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  1. Wong ELW, Kwan MK, Loh WYC, Ahmad TS
    Med J Malaysia, 2005 Jul;60 Suppl C:72-7.
    PMID: 16381288
    Shoulder arthrodesis is a secondary reconstructive option for patients with brachial plexus injuries requiring a stable shoulder. This study was undertaken to evaluate the clinical and radiological outcomes of shoulder fusion in six patients with flail upper limbs following complete brachial plexus injuries. The shoulder was fused in 30 degrees abduction, 30 degrees internal rotation and 30 degrees flexion via a direct lateral approach by using a 4.5 mm reconstruction plate without bone grafting. The average follow-up was 10.3 months. Radiological union was obtained in all patients. Five patients (83%) had relief of pain after the shoulder fusion. Improvement of function was observed in all patients with a mean improvement of 56.6 degrees (range 30 degrees-75 degrees) and 47.5 degrees (range 30 degrees-60 degrees) active flexion and abduction respectively. One patient developed humeral fracture distal to the plate and the fracture eventually healed with a splint. Successful stable fusion of the shoulder in patients with brachial plexus injuries requires rigid fixation with a single 4.5 mm reconstruction plate, protection of bone healing with a triangular abduction brace for 12 weeks and functional trapezius, levator scapulae, serratus anterior and rhomboid muscles for optimizing the functional result.
  2. Merican AM, Kwan MK, Cheok CY, Wong ELW, Sara TA
    Med J Malaysia, 2005 Jun;60(2):218-21.
    PMID: 16114164
    Near total amputation of the upper limb if unsalvageable would cause severe disability. However, delayed revascularisation can be life threatening. We report two cases of revascularisation of the upper limb following near total amputation that was successful and functional after a warm ischaemic time of ten hours. The first was a traction avulsion injury of the arm leaving major nerves contused but in continuity. The second was a sharp injury through the mid-forearm attached by only a bridge of skin. Attempting revascularisation of a proximal injury beyond 6 hours, in selected cases is worthwhile.
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