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Williams AM, Medda S, Wally MK, Seymour RB, Hysong A, Stanley A, Manzano G, Hsu JR. Suspected gluteal compartment syndrome: Etiology predicts clinical course, outcomes and resource utilization. Trauma Case Rep 2024; 51:101017. [PMID: 38590921 PMCID: PMC11000157 DOI: 10.1016/j.tcr.2024.101017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/10/2024] Open
Abstract
Background Gluteal Compartment Syndrome (GCS) is a rare subtype of acute compartment syndrome (ACS), complex to diagnose and potentially fatal if left untreated. The incidence of ACS is estimated to be 7.3 per 100,000 in males and 0.7 per 100,000 in females [1-3]. Given its rare occurrence, the incidence of GCS is not well reported. In the case of GCS, the most common etiologies are surgical positioning, prolonged immobilization secondary to substance use or loss of consciousness, and traumatic injury. Clinical findings are pulselessness, pallor, parasthesia, paralysis, and most notably pain out of proportion. Swift diagnosis and treatment are imperative to reduce morbidity and mortality, however the ideal management of GCS is difficult to ascertain given the rare occurrence and variable presentation. Methods Orthopaedic trauma database at a level 1 trauma center was reviewed to identify patients for whom the orthopaedic service was consulted due to suspicion of gluteal compartment syndrome. This yielded 11 patients between 2011 and 2019. Patients with a measured ΔP greater than 30 upon initial consultation and with a concerning exam requiring monitoring were included. Patient demographics, comorbidities, GCS etiology, laboratory values, physical exam findings, pain scores (0-10) and patient outcomes were collected via chart review. Patient demographic and injury characteristics were summarized using descriptive statistics. Results Prolonged immobilization patients had worse outcomes including longer hospital stays (40.5 days) compared to trauma patients (4.5 days). All adverse medical outcomes recorded including acute renal failure, prolonged neuropathic pain, cardiopulmonary dysfunction were exclusively experienced by prolonged immobilization patients. Conclusions Our descriptive study demonstrates the bimodal distribution of GCS patients based on etiology. Prolonged immobilization patients have a longer hospital course and more complications. Our study confirms prior reports and provides information that can be used to counsel patients and families appropriately about treatment and recovery following GCS. Level of evidence IV. Study type Epidemiological.
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Affiliation(s)
- Alicia M. Williams
- 2001 Vail Ave, Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, USA
| | - Suman Medda
- 2001 Vail Ave, Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, USA
| | - Meghan K. Wally
- 2001 Vail Ave, Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, USA
| | - Rachel B. Seymour
- 2001 Vail Ave, Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, USA
| | - Alexander Hysong
- 2001 Vail Ave, Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, USA
| | - Amber Stanley
- 2001 Vail Ave, Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, USA
| | - Givenchy Manzano
- 2001 Vail Ave, Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, USA
| | - Joseph R. Hsu
- 2001 Vail Ave, Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, USA
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von Deneen KM, Alemayehu DG, Khosla A. Acute Compartment Syndrome and Rhabdomyolysis Caused by a Single Electrical Muscle Stimulation in a 46-Year-Old Female Professional Athlete With Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Disorder: A Case Report. Clin J Sport Med 2024:00042752-990000000-00180. [PMID: 38456638 DOI: 10.1097/jsm.0000000000001216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/07/2023] [Indexed: 03/09/2024]
Abstract
ABSTRACT Electrical muscle stimulation (EMS) training has been recognized as an effective modality for improving body composition, enhancing body strength, and facilitating injury recovery. However, individuals who are new to EMS training and those with certain chronic diseases should exercise caution due to the increased risk of rhabdomyolysis. This case report describes the occurrence of rhabdomyolysis and gluteal compartment syndrome following a single session of EMS training in a 46-year-old Caucasian female professional athlete. The patient was successfully managed with intensive intravenous fluid therapy and sodium bicarbonate supplementation, along with close monitoring of electrolytes and renal function. Electrical muscle stimulation training poses an increased risk of severe complications in individuals with chronic diseases and myopathy. Therefore, careful subject selection is required for EMS training in individuals with chronic diseases and myopathy to prevent common side effects. For individuals trying EMS training for the first time, it is recommended to avoid high-frequency EMS exercises.
