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Barça F, Atilla HA, Demir EB, Çevik K, Ilgın BU, Atlı OY, Yüksel S, Şibar K, Ünlü S, Duman E, Fırat A, Akdoğan M. Comparison of single and double incision leg fasciotomy in disaster settings-Experience from 2023 Türkiye earthquakes. Injury 2024; 55:111582. [PMID: 38640595 DOI: 10.1016/j.injury.2024.111582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Although there are studies comparing methods for leg fasciotomy in compartment syndrome after fractures, choice of single or double fasciotomies in disasters was not investigated. The aim of this study was to compare the efficacy of single and double incision leg fasciotomy in the setting of disaster. METHODS Patients that have undergone fasciotomy after 2023 Kahramanmaraş earthquakes were retrospectively analyzed. The cases were separated into two groups as single incision and double incision according to the method of the first fasciotomy. The number of debridements after each fasciotomy, muscle group excisions, completion time of treatment, presence of amputation, the method of closure (primary closure or graft/flap) and positive results of wound cultures were analyzed and compared between two groups. RESULTS 62 legs of 52 patients (22 females, 30 males, age 36.9 ± 11.2 years) with compartment syndrome that have undergone fasciotomy after 2023 Kahramanmaraş earthquakes were included in the study. Single-incision group included 27 legs and double incision group included 35 legs. Amputation was needed in 15 patients (%24.2), six in single incision group and nine in double incision group. (p = 0.75). Compartment excision (eight patients in single incision, nine patients in double incision groups, p = 0.81), number of debridements (median 4 in both groups, p = 0.55), wound closure time (median 17 days in single incision, 22 days in double incision groups, p = 0.52), graft or flap requirement (11 patients in single incision, 16 patients in double incision groups, p = 0.53), positive culture results (15 patients in single incision, 16 patients in double incision groups, p = 0.44) were not different statistically between two groups. CONCLUSION Single and double incision fasciotomy methods are equally effective and safe in treatment of compartment syndrome of the leg in disaster situations. To our knowledge, this is the first study comparing outcomes of single and double incision fasciotomy in disaster settings.
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Affiliation(s)
- Fatih Barça
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye.
| | - Halis Atıl Atilla
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Ekin Barış Demir
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Kadir Çevik
- Başakşehir Çam and Sakura City Hospital, Department of Hand Surgery, Istanbul, Türkiye
| | - Bünyamin Uğur Ilgın
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Osman Yağız Atlı
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Sinan Yüksel
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Kemal Şibar
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Serhan Ünlü
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Evrim Duman
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Ahmet Fırat
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Mutlu Akdoğan
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
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Marciano ND, Sarpong K, Smart J. A Case Report of Acute Compartment Syndrome. JOURNAL OF EDUCATION & TEACHING IN EMERGENCY MEDICINE 2024; 9:V1-V5. [PMID: 38707942 PMCID: PMC11068313 DOI: 10.21980/j87061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/26/2023] [Indexed: 05/07/2024]
Abstract
Acute compartment syndrome (ACS) is a surgical emergency which requires prompt identification and intervention to prevent irreversible tissue damage. Here we present the case of a 64-year-old male with lower extremity tenderness following a crush injury. This patient presented to the emergency department (ED) more than 12 hours after the initial incident occurred and was found to have a firm right calf with decreased sensation and absent distal pulses on his right leg. The patient's outer compartment pressure measured 32 mmHg. Because these findings were concerning for acute compartment syndrome, emergent fasciotomies of the four compartments of the lower right leg were performed with improvement in neuromuscular compromise. Early identification of the condition permitted a prompt recovery for the patient who was discharged home on day five. This case report reviews the clinical presentation and interventional modalities and aims to provide new images to help visualize a diagnosis of ACS. Topics Acute compartment syndrome, fasciotomy, intramuscular pressure.
