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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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Bihari A, McClure JA, Inculet C, Del Balso C, Vinden C, Schemitsch E, Sanders D, Lawendy AR. Fasciotomy and rate of amputation after tibial fracture in adults: a population-based cohort study. OTA Int 2024; 7:e333. [PMID: 38623265 PMCID: PMC11013697 DOI: 10.1097/oi9.0000000000000333] [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] [Received: 01/02/2022] [Revised: 12/13/2023] [Accepted: 02/16/2024] [Indexed: 04/17/2024]
Abstract
Objectives Limb amputation is a possible outcome of acute compartment syndrome. We undertook this study to investigate the occurrence of fasciotomy and amputation in patients with tibial fractures in the Ontario adult population, aiming to evaluate variables that may be associated with each of these outcomes. Design Retrospective, population-based cohort study (April 1, 2003-March 31, 2016). Setting Canadian province of Ontario. Participants Patients with tibial fracture, aged 14 years and older. Interventions Fasciotomy after tibial fracture. Main Outcomes and Measures The primary outcomes were fasciotomy and amputation within 1 year of fasciotomy. Secondary outcomes included repeat surgery, new-onset renal failure, and mortality, all within 30 days of fasciotomy. Results We identified 76,299 patients with tibial fracture; the mean (SD) age was 47 (21) years. Fasciotomy was performed in 1303 patients (1.7%); of these, 76% were male and 24% female. Patients who were younger, male, or experienced polytrauma were significantly more likely to undergo fasciotomy. Limb amputation occurred in 4.3% of patients undergoing fasciotomy, as compared with 0.5% in those without fasciotomy; older age, male sex, presence of polytrauma, and fasciotomy were associated with an increased risk of amputation (age odds ratio [OR] of 1.03 [95% CI, 1.02-1.03], P < 0.0001; sex OR of 2.04 [95% CI, 1.63-2.55], P < 0.0001; polytrauma OR of 9.37 [95% CI, 7.64-11.50], P < 0.0001; fasciotomy OR of 4.35 [95% CI, 3.21-5.90], P < 0.0001), as well as repeat surgery within 30 days (sex OR of 1.54 [95% CI, 1.14-2.07], P = 0.0053; polytrauma OR of 4.24 [95% CI, 3.33-5.38], P < 0.0001). Conclusions Among tibial fracture patients, those who were male and who experienced polytrauma were at significantly higher risk of undergoing fasciotomy and subsequent amputation. Fasciotomy was also significantly associated with risk of amputation, a finding that is likely reflective of the severity of the initial injury.
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Affiliation(s)
- Aurelia Bihari
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, London, ON, Canada
- Centre for Critical Illness Research, Lawson Health Research Institute, London, ON, Canada
| | | | - Clayton Inculet
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, London, ON, Canada
| | - Christopher Del Balso
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, London, ON, Canada
| | | | - Emil Schemitsch
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, London, ON, Canada
| | - David Sanders
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, London, ON, Canada
| | - Abdel-Rahman Lawendy
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, London, ON, Canada
- Centre for Critical Illness Research, Lawson Health Research Institute, London, ON, Canada
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Sellei RM, Kobbe P, Pape HC, Hildebrand F. [Diagnostics of acute compartment syndrome : Current gold standard and the state of science of noninvasive assessment methods]. CHIRURGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00104-024-02096-9. [PMID: 38806712 DOI: 10.1007/s00104-024-02096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/30/2024]
Abstract
Acute compartment syndrome (ACS) is defined by a disorder of the microcirculation due to a persistent pathological pressure increase within a muscle compartment. The ischemia of the tissue leads to an initially reversible functional impairment and finally irreversible damage of the musculature, nerves and other structures. Based on the understanding of the pathophysiology, the current diagnostic concepts and treatment using the so-called dermatofasciotomy of the affected muscle compartments can be derived. In addition to the suspicion of a possible ACS based on the medical history of the patient, the findings of the clinical examination are decisive. This review article gives a summary of all the essential aspects of the diagnostics. In clinically uncertain cases and for monitoring, an objectification of the findings using instrument-based techniques is increasingly required. Nowadays, invasive needle pressure measurement is available; however, due to limited reliability, specificity and sensitivity, these measurements only represent an aid to decision guidance supporting or advising against the indications for dermatofasciotomy. The increasing demands on making a certain diagnosis and justification of a surgical intervention from a legal point of view, substantiate the numerous scientific efforts to develop noninvasive instrument-based diagnostics. These methods are based either on detection of increasing intracompartmental pressure or decreasing perfusion pressure and microcirculation. The various measurement principles are summarized in a lucid form.