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Affiliation(s)
- Karen M von Deneen
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, PR China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, PR China
| | - Dereje Gobena Alemayehu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China ; and
| | - Ajit Khosla
- School of Advanced Materials and Nanotechnology, Xidian University, Xi'an, Shaanxi, PR China
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Markus D, Bi AS, Neal W, Fiedler B, Tejwani N. Atraumatic Idiopathic Compartment Syndrome Requiring Emergent Fasciotomy: A Case Report and Literature Review. Cureus 2024; 16:e57208. [PMID: 38681317 PMCID: PMC11056228 DOI: 10.7759/cureus.57208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
A 42-year-old male with no past medical history presented to an emergency room with increasing pain and swelling of his left lower extremity over 48 hours with no preceding trauma. A computed tomography scan demonstrated a hematoma (20 cm × 4 cm × 10 cm) present within the gastrocnemius-soleus complex. Acute compartment syndrome (ACS) was diagnosed clinically, confirmed intraoperatively with an arterial line transducer, and treated with emergent fasciotomy. Extensive workup found no evidence of coagulopathy or source of bleeding. This case presents a patient with ACS secondary to an atraumatic gastrocnemius hematoma discovered in the emergency room with no history of coagulopathies or anticoagulation.
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Affiliation(s)
- Danielle Markus
- Orthopedic Surgery, New York University (NYU) Langone Orthopedic Hospital, New York, USA
| | - Andrew S Bi
- Orthopedic Surgery, New York University (NYU) Langone Orthopedic Hospital, New York, USA
| | - William Neal
- Orthopedic Surgery, New York University (NYU) Langone Orthopedic Hospital, New York, USA
| | - Benjamin Fiedler
- Orthopedic Surgery, New York University (NYU) Langone Orthopedic Hospital, New York, USA
| | - Nirmal Tejwani
- Orthopedics, New York University (NYU) Langone Orthopedic Hospital, New York, USA
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Ghanem D, Rogers DL, Benes G, Siler B, Lobaton G, Shafiq B. Gluteal compartment syndrome: who is most at risk? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:773-779. [PMID: 37695367 DOI: 10.1007/s00590-023-03704-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE Gluteal compartment syndrome (GCS) is a rare but devastating condition with a paucity of literature to help guide diagnosis and management. This study aims to identify and describe the risk factors and patient characteristics associated with GCS to facilitate early diagnosis. METHODS This is a retrospective case series of patients undergoing gluteal compartment release between 2015 and 2022 at an academic Level I trauma center. Chart reviews were performed to extract data on patient demographics, presenting symptoms, risk factors, operative findings, and postoperative outcomes. RESULTS 14 cases of GCS were identified. 12 (85.7%) were male, with a mean age of 39.4 ± 13 years and a mean BMI of 25.1 ± 4.1 kg/m2. 12 (85.7%) patients did not present as traumas and only 3 had ≥ 1 fracture. 9 patients reported drug use. Hemoglobin (Hgb) (11.7 ± 4 g/dL) was generally low (5 had Hgb < 10 g/dL). Creatine kinase (49,617 ± 60,068 units/L) was consistently elevated in all cases, and lactate (2.8 ± 1.6 mmol/L) was elevated in 9. 13 had non-viable muscle requiring debridement. Postoperatively, the mean ICU length of stay was 12 ± 23 days. 2 patients died during admission and all remaining patients required discharge to rehabilitation facilities. CONCLUSION GCS is more likely to present in a young to middle-aged, otherwise healthy, male using drugs who is either found down or experienced an iatrogenic injury. Recognizing that GCS is different from that of the leg, in terms of etiology, may help avoid delays in diagnosis and treatment.
