Few cases of mucormycosis were described in patients with liver cirrhosis, mostly rhino-orbital. To our knowledge, only two cases of upper extremity involvement was reported in cirrhosis while a few cases were reported in the post-transplant setting. Read More

Conf Proc IEEE Eng Med Biol Soc 2012 ;2012:4332-5

Electrical Engineering Department, Bioelectronics Section, CINVESTAV-IPN, Mexico, D.F., Mexico.

Individuals with a transhumeral amputation have a large functional deficit and require basic functions out of their prosthesis. Myoelectric prostheses have used amplitude control techniques for decades to restore one or two degrees of freedom to these patients. Pattern recognition control has also been investigated for transhumeral amputees, but in recent years, has been more focused on transradial amputees or high-level patients who have received targeted muscle reinnervation. Read More

Niger J Med 2012 Apr-Jun;21(2):249-51

Department of Orthopaedics and Traumatology, National Orthopaedic Hospital, Enugu, Nigeria.

Background: Human bite is a common injury sustained during a fight, love passion, self mutilation, cannibalism or vampirism. Although widely reported as being more dangerous than animal bites, such complications as limb amputation from gangrene and eventually death is either uncommon or scarcely reported in our environment.

Objective: To highlight the dangers of human bite as a potential cause of severe morbidity and mortality especially when poorly managed. Read More

J Emerg Trauma Shock 2012 Oct;5(4):363-6

Department of Surgery, Arrowhead Regional Medical Center, Colton, CA, USA.

Scapulothoracic dissociation (STD) is a devastating consequence of high-energy trauma sustained by the shoulder girdle that can easily result in rapid mortality. Since described by Oreck et al. in 1984, STD has been reported in a handful of journals and individual case series, though is still considered a rare occurrence in the context of shoulder injuries. Read More

Acupunct Med 2013 Mar 6;31(1):101-4. Epub 2012 Dec 6.

Brynhyfryd Surgery, Brynhyfryd Square, Swansea SA5 9EB, UK.

A 45-year-old man presented with phantom limb pain and phantom limb sensation 12 weeks after an above-elbow amputation of his right arm. He underwent seven sessions of acupuncture at weekly intervals carried out by his general practitioner on his intact left arm, with complete relief of the phantom limb pain and considerable improvement of the phantom limb sensation of his right arm. This case demonstrates the possible benefits from the use of short acupuncture sessions for a potentially chronic condition undertaken within the constraints of a busy general medical practice. Read More

Case Rep Pathol 2012 3;2012:353215. Epub 2012 Nov 3.

Department of Pathology, J.S.S. Medical College, J.S.S. University, Karnataka, Mysore, 570015, India.

Neurofibromas are uncommon benign tumours and are still rarer in intramuscular locations. They are not detected until they cause a significant damage to the neighbouring tissues. We present a case of a giant intramuscular myxoid neurofibroma of the left forearm which eroded the radius and ulna, restricting the movements at the elbow and wrist joints and causing wrist drop resulting in an above elbow amputation. Read More

Chir Main 2012 Oct 7;31(5):221-6. Epub 2012 Sep 7.

Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, hôpital d'enfant, CHU de Nancy, rue du Morvan, 54000 Brabois-Vandœuvre-lès-Nancy, France.

Digital amputations in children are usually caused by crush or avulsion injuries (door hinge, bicycle chain, etc.). The preponderance of this mechanism of injury means a survival rate generally lower than in adults. Read More