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Affiliation(s)
- Richard Martin Sellei
- Klinik für Unfallchirurgie und Orthopädische Chirurgie, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach am Main, Deutschland.
| | - Philipp Kobbe
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle und Universitätsklinikum Halle, Halle, Deutschland
| | | | - Frank Hildebrand
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum der RWTH AACHEN, Aachen, Deutschland
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Long Y, Yang S, Guo J, Hou Z. Blister formation in acute compartment syndrome: Unraveling the underlying predictors. Medicine (Baltimore) 2024; 103:e38191. [PMID: 38758865 PMCID: PMC11098220 DOI: 10.1097/md.0000000000038191] [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: 01/06/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024] Open
Abstract
Blisters are a common complication of orthopedic trauma and can cause surgery delay and increase the risk of infection. This study aims to identify risk factors for blisters in patients with acute compartment syndrome (ACS). Our study collected data from 206 ACS patients admitted to 2 hospitals between November 2013 and January 2021. Patients were divided into 2 groups: the blister group (BG) and the control group (CG), based on the presence or absence of blisters. We conducted univariate analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis to identify any significant differences in demographics, comorbidities, and admission laboratory test results between the 2 groups. Our study found that the incidence of blisters in ACS patients was 21.8% (45 out of 206). Univariate analysis identified several factors that were significantly associated with blister formation. Logistic regression analysis showed that patients who developed ACS in the winter or spring (P = .007, OR = 2.690, 95% CI [1.308-5.534]), patients who received a referral (the process whereby patients are transferred between medical facilities for further evaluation and treatment attempts prior to admission to our hospital) (P = .009, OR = 4.235, 95% CI [1.432-12.527]), and patients with higher PLR (P = .036, OR = 1.005, 95% CI [1.000-1.009]) were independent risk factors for blisters. Additionally, a history of drinking (P = .039, OR = 0.027, 95% CI [0.046-0.927]) was found to be a protective factor for blister formation in these patients. Moreover, ROC curve analysis showed that a PLR value of 138 was the cutoff point for predicting the development of blisters in ACS patients. Our study identified seasonal factors (refer to these months like winter or spring), referral, and patients with higher PLR as independent risk factors, and a history of drinking as a protective factor for blister formation in ACS patients. These findings allow clinicians to individualize the evaluation of blister risk and perform early targeted therapies.
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Affiliation(s)
- Yubin Long
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, P.R. China
- The Third Department of Orthopedics, Baoding First Central Hospital, Hebei, P.R. China
| | - Shuo Yang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Junfei Guo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, P.R. China
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, P.R. China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, Hebei, P.R. 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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An M, Jia R, Wu L, Ma L, Qi H, Long Y. Identifying key risk factors for acute compartment syndrome in tibial diaphysis fracture patients. Sci Rep 2024; 14:8913. [PMID: 38632464 PMCID: PMC11024173 DOI: 10.1038/s41598-024-59669-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
Acute compartment syndrome (ACS) is a severe orthopedic issue that, if left untreated, can result in lasting nerve and muscle damage or even necessitate amputation. The association between admission laboratory blood test indicators and the occurrence of ACS in patients with tibial diaphysis fractures is currently a subject of debate. The objective of this research was to identify the contributing factors for ACS in individuals suffering from tibial diaphysis fractures. In this retrospective study, we collected data on a total of 705 individuals from our hospital, comprising 86 ACS patients and 619 non-ACS patients with tibial diaphysis fractures. These participants were categorized into two distinct groups: the ACS group and the non-ACS group. Despite the inherent limitations associated with retrospective analyses, such as potential biases in data collection and interpretation, we conducted a comprehensive analysis of demographics, comorbidities, and admission lab results. Our analytical approach included univariate analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis techniques, aiming to mitigate these limitations and provide robust findings. The statistical analysis revealed several predictors of ACS, including gender (p = 0.011, OR = 3.200), crush injuries (p = 0.004, OR = 4.622), lactic dehydrogenase (LDH) levels (p < 0.001, OR = 1.003), and white blood cell (WBC) count (p < 0.001, OR = 1.246). Interestingly, the study also found that certain factors, such as falls on the same level (p = 0.007, OR = 0.334) and cholinesterase (CHE) levels (p < 0.001, OR = 0.721), seem to provide a degree of protection against ACS. In order to better predict ACS, the ROC curve analysis was employed, which determined threshold values for LDH and WBC. The established cut-off points were set at 266.26 U/L for LDH and 11.7 × 109 cells per liter for WBC, respectively. Our research has successfully pinpointed gender, crush injuries, LDH levels, and white blood cell (WBC) count as crucial risk factors for the development of ACS in patients experiencing tibial diaphysis fractures. Furthermore, by establishing the cut-off values for LDH and WBC, we have facilitated a more personalized assessment of ACS risk, enabling clinical doctors to implement targeted early interventions and optimize patient outcomes.