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Affiliation(s)
- Diane Ghanem
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA.
| | - Davis L Rogers
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Gregory Benes
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Brad Siler
- School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Gilberto Lobaton
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Babar Shafiq
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
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Yang SS, Anidjar M, Azzam MA. 'A pain in the buttock': A case report of gluteal compartment syndrome after robotic partial nephrectomy. J Perioper Pract 2023; 33:263-268. [PMID: 35485632 DOI: 10.1177/17504589221092563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute compartment syndrome is a surgical emergency that, if unrecognised, leads to tissue and muscle ischaemia, necrosis, multi-organ failure and even death. Gluteal compartment syndrome is a rare type of compartment syndrome that typically occurs as a sequela of trauma, and its presentation may be difficult to recognise. We describe a case of a patient who developed gluteal compartment syndrome following a prolonged renal surgery in lateral decubitus position. Our case report aims to raise clinicians' awareness to consideration of this rare syndrome in patients presenting with lower extremity or back pain after prolonged surgery.
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Affiliation(s)
- Stephen Su Yang
- Department of Anesthesia, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
- Department of Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Maurice Anidjar
- Division of Critical Care, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Milène A Azzam
- Department of Anesthesia, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Abouzahir H, Belhouss A, Benyaich H. Postoperative rhabdomyolysis following otoplasty: an autopsy case report. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00701-7. [PMID: 37624532 DOI: 10.1007/s12024-023-00701-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
Postoperative rhabdomyolysis is a significant complication that can arise from prolonged surgery, causing potential harm to the kidneys and leading to acute renal failure. Despite its importance, the incidence of rhabdomyolysis following ear reconstruction surgery remains undocumented in the literature. In this report, we present a case study of a male patient in his forties who underwent otoplasty for ear reconstruction after the amputation of his right ear due to a physical assault. The surgery lasted for 8 h under general anesthesia, and unfortunately, the patient developed postoperative rhabdomyolysis, which resulted in severe renal failure and ultimately an unrecoverable cardiac arrest, leading to his death. The autopsy findings indicated no identifiable lesions except for organ congestion, while histopathology revealed acute tubular necrosis of the kidney and muscle rhabdomyolysis. Previous literature has explored the association between surgical duration, location, and rhabdomyolysis, underscoring that this condition is an infrequent yet preventable consequence of prolonged surgery. The co-occurrence of rhabdomyolysis and acute renal injury in this case suggests the presence of comorbidity, emphasizing the need for prompt action to mitigate the negative consequences of rhabdomyolysis. Awareness and early intervention are crucial in preventing and managing this condition effectively.
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Affiliation(s)
- Hind Abouzahir
- Medicolegal Institute, Ibn Rochd University Hospital, Casablanca, Morocco.
- Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco.
| | - Ahmed Belhouss
- Medicolegal Institute, Ibn Rochd University Hospital, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Hicham Benyaich
- Medicolegal Institute, Ibn Rochd University Hospital, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
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Gunn JL, Yatsonsky D, Pasquinelly A, Kosco E, Schwartz TG, Sanford C, Georgiadis GM. Contralateral Gluteal Compartment Syndrome After Prolonged Use of a Fracture Table in a Scissoring Position: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00007. [PMID: 37437053 DOI: 10.2106/jbjs.cc.23.00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
CASE A 62-year-old Caucasian man presented with a comminuted subtrochanteric fracture after a low-energy fall. Physical examination postoperatively revealed a firm hard gluteal compartment in the contralateral buttocks. The patient underwent a fasciotomy, using the Kocher-Langenbeck approach, to release the gluteus maximus and lateral thigh fascia. At the most recent 6-month follow-up, gluteal function was intact with no long-term sequelae from compartment syndrome. CONCLUSION Prolonged positioning on a fracture table can result in gluteal compartment syndrome of the contralateral extremity.
