The Mangled Extremity team was contacted about a man that sustained a work-related injury when he fell while working on a road construction crew. His arm was pinned under the road compacting machine for a number of minutes.  He was taken emergently to a trauma center and after he was stabilized the Extremities at Risk team was contacted. He was transferred to Presbyterian/St. Luke's Medical Center for care of his arm. The image to the right shows the soft tissue loss on the top surface of his arm. His hand is swollen from the injury.

He was taken to surgery immediately because he was developing a compartment syndrome.  This is common in an injury as severe has the one he sustained. If the pressure in the compartment isn't released urgently there is a high possibility of damage to the muscles that control the wrist and hand.  The tip of his index and little fingers were amputated because they were crushed during the accident.

Initial x-rays showing fractures in   both bones of the forearm.	Intraoperative photo showing the   external fixation placed to hold the   fractures in place, and opening of   the forearm to relieve pressure that    resulted from the injury.    Antibiotic beads are seen in the   area to help fight possible infection   due to the extent of the injury.

Six days later he was taken back to the operating room for internal fixation of the fractures and reconstruction of the soft tissue that was injured. 

External fixation removed,   forearm fractures are plated   (not visible),   soft tissue is prepped for   muscle flap.	Rectus abdominus muscle   (from stomach area) is placed   into the area of injury on   the forearm.	Skin mesh placed over   the flap for coverage.

He did well after leaving the hospital and was able to start rehabilitation with the hand therapist. 

X-ray 6 months later   showing internal   plates for the   forearm fractures.	Picture of forearm where rectus   muscle flap was placed. The muscle   flap contracts over a few weeks.	Patient demonstrating bending his   wrist.

After approximately 8 months he was able to return to a lighter duty construction job without difficulty.