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Affiliation(s)
| | - Keneth Sarpong
- University of California, Irvine, Department of Emergency Medicine, Orange, CA
| | - Jonathan Smart
- University of California, Irvine, Department of Emergency Medicine, Orange, CA
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3
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Aguirre JA, Wolmarans M, Borgeat A. Acute Extremity Compartment Syndrome and (Regional): Anesthesia: The Monster Under the Bed. Anesthesiol Clin 2022; 40:491-509. [PMID: 36049877 DOI: 10.1016/j.anclin.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Acute compartment syndrome (ACS) is a potential orthopedic emergency that leads, without prompt diagnosis and immediate treatment with surgical fasciotomy, to permanent disability. The role of regional anesthesia (RA) for analgesia in patients at risk for ACS remains unjustifiably controversial. This critical review aims to improve the perception of the published literature to answer the question, whether RA techniques actually delay or may even help to hasten the diagnosis of ACS. According to literature, peripheral RA alone does not delay ACS diagnosis and surgical treatment. Only in 4 clinical cases, epidural analgesia was associated with delayed ACS diagnosis.
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Affiliation(s)
- José A Aguirre
- Institute of Anaesthesiology, Triemli City Hospital Zurich, Birmensdorferstrasse 497, 8063 Zürich, Switzerland; Balgrist Campus, Lengghalde 5, 8008 Zürich, Switzerland.
| | - Morné Wolmarans
- Department of Anesthesia, Norfolk and Norwich University Hospital NHS Trust, Regional Anesthesia UK (RA-UK), Colney Lane, Norwich NR4 7UY, UK
| | - Alain Borgeat
- Balgrist Campus, Lengghalde 5, 8008 Zürich, Switzerland; Department of Surgery, University of Illinois at Chicago, 402 CSB MC 958840 South Wood Street, Chicago, IL 60612, USA
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4
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Hoefnagel AL, Timmermann TN, Riga A, Kaye MB, Braunecker S, Mongan PD. A Unique Treatment for Compartment Syndrome After Intravenous Catheter Extravasation: A Case Report. A A Pract 2021; 15:e01496. [PMID: 34185027 DOI: 10.1213/xaa.0000000000001496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intravenous cannulation is performed on nearly every patient presenting for an anesthetic. Complications of the procedure include infiltration and extravasation, which can have a varied impact on the patient. Here, we present a case of severe intravenous (IV) extravasation, resulting in compartment syndrome of the hand. Rather than treating the compartment syndrome with fasciotomies as is standard, we utilized compression therapy via an Esmarch surgical dressing wrapped distal to proximal on the effected limb, which resulted in marked decrease in swelling and return of perfusion to the hand.
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Affiliation(s)
| | | | - Andrew Riga
- Orthopedic Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Marc B Kaye
- Orthopedic Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
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5
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Sellei RM, Warkotsch U, Kobbe P, Weber CD, Reinhardt N, de la Fuente M, Radermacher K, Hildebrand F. Non-invasive and reliable assessment of compartment elasticity by pressure related ultrasound: An in-vitro study. Injury 2021; 52:724-730. [PMID: 33902865 DOI: 10.1016/j.injury.2020.10.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/26/2020] [Accepted: 10/15/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The development of acute compartment syndrome is a serious threat to trauma patients. The clinical assessment alone is not reliable enough to determine the need for fasciotomy in many cases. The Physician´s assessment of the elasticity of the muscle compartment might be particularly important to objectively evaluate the pressure in this enclosed space. The purpose of this study was to determine the observer´s reproducibility, of compartment elasticity measurements by a novel ultrasonic approach. METHODS Increasing intra-compartmental pressures (ICP) were simulated in a water filled in-vitro model. Pressure related ultrasound was used to determine the relative elasticity (RE) of soft tissue compartments. A pressure transducing probe head was combined with the ultrasonic probe to obtain cross section views of the simulated compartment and to detect the amount of applied pressure by the observer. In this model, the compartment depth without compression (P0) was set to be 100%. Changes of the compartment depth due to a probe pressure of 80 mmHg (P80) were correlated to P0 and an elasticity quotient as a value for RE (%) was calculated. Twelve blinded observers performed measurements for RE determination (%) under three pressure conditions. Reproducibility was calculated using intraclass correlation coefficient (ICC). RESULTS Measurements (n = 432) revealed that the RE (%) in the control group was 17,06% (SD+/-2,13), whereas the RE of the group ICP30 significantly decreased to 12,66% (SD+/- 1,19) (p<0,001). The ICP50 group revealed a further significant decrease to 8,43% (SD+/- 0,67) (p<0,001). Repeated measurement of RE and ICP showed a high level of correlation (spearman correlation coefficient: roh=0,922). A RE <14% resulted in a sensitivity of 96% and a specificity of 90,3% for diagnosis of an ICP >30 mmHg. ICCinter was 0,986; 95%, CI: 0,977-0,992 (p<0,001). DISCUSSION The presented ultrasound-based approach reliably assesses the elasticity in a simulated compartment model. In this pioneer study investigating the inter- and intra-observer reproducibility, this method of measurement appears to be of low cost in addition to being an easy and secure approach that may have the potential to substitute invasive measurement. Further investigations are required to improve its feasibility and to confirm the reliability under clinical conditions.