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Affiliation(s)
- Jenna L Gunn
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - David Yatsonsky
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Adam Pasquinelly
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Ethan Kosco
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Tyler G Schwartz
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Christopher Sanford
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Gregory M Georgiadis
- Section of Orthopaedic Trauma, Department of Orthopaedic Surgery, ProMedica Toledo Hospital, Toledo, Ohio
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Vikatmaa P. Emergencies during oncovascular surgery: Strategies and pitfalls. Semin Vasc Surg 2023; 36:157-162. [PMID: 37330230 DOI: 10.1053/j.semvascsurg.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
In a growing number of pathologies, vascular invasion is no longer considered a contraindication for surgery with a curative intention. This has led vascular surgeons to be more involved in the treatment of pathologies that they are not used to. These patients should be managed in a multidisciplinary manner. New types of emergencies and complications have emerged. Emergencies in oncovascular surgery are mostly avoidable with careful planning and good collaboration between oncological surgeons and a dedicated vascular surgery team. The operations often involve difficult vascular dissection and complex reconstructive techniques in a potentially contaminated and irradiated field, and the risk of postoperative complications and blow out is increased. However, after a successful operation and immediate postoperative course, the patients often recover faster than the typical fragile vascular surgical patient. This narrative review focuses on emergencies that are more or less specific to oncovascular procedures. A scientific approach and international collaboration are needed, so that we can better identify which patients should be operated, what problems to anticipate and could be avoided with better planning, and which solutions improve patient outcome.
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Affiliation(s)
- Pirkka Vikatmaa
- Vascular Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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9
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Kuroki Y, Imamura R, Inoue H, Inoue T, Ebihara T, Nakamura K, Izumi T, Hamada T, Inokuchi A, Arizono T. Gluteal Compartment Syndrome After Femoral Nail Extraction: A Case Report. Cureus 2023; 15:e37289. [PMID: 37168203 PMCID: PMC10166009 DOI: 10.7759/cureus.37289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 05/13/2023] Open
Abstract
Gluteal compartment syndrome is a rare disorder and no definitive treatment has yet been established. Fasciotomy is often the treatment of choice for gluteal compartment syndrome, but there have been only a few cases that have improved with conservative therapy. A 26-year-old male with a body mass index of 40.5 who underwent femoral nail extraction surgery had severe pain in the right buttock and numbness in the right lower extremity. Initially, we suspected transient pain due to prolonged exposure to the same posture, but muscle weakness in the lower extremities and worsening of renal function appeared over time. Orthopedic evaluation revealed physical examination findings and MRI imaging findings consistent with gluteal compartment syndrome. Conservative treatment with temporary dialysis was chosen instead of fasciotomy because of the time required for diagnosis. Dialysis was started on postoperative day 3, renal function and muscle weakness recovered over time, and the patient was discharged home on postoperative day 37. At six months post-op, the patient was walking without pain and he had no changes in his peripheral neurologic examination compared to his preoperative baseline. Orthopedic surgeons should always be aware of the possibility of gluteal compartment syndrome when especially obese patients with prolonged operation times appeal to acute buttock pain. Diagnosis should be made as early as possible to get a good prognosis.
