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Li W, Zeng Q, Li Y, Chen Y, Bal L, Zhuang Q. Treatment of bilateral Posterior Tibial Compartment Syndrome using a Novel Surgical Approach: A Case Report of the Posterior Approach. Orthop Rev (Pavia) 2024; 16:116374. [PMID: 38666189 PMCID: PMC11043026 DOI: 10.52965/001c.116374] [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: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Osteofascial compartment syndrome is a serious surgical emergency that requires prompt diagnosis and treatment. It presents a challenge for surgeons due to its high disability rate and difficult management. Early fasciotomy decompression is crucial in preventing severe complications. Classic fasciotomy approaches for tibial osteofascial compartment syndrome include double-incision and single-incision techniques.This paper presents a case of a 24-year-old female with bilateral tibial posterior compartment syndrome resulting from prolonged squatting after alcohol intoxication, which is a relatively rare mechanism. We employed an innovative posterior approach to manage the patient with tibial posterior compartment syndrome. Ultimately, we successfully preserved the patient's legs and achieved a good functional recovery.The paper reported a rare case with bilateral posterior tibial compartment syndrome resulting from squatting for 10 hours after alcohol intoxication. The patient achieved favorable outcomes in lower limb function following treatment with a new fasciotomy approach, the posterior approach.The new approach for treating posterior tibial compartment syndrome can serve as a valuable reference for surgeons.
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Affiliation(s)
- Wei Li
- Department of orthopedic, No.2 people's hospital of Fuyang city, Yingzhou district, Fuyang city, Anhui province, 23600,China
| | - Qingliang Zeng
- Department of orthopedic, No.2 people's hospital of Fuyang city, Yingzhou district, Fuyang city, Anhui province, 23600,China
| | - Yang Li
- Department of orthopedic, No.2 people's hospital of Fuyang city, Yingzhou district, Fuyang city, Anhui province, 23600,China
| | - Yong Chen
- Department of orthopedic, No.2 people's hospital of Fuyang city, Yingzhou district, Fuyang city, Anhui province, 23600,China
| | - Liang Bal
- Department of orthopedic, No.2 people's hospital of Fuyang city, Yingzhou district, Fuyang city, Anhui province, 23600,China
| | - Quankui Zhuang
- Department of orthopedic, No.2 people's hospital of Fuyang city, Yingzhou district, Fuyang city, Anhui province, 23600,China
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Lin Z, Hou Z, Guo J, Lin Y, Zhang Y. Risk factors for poor outcomes in patients with acute lower leg compartment syndrome: a retrospective study of 103 cases. J Orthop Surg Res 2024; 19:252. [PMID: 38643123 PMCID: PMC11031945 DOI: 10.1186/s13018-024-04719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/05/2024] [Indexed: 04/22/2024] Open
Abstract
PURPOSE The primary aim of this study was to investigate the risk factors associated with poor outcomes following acute compartment syndrome (ACS) of lower leg. The secondary objective was to determine if delayed fasciotomy is linked to poor outcomes. METHODS In this retrospective case control study approved by the institutional review board, we identified 103 patients with ACS of the lower leg. Poor outcome was defined as a composite variable that included limb amputation, neurological deficit and contracture. Among these, 44 patients exhibited poor outcome while 59 patients demonstrated a good outcome. Patient-related factors, laboratory values, and treatment-related factors were analyzed using electronic medical records. Univariate statistical and logistic regression analyses were conducted to determine significance. RESULTS Bivariate analyses showed that the mechanism of injury (P = 0.021), open injury (P = 0.001), arterial injury (P<0.001), hemoglobin levels (HB) (P < 0.001), white blood cell count (WBC) (P = 0.008), albumin levels (ALB) (P<0.001), creatine kinase levels (CK) at presentation (P = 0.015), CK at peak (P<0.001), creatine kinase levels (Ca) (P = 0.004), dehydrating agent (P = 0.036), and debridement (P = 0.005) were found to be associated with the risk of poor outcomes. Logistic regression analyses revealed that arterial injury [ P< 0.001, OR = 66.172, 95% CI (10.536, 415.611)] was an independent risk factor for poor outcomes. However, HB [P = 0.005, OR = 0.934, 95% CI (0.891, 0.979)] was a protective factor against poor outcomes. Receiver operating characteristic (ROC) curve analysis showed that the cut-off values of HB to prevent poor outcome following ACS was 102.45 g/L. CONCLUSIONS ACS of the lower leg is a serious complication often associated with a poor prognosis. Patients with arterial injury or lower HB have a significantly increased risk of having poor outcomes. Poor outcomes were not found to be associated with the timing of fasciotomy in this study.