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Affiliation(s)
- Ming An
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China
| | - Ruili Jia
- Department of Nephrology, The First Central Hospital of Baoding, Baoding, 071000, China
| | - Limei Wu
- Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, 050000, China
| | - Leilei Ma
- Department of Burns and Plastic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Hui Qi
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China.
| | - Yubin Long
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China.
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Davidson AL, Sutherland MA, Siska RC, Janis JE. Practical Review on the Contemporary Diagnosis and Management of Compartment Syndrome. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5637. [PMID: 38463703 PMCID: PMC10923313 DOI: 10.1097/gox.0000000000005637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/17/2024] [Indexed: 03/12/2024]
Abstract
Acute compartment syndrome (ACS) is a limb-threatening pathology that necessitates early detection and management. The diagnosis of ACS is often made by physical examination alone; however, supplemental methods such as compartment pressure measurement, infrared spectroscopy, and ultrasound can provide additional information that support decision-making. This practical review aims to incorporate and summarize recent studies to provide evidence-based approaches to compartment syndrome for both resource-rich and -poor settings among several patient populations.
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Affiliation(s)
- Amelia L. Davidson
- From the Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, N.C
| | - Mason A. Sutherland
- Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, N.C
| | - Robert C. Siska
- Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, N.C
| | - Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, Ohio State University, Wexner Medical Center, Columbus, Ohio
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Haeuser L, Münker M, Frey UH, Klaaßen M, Noldus J, Palisaar R. Hypoxemia of the lower limbs during robot-assisted radical prostatectomy in Trendelenburg position. BJUI COMPASS 2024; 5:313-318. [PMID: 38371210 PMCID: PMC10869652 DOI: 10.1002/bco2.296] [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: 05/15/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 02/20/2024] Open
Abstract
Objectives The objective of this study is to assess frequency and risk factors for intraoperative hypoxemia of the lower limbs during robot-assisted radical prostatectomy (RARP). Trendelenburg position during RARP may contribute to hypoxemia and compartment syndrome (CS) of the lower limbs as a major but rare complication. Patients and methods This prospective study included patients undergoing RARP for prostate cancer. Preoperative calculation of the ankle-brachial-index (ABI) was performed. Peripheral oxygen saturation (SpO2) at the toes was routinely measured. Occurrence of SpO2 levels of <90% was defined as hypoxemic events and treated immediately. Blood pressure, intraabdominal pressure, SpO2 of the upper limb and surgery time were monitored in case of hypoxemia. A multivariable logistic regression model was performed with age, BMI, nicotine abuse, MAP, comorbidities as covariates and hypoxemia of the lower limbs as the outcome. Results A total of 207 patients were included. Among these, 126 patients had ABI measurements with 10.6% having an abnormal ABI value. One, two or at least three events of lower limb hypoxemia occurred intraoperatively in 19.7%, 14.8% and 16.9%, respectively. In 20 events, surgical instruments were affecting vascular perfusion by compression. None of the covariates were statistically significant associated with lower limb hypoxemia. No patient developed a compartment syndrome. Conclusion Decrease in oxygen saturation of the lower extremities was observed frequently during RARP, without revealing any risk factors for its occurrence. Routine oximetry leads to an early detection of hypoxemia of the lower extremities, giving the anaesthesiologist and surgeon the opportunity to make adequate adjustments (increasing blood pressure and ending iliac vessel compression).