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Affiliation(s)
- Yosuke Kuroki
- Orthopedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Ryuta Imamura
- Orthopedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Hayato Inoue
- Orthopedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Takahiro Inoue
- Orthopedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Toshihiro Ebihara
- Orthopedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Kimitaka Nakamura
- Orthopedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Teiyu Izumi
- Orthopedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Takahiro Hamada
- Orthopedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Akihiko Inokuchi
- Orthopedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Takeshi Arizono
- Orthopedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
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Posner AD, Anoushiravani AA, Perloff EM, Vig KS, Smith MP, Mulligan MT. Measurement of the gluteal compartment pressures: A cadaveric study describing safety and reproducibility of two methods. Injury 2023:S0020-1383(23)00270-X. [PMID: 36959021 DOI: 10.1016/j.injury.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Gluteal compartment syndrome is an uncommon entity and physicians may use intracompartmental pressure measurements for confirmation of the clinical diagnosis, or in cases where the physical exam is indeterminate. However, there is a paucity of literature describing a safe and reproducible technique to measure gluteal intracompartmental pressures during the diagnosis of gluteal compartment syndrome. The purpose of this cadaveric study is to evaluate the sole previous technique described in the literature to measure gluteal intracompartmental pressures and provide a modified technique which can be safely and reliably utilized clinically. METHODS A cadaveric study with three phases was performed in 16 gluteal regions in 8 cadavers. In the first phase, the previously described technique was assessed. In the second phase, a modified set of techniques was created and evaluated. In the third phase, inter-user reliability of the modified set of techniques was assessed and calculated using Cohen's ĸ coefficient. In all three phases, methylene blue was injected through pressure monitoring needles into the gluteus maximus (GMax), gluteus medius/minimus (GMM), and the tensor fascia lata (TFL) compartments. Following dissection, rate of successful penetration into each targeted compartment and distance from the neurovascular structures was recorded. RESULTS The previously described set of techniques was found to be variable. The modified set of techniques was effective, successfully reaching the GMax, GMM, and TFL compartments in 100%, 100%, and 81% of attempts, respectively. Inter-user reliability was excellent (ĸ = 1) for the techniques to reach both the GMax and GMM compartments, and moderate (ĸ = 0.54) for the technique to reach the TFL compartment. Within the GMax, the pressure monitoring needle was at a mean of 5.4±0.6 cm, 4.1±0.7 cm, 6.4±0.5 cm from the sciatic nerve (SN), superior gluteal nerve (SGN), and inferior gluteal nerve (IGN), respectively. Within the GMM, the pressure monitoring needle was at a mean of 9.7±1.4 cm, 7.4±1.3 cm, 11.1±1.7 cm from the SN, SGN, and IGN, respectively. CONCLUSION The modified set of techniques presented allows the three gluteal compartments to be safely and reproducibly reached to measure intracompartmental pressures during the diagnosis of gluteal compartment syndrome.
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Affiliation(s)
- Andrew D Posner
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | | | - Eric M Perloff
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Khushdeep S Vig
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Michael P Smith
- Department of Anatomy, Anatomical Simulation and Research, Albany Medical Center, Albany, NY, USA
| | - Michael T Mulligan
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
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Jeong JG, Choi SH, Kim AR, Hwang JM. Gluteal Compartment Syndrome and Rhabdomyolysis after Prolonged Laparoscopic Nephroureterectomy and Treatment Strategies Including Rehabilitation: A Case Report. Healthcare (Basel) 2021; 10:healthcare10010047. [PMID: 35052211 PMCID: PMC8775820 DOI: 10.3390/healthcare10010047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/23/2021] [Accepted: 12/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Rhabdomyolysis is a clinical symptom caused by the rapid release of intracellular components such as myoglobin, lactate dehydrogenase, and creatine kinase into the blood circulation. It is commonly caused by muscular injury including compartment syndrome, infection, drugs, etc. Although it rarely occurs during surgery, the incidence may increase if risk factors such as long operation time, improper posture, and condition of being overweight exist. Case Presentation: A 46-year-old male patient complained of pain and weakness in the right hip area and several abnormal findings were observed in the blood sample, reflecting muscle injury and decreased renal function after prolonged urological surgery. He was confirmed as having rhabdomyolysis, which was caused by compartment syndrome of the right gluteal muscle. After the diagnosis, conservative cares were performed in the acute phase and rehabilitation treatments were performed in the chronic phase. After conservative treatment and rehabilitation, blood sample values returned to almost normal ranges and both level of pain and muscle strength were significantly improved. In addition, about 25 days after discharge, he almost recovered to pre-operative condition. Conclusion: Careful attention is required to prevent intraoperative compartment syndrome. It also suggests that not only medical treatment but also early patient-specific rehabilitation is important in patients with rhabdomyolysis after prolonged surgery.
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Affiliation(s)
- Jae-Gyeong Jeong
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea; (J.-G.J.); (A.-R.K.)
| | - Seock Hwan Choi
- Department of Urology, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
| | - Ae-Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea; (J.-G.J.); (A.-R.K.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Jong-Moon Hwang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea; (J.-G.J.); (A.-R.K.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Correspondence:
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