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Affiliation(s)
- Zhe Lin
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, China
- Orthopaedic Research Institution of Hebei Province, Hebei, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, China.
- The Third Affiliated Hospital, Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
| | - Jialiang Guo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, China
- Orthopaedic Research Institution of Hebei Province, Hebei, China
| | - Yongsheng Lin
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, China
- Orthopaedic Research Institution of Hebei Province, Hebei, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, China
- Orthopaedic Research Institution of Hebei Province, Hebei, China
- Chinese Academy of Engineering, Beijing, China
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Abstract
BACKGROUND We aimed to describe the demographic, injury-related, and treatment-related characteristics of patients who undergo fasciotomies for acute hand compartment syndrome. METHODS A cohort of 53 adult patients with acute hand compartment syndrome treated with fasciotomy at 2 tertiary care referral centers over a 10-year time period from January 1, 2006, to June 30, 2015, were retrospectively identified. We reviewed the electronic medical record for patient-related variables (eg, age, sex, smoking status, diabetes mellitus), injury-related variables (eg, mechanism of injury, presence of fractures), and treatment-related variables (eg, compartments released, number of operations, use of split-thickness skin grafts, and time from injury to surgery). RESULTS The mean age of our cohort was 45 years, and 33 patients (62%) were men. The mechanism of injury varied widely, but the most common causative mechanisms were crush injury (25%), prolonged decubitus (17%), and infection (11%). Associated hand fractures were present in 15 (28%) patients. The surgically released compartments varied; the dorsal interosseous compartments (83%), thenar compartment (75%), and hypothenar compartment (74%) were most frequently released, while the adductor pollicis compartment (43%) and Guyon canal (28%) were least frequently released. CONCLUSIONS The demographics of acute hand compartment syndrome have evolved in the last 25 years compared with the prior literature, partly as a result of the opioid epidemic leading to a rise in "found down" compartment syndrome. Treating providers should recognize crush injury, prolonged decubitus, and infection as the most common causes of acute hand compartment syndrome.
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Affiliation(s)
| | - George S. M. Dyer
- Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Department of Orthopedic Surgery, Boston, MA, USA
| | - Arvind von Keudell
- Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Department of Orthopedic Surgery, Boston, MA, USA
| | - Dafang Zhang
- Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Department of Orthopedic Surgery, Boston, MA, USA
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Williams DW, Dyer GSM, von Keudell A, Zhang D. Characteristics and outcomes of patients who undergo fasciotomies for upper arm compartment syndrome. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2291-2296. [PMID: 36344794 DOI: 10.1007/s00590-022-03416-7] [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: 06/23/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Describe the demographic, injury-related, treatment-related, and outcome-related characteristics of patients who undergo fasciotomies for acute upper arm compartment syndrome (ACS). METHODS From January 1, 2006, to June 30, 2015, 438 patients with a diagnosis code of upper extremity (including hand, forearm, arm, and shoulder) compartment syndrome at two tertiary care centers were identified. Of those patients, 423 were excluded for a diagnosis other than upper arm ACS or incomplete documentation. A final cohort of 15 adult patients with acute upper arm compartment syndrome treated with fasciotomy was included. The electronic medical record for patient-related variables, lab data, mechanism of injury, presence of additional injuries, and treatment-related variables were reviewed. RESULTS The mean age of our cohort was 52 years, and 73% were male. The most common mechanisms of injury were blunt trauma (20%), vascular injury (20%), oncologic resection (13%), and infection related to intravenous drug use (13%). Humerus fractures and biceps tendon ruptures were associated with 13 and 27% of the cases, respectively. More than two-thirds of the patients had elevated international normalized ratios (INR). While 27% of cases underwent fasciotomy within 6 h after injury, seven patients (47%) underwent fasciotomy more than 24 h after injury. Six patients had no major deficits, while 7 patients had long-term deficits. CONCLUSION Upper arm ACS is a potentially devastating condition that can be seen after blunt trauma, vascular injury, oncologic resection, and intravenous drug use. Clinicians should have high suspicion in cases of elevated INR and biceps tendon rupture.