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Affiliation(s)
- R M Sellei
- Department of Orthopaedic Trauma, Sana Hospital Offenbach, Offenbach am Main, Germany; Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany.
| | - U Warkotsch
- Department of Vascular Surgery, Sana Hospital Offenbach, Offenbach am Main, Germany
| | - P Kobbe
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany
| | - C D Weber
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany
| | - N Reinhardt
- Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - M de la Fuente
- Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - K Radermacher
- Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - F Hildebrand
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany
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Witthauer L, Cascales JP, Roussakis E, Li X, Goss A, Chen Y, Evans CL. Portable Oxygen-Sensing Device for the Improved Assessment of Compartment Syndrome and other Hypoxia-Related Conditions. ACS Sens 2021; 6:43-53. [PMID: 33325684 DOI: 10.1021/acssensors.0c01686] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Measurement of intramuscular oxygen could play a key role in the early diagnosis of acute compartment syndrome, a common condition occurring after severe trauma leading to ischemia and long-term consequences including rhabdomyolysis, limb loss, and death. However, to date, there is no existing oxygen sensor approved for such a purpose. To address the need to improve the assessment of compartment syndrome, a portable fiber-optic device for intramuscular oxygen measurements was developed. The device is based on phosphorescence quenching, where the tip of an optical fiber was coated with a poly(propyl methacrylate) (PPMA) matrix containing a brightly emitting Pt(II)-core porphyrin. The optoelectronic circuit is highly portable and is based on a microspectrometer and a microcontroller readout with a smartphone. Results from an in vivo tourniquet porcine model show that the sensor is sensitive across the physiological oxygen partial pressure range of 0-80 mmHg and exhibits an appropriate and reproducible response to changes in intramuscular oxygen. A commercial laboratory oxygen sensor based on a lifetime measurement did not respond as expected.
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Affiliation(s)
- Lilian Witthauer
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
| | - Juan Pedro Cascales
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
| | - Emmanuel Roussakis
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
| | - Xiaolei Li
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
| | - Avery Goss
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
| | - Yenyu Chen
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
| | - Conor L. Evans
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
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7
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Ogoshi T, Yoshimiya M, Ichibakase H, Kimura T, Kameoka M, Yoshioka H, Ueda T, Homma M, Enokida S. Paravertebral compartment syndrome after exercise: a case report. J Med Case Rep 2020; 14:208. [PMID: 33129357 PMCID: PMC7603721 DOI: 10.1186/s13256-020-02535-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paravertebral compartment syndrome occurring without trauma is quite rare. We report a case of compartment syndrome that occurred after spinal exercises. CASE PRESENTATION A 23-year-old Japanese rower developed severe back pain and was unable to move 1 day after performing exercises for the spinal muscles. Initial evaluation at a nearby hospital revealed hematuria and elevated creatine phosphokinase levels. He was transferred to our hospital, where magnetic resonance imaging revealed no hematoma but confirmed edema in the paravertebral muscles. The compartment pressure measurements were elevated bilaterally. Despite his pain being severe, his creatine phosphokinase levels were expected to peak and decline; his urine output was normal; and surgery was undesirable. Therefore, we opted for conservative management. The next day, the patient's compartment pressure diminished, and his pain levels decreased to 2/10. After 5 days, he was able to walk without medication. CONCLUSIONS We present a rare case of compartment syndrome of the paravertebral muscles with good resolution following conservative management. We hope our case findings will help avoid unnecessary surgery in cases of paravertebral compartment syndrome.
