"Tug-of-war" injury

This somewhat gruesome case report in the August issue of this Journal (Orthopedics. 1999;22:769-770) was authored by Bruce and Hayes from the Chattanooga College of Medicine at the University of Tennessee. A 21 -year-old, right hand dominant man was participating as "the lead-off man" in tug-of-war at his annual company picnic. The patient was one of the 50 adult (two teams of 25 men each) tug-of-war participants. As the "lead-off man," he looped the 1 inch rope around his right distal forearm approximately 2 inches proximal to his wrist. Upon initiation of the mg, his distal radius and ulna were broken and his right hand was pulled off his arm just proximal to the wrist. His amputated hand was placed on ice immediately and a compression dressing applied to his remaining forearm. Within 40 minutes of the injury, the patient reached the area Level 1 Trauma Center via air ambulance. The patient was in surgery by 90 minutes from the time of his injury. Both the ulnar and median nerves showed stretch injuries with avulsion several centimeters proximal to the transection site. The radial artery was avulsed 8 cm proximal. All tendons were pulled apart at multiple levels which, unfortunately, made completion of amputation at the mid-forearm level necessary. The patient has achieved great skill in using a hand/arm prosthesis and was able to return to his pre-injury job 20 months after the avulsion.