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Affiliation(s)
- Lorine Haeuser
- Department of Urology and Neuro‐Urology, Marien Hospital HerneRuhr University BochumHerneGermany
| | - Mara Münker
- Department of Urology and Neuro‐Urology, Marien Hospital HerneRuhr University BochumHerneGermany
| | - Ulrich H. Frey
- Department of Anesthesiology, Surgical Intensive Care, Pain and Palliative Care, Marien Hospital HerneRuhr University BochumHerneGermany
| | - Marina Klaaßen
- Department of Anesthesiology, Surgical Intensive Care, Pain and Palliative Care, Marien Hospital HerneRuhr University BochumHerneGermany
| | - Joachim Noldus
- Department of Urology and Neuro‐Urology, Marien Hospital HerneRuhr University BochumHerneGermany
| | - Rein‐Jüri Palisaar
- Department of Urology and Neuro‐Urology, Marien Hospital HerneRuhr University BochumHerneGermany
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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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AlHussain A, Almagushi NA, Alowid F, AlObaid B, Almagushi NA, Alotaibi SN, Almosa MS, Alhossan MA, Alanazi SS, Alhuwairini F, Bin Dukhi MM. Predictors of Acute Compartment Syndrome in Patients With Forearm Fractures: A Systematic Review. Cureus 2024; 16:e54757. [PMID: 38524047 PMCID: PMC10961054 DOI: 10.7759/cureus.54757] [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: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Acute compartment syndrome (ACS) is a critical orthopedic and traumatology emergency arising from elevated pressure within a confined osteofascial compartment, leading to compromised blood circulation and tissue ischemia. This systematic review aims to comprehensively identify and analyze the most predictable risk factors associated with ACS development in patients with forearm fractures. Published articles on ACS were meticulously searched and evaluated on reputable medical databases such as PubMed. The keywords "risk factors associated with the ACS in patients who have sustained forearm fractures"were used to create the search syntax on various databases. Data were gathered on raw prevalence, population under study, and methodology. A total of 10 articles that met the search criteria were identified and included in this review with a total of more than 300,000 patients across the studies. Fracture-related ACS was the most common, followed by soft tissue damage among patients with forearm fractures. This review underscores fractures as primary ACS catalysts, along with the role of soft tissue trauma. Meticulous consideration of these risk factors can enhance clinical decision-making, early detection, and intervention, improving patient outcomes and care quality.
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Affiliation(s)
- Ahmed AlHussain
- Orthopaedic Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Nouf A Almagushi
- Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Fay Alowid
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Bashayer AlObaid
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Sultan N Alotaibi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohammad S Almosa
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mashari A Alhossan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Saif S Alanazi
- Medical School, Imam Abdulrahman Bin Faisal University, Al Khobar, SAU
| | | | - Musaad M Bin Dukhi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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11
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Micicoi L, Gonzalez JF, Gauci MO, Chabrand P, Machado A, Bronsard N, Micicoi G. Acute compartment syndrome of the lower limbs: Fasciotomy or dermofasciotomy? A cadaver study of compartment pressures. Orthop Traumatol Surg Res 2024; 110:103736. [PMID: 37890523 DOI: 10.1016/j.otsr.2023.103736] [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: 08/28/2022] [Revised: 03/06/2023] [Accepted: 03/15/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Acute compartment syndrome (ACS) of the lower limbs is a function-threatening event usually managed by extended dermofasciotomy. Closure of the skin may be delayed, creating a risk of complications when there is an underlying fracture. Early treatment at the pre-ACS stage might allow isolated fasciotomy with no skin incision. The primary objective of this study was to compare intracompartmental pressure (ICP) changes after fasciotomy and after dermofasciotomy. The secondary objectives were to evaluate potential associations linking the starting ICP to achievement of an ICP below the physiological cut-off of 10mm Hg and to determine whether the ICP changes after fasciotomy and dermofasciotomy varied across muscle compartments. HYPOTHESIS Fasciotomy with no skin incision may not provide a sufficient ICP decrease, depending on the initial ICP value. MATERIAL AND METHODS A previously validated model of cadaver ACS of the lower limbs