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Affiliation(s)
| | - George S M Dyer
- Harvard Medical School, 25 Shattuck St, MA, 02115, Boston, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Arvind von Keudell
- Harvard Medical School, 25 Shattuck St, MA, 02115, Boston, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Rigshospitalet, Department of Orthopedic Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Dafang Zhang
- Harvard Medical School, 25 Shattuck St, MA, 02115, Boston, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
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Bi AS, Fisher ND, Konda SR, Egol KA, Ganta A. Delayed Versus Primary Closure of Diaphyseal Forearm Fractures in Adults: Short-Term Soft Tissue Outcomes. Indian J Orthop 2022; 56:1594-1600. [PMID: 36052385 PMCID: PMC9385914 DOI: 10.1007/s43465-022-00688-3] [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: 04/01/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate the effect of delayed closures, whether delayed primary closure (DPC) or split-thickness skin grafting (STSG), of operatively treated forearm fractures on short-term soft tissue outcomes. METHODS In this retrospective cohort comparative study of two academic-level one trauma centers from 2010 to 2020, adult patients with diaphyseal forearm fractures who underwent open reduction and internal fixation (ORIF) were either closed primarily at index surgery, or underwent delayed closure, either with DPC or with a STSG. Primary outcome measures were soft-tissue outcomes as measured by wound healing (delayed healing, dehiscence, or skin breakdown) and fracture-related infection (FRI) at time of final follow-up. RESULTS Eighty-one patients with 81 diaphyseal forearm fractures underwent ORIF with a mean follow-up of 14.3 months. Forty-one fractures (50.6%) were open injuries. Thirteen patients (16.0%) were unable to be closed primarily and underwent an average of 2.46 ± 0.7 surgeries including final coverage, with an average of 4.31 ± 2.8 days to final coverage. Four patients (30.8%) underwent DPC and 9 (69.2%) underwent STSG. Five (6.6%) patients in the delayed closure group had pre-operative compartment syndrome and underwent formal two-incision fasciotomies. There were no significant differences between delayed versus primary closure in wound healing complication rates, FRI, or radiographic union. CONCLUSIONS Diaphyseal forearm fractures that undergo ORIF have equivalent short-term soft tissue outcomes when closed primarily at index surgery or when closed in a delayed fashion.
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Affiliation(s)
- Andrew S. Bi
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003 USA
| | - Nina D. Fisher
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003 USA
| | - Sanjit R. Konda
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003 USA ,Department of Orthopedic Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Espy, Richmond Hill, NY 11418 USA
| | | | - Abhishek Ganta
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003 USA ,Department of Orthopedic Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Espy, Richmond Hill, NY 11418 USA
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Association of trauma severity scores with limb amputation and death in acute leg compartment syndrome. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:621-625. [PMID: 33098005 DOI: 10.1007/s00590-020-02818-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/15/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Limb amputation and death are devastating sequelae of acute compartment syndrome (ACS), and have been posited to result either from the initial injury burden or from pathophysiologic sequelae, such as rhabdomyolysis leading to acute renal failure. We aimed to test the hypothesis that severity of trauma is associated with limb amputation and death in patients with traumatic leg ACS. METHODS We retrospectively reviewed 302 patients with ACS of 302 legs treated with fasciotomies from 2000 to 2015 at two tertiary trauma centers. Our response variables were death and limb amputation during inpatient hospital admission. Three common trauma severity scores, injury severity score (ISS), revised trauma score (RTS), and Glasgow coma scale (GCS), were studied. Patient- and injury-related explanatory variables were studied. Bivariate analyses were used to identify factors associated with limb amputation and death. RESULTS Of 302 patients, 13 (4%) underwent limb amputation and 10 (3%) died during the inpatient admission. Only one of 10 patients who expired died secondary to acute renal failure. ISS and GCS were significantly associated with limb amputation, and RTS was marginally associated. ISS, RTS, and GCS were significantly associated with death. Moreover, smoking and open fracture were significantly associated with limb amputation, and diabetes mellitus, presence of fracture, closed head injury, and chest or abdominal injury were associated with death. CONCLUSION Trauma severity scores are associated with both limb amputation and death during inpatient admission for traumatic leg ACS. These adverse sequelae of leg ACS are likely driven by the initial injury burden.
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