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Affiliation(s)
- Tomofumi Ogoshi
- Department of Emergency and Critical Medicine, Tottori University Hospital, 36-1, Nishichou, Yonago, Tottori, Japan.
| | - Motoo Yoshimiya
- Department of Emergency and Critical Medicine, Tottori University Hospital, 36-1, Nishichou, Yonago, Tottori, Japan
| | - Hiroshi Ichibakase
- Department of Emergency and Critical Medicine, Tottori University Hospital, 36-1, Nishichou, Yonago, Tottori, Japan
| | - Takayoshi Kimura
- Department of Emergency and Critical Medicine, Tottori University Hospital, 36-1, Nishichou, Yonago, Tottori, Japan
| | - Masafumi Kameoka
- Department of Emergency and Critical Medicine, Tottori University Hospital, 36-1, Nishichou, Yonago, Tottori, Japan
| | - Hayato Yoshioka
- Department of Emergency and Critical Medicine, Tottori University Hospital, 36-1, Nishichou, Yonago, Tottori, Japan
| | - Takahiro Ueda
- Department of Emergency and Critical Medicine, Tottori University Hospital, 36-1, Nishichou, Yonago, Tottori, Japan
| | - Masato Homma
- Department of Emergency and Critical Medicine, Tottori University Hospital, 36-1, Nishichou, Yonago, Tottori, Japan
| | - Shinpei Enokida
- Department of Orthopedics, Tottori University Hospital, 36-1, Nishichou, Yonago, Tottori, Japan
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8
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Well Leg Compartment Syndrome after Contralateral Femoral Neck ORIF. Case Rep Orthop 2020; 2020:8859954. [PMID: 32802539 PMCID: PMC7415110 DOI: 10.1155/2020/8859954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022] Open
Abstract
The authors present a case of WLCS after femoral neck fracture fixation. While this is a rare complication, a high index of suspicion should exist. Surgeons should use well leg holders with caution and limit utilization time. Alternative methods of positioning to allow for fluoroscopic imaging exist. WLCS remains a clinical diagnosis; intracompartmental measurements can be used but should be cautiously interpreted. When the diagnosis of WLCS is made, emergent fasciotomies of the affected compartments should be performed. Surgeons should be aware of this complication when using a well leg holder and the potential catastrophic consequences if left ignored.