was used. Saline was injected gradually to raise the ICP to>15mmHg (ICP15), >30mmHg (ICP30), and >50mmHg (ICP50). We studied 70 leg compartments (anterior, lateral, and superficial posterior) in 13 cadavers (mean age, 89.1±4.6years). ICP was monitored continuously. Percutaneous, minimally invasive fasciotomy consisting in one to three 1-cm incisions was performed in each compartment. ICP was measured before and after fasciotomy then after subsequent skin incision. The objective was to decrease the ICP below 10mmHg after fasciotomy or dermofasciotomy. RESULTS Overall, mean ICP was 37.8±19.1mmHg after the injection of 184.0±133.01mL of saline. In the ICP15 group, the mean ICP of 16.1mmHg fell to 1.4mmHg after fasciotomy (ΔF=14.7) and 0.3mmHg after dermofasciotomy (ΔDF=1.1). Corresponding values in the ICP30 group were 33.9mmHg, 4.7mmHg (ΔF=29.2), and 1.2mmHg (ΔDF=3.5); and in the ICP50 group, 63.7mmHg, 17.0mmHg (ΔF=46.7), and 1.2mmHg (ΔDF=15.8). Thus, in the group with initial pressures >50mmHg, the ICP decrease was greater after both procedures, but fasciotomy alone nonetheless failed to achieve physiological values (<10mmHg). The pressure changes were not significantly associated with the compartment involved (anterior, lateral, or superficial posterior) (p<0.05). CONCLUSION Under the conditions of this study, higher baseline ICPs were associated with larger ICP drops after fasciotomy and dermofasciotomy. Nevertheless, when the baseline ICP exceeded 50mmHg, fasciotomy alone failed to decrease the ICP below 10mmHg. Adding a skin incision achieved this goal. LEVEL OF EVIDENCE IV, experimental study.
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Affiliation(s)
- Lolita Micicoi
- IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), CHU de Nice, Université Côte d'Azur (UCA), Nice, France
| | - Jean-François Gonzalez
- IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), CHU de Nice, Université Côte d'Azur (UCA), Nice, France
| | - Marc-Olivier Gauci
- IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), CHU de Nice, Université Côte d'Azur (UCA), Nice, France
| | | | - Axel Machado
- IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), CHU de Nice, Université Côte d'Azur (UCA), Nice, France
| | - Nicolas Bronsard
- IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), CHU de Nice, Université Côte d'Azur (UCA), Nice, France
| | - Grégoire Micicoi
- IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), CHU de Nice, Université Côte d'Azur (UCA), Nice, France.
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12
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Gök M, Melik MA. Clinical features and outcomes of orthopaedic injuries after the kahramanmaraş earthquake: a retrospective study from a hospital located in the affected region. Scand J Trauma Resusc Emerg Med 2024; 32:10. [PMID: 38291453 PMCID: PMC10829300 DOI: 10.1186/s13049-024-01181-6] [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] [Received: 11/23/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The purpose of this retrospective, single-institutional study was to report the clinical features and outcomes of orthopaedic injuries after the Kahramanmaraş earthquake. METHODS An institutional database review was conducted to evaluate the results of patients who applied to our hospital's emergency department after the Kahramanmaraş earthquake. Trauma patients referred to orthopaedics and traumatology were identified. Patient records were checked for injury type, fracture site, treatment type (conservative or surgical), surgical technique, and outcome. Diagnosis with crush syndrome and the need for haemodialysis were also noted. Bedside fasciotomy was undertaken based on the urgency of the patient's condition, number of patients and the availability of the operating theatre. A team consisting of a trauma surgeon, a plastic surgeon, a board-certified physician in infectious disease, a reanimation specialist, a general surgeon and a nephrologist followed up with the patients. RESULTS Within the first 7 days following the earthquake, 265 patients were admitted to the emergency department, and 112 (42.2%) of them were referred to orthopaedics and traumatology. There were 32 (28.5%) patients diagnosed with acute compartment syndrome. Fasciotomy was performed on 43 extremities of 32 patients. Of these extremities, 5 (11.6%) were upper and 38 (88.4%) were lower extremities.The surgeries of 16 (50%) of the patients who underwent fasciotomy were performed in the emergency department. There was no significant difference in terms of complications and outcomes between performing the fasciotomy at the bedside or in the operating theatre (p = 0.456). CONCLUSIONS Fasciotomy appears to be a crucial surgical procedure for the care of earthquake causalities. Fasciotomy can be safely performed as a bedside procedure based on the urgency of the patient's condition as well as the availability of the operating theatre.
