Rozen WM, Chubb D, Whitaker IS, Acosta R (2010) The efficacy of postoperative monitoring: a single surgeon comparison of clinical monitoring and the implantable Doppler probe in 547 consecutive free flaps. Plast Reconstr Surg 124:295–302eĬhubb D, Rozen W, Whitaker I, Acosta R, Grinsell D, Ashton M (2010) The efficacy of clinical assessment in the postoperative monitoring of free flaps: a review of 1140 consecutive cases. Salgado CJ, Moran SL, Mardini S (2009) Flap monitoring and patient management. In: Post mortem changes and artifacts occurring during the early postmortem interval. Tsokos M (2005) Forensic pathology review, vol. Hirigoyen MB, Urken ML, Weinberg H (1995) Free flap monitoring: a review of current practice. Jones BM (1983) Monitors for the cutaneous microcirculation. Neligan PC (1993) Monitoring techniques for the detection of flow failure in the post-operative period. May JW, Chait LA, Obrien BM, Hurley JV (1978) The no-reflow phenomenon in experimental free flaps. A brisk capillary refill means that the color. Eur J Plast Surg 27:315–321Ĭreech B, Miller S (1975) Evaluation of circulation in skin flaps. Capillary refill refers to how quickly the color returns to the external capillary bed following pressure that has been applied to an area. 55.3 and 55.4 ).Whitaker IS, Karoo ROS, Oliver DW, Ganchi PA, Gulati V, Malata CM (2005) Current techniques in the post-operative monitoring of microvascular free-tissue transfers. Two views of the humerus are obtained, again demonstrating the fracture note that there is overriding of fracture fragments with posterior and lateral displacement of the distal facture fragment ( Figs. In this view, the complete humerus is not visualized and full humeral imaging is indicated to assess for associated distal humeral injury. Shoulder imaging was obtained revealing a proximal humerus shaft fracture with 2 cm of overlap the humeral head is aligned with the glenoid ( Figs. What does this meanCorrect:Capillary refill is a measure of arterial blood supply to the extremities. If there is a complex fracture or concern for neurovascular injury, MRI may have a role, but consultation with Pediatric Orthopedics or an orthopedist comfortable with the management of these fractures in the pediatric patient is reasonable prior to advanced imaging. Tina had brisk capillary refill (less than 3 seconds). In cases of complex fractures, there may be a role, but consultation with Pediatric Orthopedics or an orthopedist comfortable with the management of these fractures in the pediatric patient is reasonable prior to advanced imaging.Īs with CT, MRI is generally not indicated in the initial evaluation of proximal humerus fractures. Intranasal fentanyl (a dose of 2 μg/kg) has been proven to be effective pain control with minimal side effects, allowing for imaging of the patient.ĬT is not indicated in the evaluation of humeral shaft fractures. Prior to obtaining imaging, adequate pain control should be provided. Consideration should be given to imaging joints above and below an injury humeral radiographs will generally adequately visualize the elbow and shoulder joints, but dedicated imaging of those sites should be performed if clinically indicated. , Comparative views are generally not indicated. , Two-view imaging (AP and lateral projections) of the affected extremity is generally sufficient when evaluating pediatric long bone injuries and is appropriate to diagnose humeral shaft fractures in these patients. The proximal humerus can be visualized with a shoulder series and typical views include anteroposterior (AP), scapular Y, and axillary views. A child may not be able to indicate exactly where the source of their pain might be and shoulder imaging may be obtained rather than dedicated imaging of the humerus if a shoulder injury is initially suspected. The classification of humerus fractures depends on their location: proximal physeal fractures are classified using the Salter-Harris Classification, with the majority being Salter-Harris type I or II fractures, whereas humeral shaft fractures are classified by angulation, displacement, and location. There are no lacerations or abrasions of the skin. Peripheral Vascular Exam: Capillary refill less than 3 seconds. Abdominal and genitourinary exams are unremarkable for this circumcised male. pupils 3 mm, brisk and equal pupil reflex in right and left pupils, no hand or leg. He has brisk capillary refill and a strong radial pulse. There is tachycardia but no murmurs, rubs, or gallop with a brisk capillary refill. There is no apparent weakness or numbness. His vital signs are age appropriate and there is no obvious injury other than mild edema and tenderness of his proximal right humerus. There is no reported loss of consciousness and he denies neck pain, abdominal pain, back pain, or elbow pain. A 6-year-old boy presents with right upper arm and shoulder pain after falling off a horse while riding at a brisk trot.
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