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9
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Post-exercise leg compartment pressure measurements in asymptomatic collegiate distance runners: a prospective study. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Wuarin L, Gonzalez AI, Zingg M, Belinga P, Hoffmeyer P, Peter R, Lübbeke A, Gamulin A. Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial shaft fractures: a retrospective cohort study. BMC Musculoskelet Disord 2020; 21:25. [PMID: 31931775 PMCID: PMC6958679 DOI: 10.1186/s12891-020-3044-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 01/06/2020] [Indexed: 01/18/2023] Open
Abstract
Background The purpose of this study was to evaluate the association between epidemiological, clinical and radiographic factors of patients with tibial shaft fractures and the occurrence of acute compartment syndrome. Methods 270 consecutive adult patients sustaining 273 tibial shaft fractures between January 2005 and December 2009 were included in this retrospective cohort study. The outcome measure was acute compartment syndrome. Patient-related (age, sex), fracture-related (high- vs. low-energy injury, isolated trauma vs. polytrauma, closed vs. open fracture) and radiological parameters (AO/OTA classification, presence or absence of a noncontiguous tibial plateau or pilon fracture, distance from the centre of the tibial fracture to the talar dome, distance between tibial and fibular fracture if associated, and angulation, translation and over-riding of main tibial fragments) were evaluated regarding their potential association with acute compartment syndrome. Univariate analysis was performed and each covariate was adjusted for age and sex. Finally, a multivariable logistic regression model was built, and odds ratios and 95% confidence intervals were obtained. Statistical significance was defined as p < 0.05. Results Acute compartment syndrome developed in 31 (11.4%) cases. In the multivariable regression model, four covariates remained statistically significantly associated with acute compartment syndrome: polytrauma, closed fracture, associated tibial plateau or pilon fracture and distance from the centre of the tibial fracture to the talar dome ≥15 cm. Conclusions One radiological parameter related to the occurrence of acute compartment syndrome has been highlighted in this study, namely a longer distance from the centre of the tibial fracture to the talar dome, meaning a more proximal fracture. This observation may be useful when clinical findings are difficult to assess (doubtful clinical signs, obtunded, sedated or intubated patients). However, larger studies are mandatory to confirm and refine the prediction of acute compartment syndrome occurrence. Radiographic signs of significant displacement were not found to be correlated to acute compartment syndrome development. Finally, the higher rate of acute compartment syndrome occurring in tibial shaft fractures associated to other musculoskeletal, thoraco-abdominal or cranio-cerebral injuries must raise the level of suspicion of any surgeon managing multiply injured patients.
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Affiliation(s)
- Lydia Wuarin
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Amanda I Gonzalez
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Matthieu Zingg
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Patrick Belinga
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Pierre Hoffmeyer
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Robin Peter
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Anne Lübbeke
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Axel Gamulin
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland.
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11
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Yen CC, Huang SM. Acute compartment syndrome by improper postdialytic hemostasis. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_50_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bond MC, Willis GC. Risk Management and Avoiding Legal Pitfalls in the Emergency Treatment of High-Risk Orthopedic Injuries. Emerg Med Clin North Am 2019; 38:193-206. [PMID: 31757250 DOI: 10.1016/j.emc.2019.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many orthopedic injuries can have hidden risks that result in increased liability for the emergency medicine practitioner. It is imperative that emergency medicine practitioners consider the diagnoses of compartment syndrome, high-pressure injury, spinal epidural abscess, and tendon lacerations in the right patient. Consideration of the diagnosis and prompt referrals can help to minimize the complications these patients often develop.
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Affiliation(s)
- Michael C Bond
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA.
| | - George C Willis
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA. https://twitter.com/DocWillisMD
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Tummala S, Scherbel D. Clinical Assessment of Peripheral Arterial Disease in the Office: What Do the Guidelines Say? Semin Intervent Radiol 2019; 35:365-377. [PMID: 30728652 DOI: 10.1055/s-0038-1676453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Lower extremity peripheral arterial disease (PAD) is the manifestation of atherosclerotic disease within the lower extremities. The presentation of PAD is diverse ranging from asymptomatic disease to claudication or to debilitating rest pain, nonhealing ulcers, and gangrene. PAD is associated with significant morbidity, mortality, and healthcare costs. Proper diagnosis and management of PAD is important so as to maintain quality of life and reduce the risk of cardiovascular disease and adverse limb events such as amputation. This document provides a comprehensive outpatient approach to the clinical assessment of PAD that includes risk factors, diagnosis, treatment, and follow-up options.
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Affiliation(s)
- Srini Tummala
- Limb Preservation Program, Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Derek Scherbel
- University of Miami, Miller School of Medicine, Miami, Florida
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14
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Caspers CG. Care of Traumatic Conditions in an Observation Unit. Emerg Med Clin North Am 2017; 35:673-683. [PMID: 28711130 DOI: 10.1016/j.emc.2017.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients presenting to the emergency department with certain traumatic conditions can be managed in observation units. The evidence base supporting the use of observation units to manage injured patients is smaller than the evidence base supporting the management of medical conditions in observation units. The conditions that are eligible for management in an observation unit are not limited to those described in this article, and investigators should continue to identify types of conditions that may benefit from this type of health care delivery.
