Symmetrical peripheral gangrene is a severe condition marked by symmetric acral necrosis without obstruction of the major blood vessels. This case report examines the critical decisions involved in choosing between early and delayed amputation, as well as determining the extent of the necessary amputation. We present three cases: one involving antiphospholipid syndrome, another with disseminated intravascular coagulation, and a third associated with diabetes mellitus. All three cases ultimately required amputation due to symmetrical peripheral gangrene. In the first two cases, amputation was delayed, which is typically advantageous as it allows for the clear demarcation of necrotic tissue. However, in the third case, where infection was evident, immediate amputation was necessary despite the patient's overall poor health.
, Erica Kholinne
, Suk-Joong Lee, Jong Pil Yoon, Jun Tan
, In-Ho Jeon This study aimed to quantify the relationship between proximal humeral rotation and the lateral border of the bicipital groove on fluoroscopic imaging.
A composite normal humerus with a marker placed on the lateral border of the bicipital groove was affixed to a custom rotation device at the proximal cut segment. Consecutive fluoroscopic images were captured from −60° to 60° in 5° increments and from −15° to 15° in 1° increments. The index value was calculated by taking the ratio of the distance from the medial boundary of the proximal humerus to the lateral border of the bicipital groove to the distance between the medial and lateral boundaries of the proximal humerus. The correlation between the humeral rotation and the index value was determined.
The index value showed a strong positive linear correlation position during internal rotation of the humerus across the entire range (r=0.998, P<0.001), as well as when the humerus was externally rotated, ranging from 15° of internal rotation to 15° of external rotation (r=0.991, P<0.001).
The lateral border of the bicipital groove may serve as a useful intraoperative landmark for assessing proximal humeral rotation. This could potentially enhance the outcomes of humeral fracture repair and upper arm arthroplasty.
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