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Affiliation(s)
- Christopher G Caspers
- Ronald O. Perelman Department of Emergency Medicine, New York University Langone Medical Center, 560 First Avenue, New York, NY 10016, USA.
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15
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Willy C, Stichling M, Engelhardt M, Vogt D, Back DA. [Acute therapeutic measures for limb salvage Part 1 : Haemorrhage control, emergency revascularization, compartment syndrome]. Unfallchirurg 2017; 119:374-87. [PMID: 27160729 DOI: 10.1007/s00113-016-0179-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The primary care of Gustilo-Anderson type IIIC extremity injuries with relevant vessel lacerations is decisive for the success of a limb salvage procedure. This article shall present substantial emergency procedures for the salvage of the nutritive perfusion of a mangled extremity, based on the current literature. After provisory control of a peripheral haemorrhage (e. g. by manual pressure or tourniquet), an immediate decision must be made about the kind of emergency revascularization to be implemented as the limb salvage procedure. Here, the temporary intravascular shunt will be the fastest technique that can ensure a sufficient tissue perfusion in the case of vessel lacerations. Regarding the treatment of a fracture versus perfusion recovery, a shortening of ischemia time should have priority over fracture stabilization.If an acute compartment syndrome is suspected, a documented monitoring has to be performed in the limb salvage situation for 24 hours with clinical controls every 4 hours. Disproportional pain that does not respond to analgesics, and passive muscle stretching pain can be seen as cardinal symptoms. The positive predictive value of clinical findings is <15 %. During the observation period with an impending but not manifest compartment syndrome, an elevation of the extremity above heart level or its cooling are contraindicated. An intracompartmental pressure measurement is the most important instrument-based supplemental diagnostic method. The open fasciotomy of the affected compartments is the only causal therapy and should be performed as fast as possible. A decision against fasciotomy in cases of non-explicit clinical signs should not be made without a documented intracompartmental pressure measurement.
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Affiliation(s)
- C Willy
- Abteilung Unfallchirurgie und Orthopädie, Septisch-Rekonstruktive Chirurgie, Forschungs- und Behandlungszentrum Rekonstruktion von Defektwunden, Exzellenz-Zentrum zur Versorgung von Verwundeten aus Kriegs- und Krisengebieten, Bundeswehrkrankenhaus Berlin, Scharnhorststr. 13, 10115, Berlin, Deutschland.
| | - M Stichling
- Sektion Gefäß- und Thoraxchirurgie, Abteilung Unfallchirurgie und Orthopädie, Septisch-Rekonstruktive Chirurgie, Bundeswehrkrankenhaus Berlin, Scharnhorststr. 13, 10115, Berlin, Deutschland
| | - M Engelhardt
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Zentrum für Gefäßmedizin der Bundeswehr, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - D Vogt
- Abteilung Unfallchirurgie und Orthopädie, Septisch-Rekonstruktive Chirurgie, Forschungs- und Behandlungszentrum Rekonstruktion von Defektwunden, Exzellenz-Zentrum zur Versorgung von Verwundeten aus Kriegs- und Krisengebieten, Bundeswehrkrankenhaus Berlin, Scharnhorststr. 13, 10115, Berlin, Deutschland
| | - D A Back
- Abteilung Allgemein- und Viszeralchirurgie, Bundeswehrkrankenhaus Berlin, Scharnhorststr. 13, 10115, Berlin, Deutschland
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Pressure, perfusion, and compartments: challenges for the acute care surgeon. J Trauma Acute Care Surg 2014; 76:1341-8. [PMID: 24854298 DOI: 10.1097/ta.0000000000000240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Extremity compartment syndrome and fasciotomy: a literature review. Eur J Trauma Emerg Surg 2013; 39:561-7. [DOI: 10.1007/s00068-013-0329-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 09/07/2013] [Indexed: 10/26/2022]
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