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Affiliation(s)
- Murat Gök
- Medicalpoint Gaziantep Hospital, Mücahitler 52063. Sk. No: 2,27584 Şehitkamil, 27100, Gaziantep, Turkey.
| | - Mehmet Ali Melik
- Medicalpoint Gaziantep Hospital, Mücahitler 52063. Sk. No: 2,27584 Şehitkamil, 27100, Gaziantep, Turkey
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13
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Honkonen EE, Repo JP, Lehtokangas H, Luoma E, Uimonen M, Nurmi S, Ylitalo A, Riuttanen A, Kivelä T, Mattila VM, Suomalainen P. Suprapatellar tibial fracture nailing is associated with lower rate for acute compartment syndrome and the need for fasciotomy compared with the infrapatellar approach. J Orthop Traumatol 2024; 25:5. [PMID: 38282098 PMCID: PMC10822828 DOI: 10.1186/s10195-024-00749-3] [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: 07/14/2023] [Accepted: 01/10/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Intramedullary tibial nailing (IMN) is the gold standard for stabilizing tibial shaft fractures. IMN can be performed through an infra- or suprapatellar approach. PURPOSE The aim of this study is to compare the rate of fasciotomies for acute compartment syndrome between infra- and suprapatellar approaches. METHODS A total of 614 consecutive patients who were treated with IMN for tibial fracture between October 2007 and February 2020 were included in the study. The approach used for IMN was determined by the operating surgeon. Infrapatellar IMN was performed with the knee in deep flexion position, with or without calcaneal traction. Suprapatellar IMN was performed in straight or semiflexed position. The diagnosis of compartment syndrome was based on clinical analysis, but for some patients, a continuous compartment pressure measurement was used. The primary outcome was the rate of peri- and postoperative compartment syndrome treated with fasciotomies. RESULTS The study sample included 513 patients treated with infrapatellar IMN and 101 patients treated with suprapatellar IMN technique. The mean age of the patients was 44.7 years (infrapatellar technique) and 48.4 years (suprapatellar technique). High energy trauma was seen in 138 (27%) patients treated with infrapatellar technique and in 39 (39%) patients treated with suprapatellar technique. In the suprapatellar group (n = 101), there were no cases of peri- or postoperative compartment syndrome treated with fasciotomies. In the infrapatellar group (n = 513), the need for fasciotomies was stated in 67 patients, 31 patients (6.0%) perioperatively and in 36 patients (7.0%) postoperatively. The rate of fasciotomies (0/101 versus 67/513 cases) differed significantly (p < 0.001). There were no significant differences in the fracture morphology or patient demographics between the study groups. CONCLUSIONS The suprapatellar technique is recommended over the infrapatellar approach in the treatment of tibial shaft fractures. The rate of peri- and postoperative compartment syndrome and the need for fasciotomies was significantly lower with the suprapatellar technique. The major cause of increased rate of peri- or postoperative acute compartment syndrome with infrapatellar IMN technique is presumably associated with the positioning of the patient during the operation. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Essi E Honkonen
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland.
| | - Jussi P Repo
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
| | - Heidi Lehtokangas
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
| | - Emma Luoma
- Department of Surgery, Central Finland Central Hospital, Nova Hospital, Hoitajantie 3, 40620, Jyväskylä, Finland
| | - Mikko Uimonen
- Department of Surgery, Central Finland Central Hospital, Nova Hospital, Hoitajantie 3, 40620, Jyväskylä, Finland
| | - Sami Nurmi
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
| | - Antti Ylitalo
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
| | - Antti Riuttanen
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
| | - Tiia Kivelä
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
| | - Ville M Mattila
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
| | - Piia Suomalainen
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
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14
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Dong Q, Long Y, Jin L, Hou G, Li G, Wang T, Jia H, Yin Y, Guo J, Ma H, Xu S, Zhang Y, Hou Z. Establishment and pathophysiological evaluation of a novel model of acute compartment syndrome in rats. BMC Musculoskelet Disord 2024; 25:70. [PMID: 38233913 PMCID: PMC10792863 DOI: 10.1186/s12891-024-07187-6] [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: 03/09/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Researches have used intra-compartmental infusion and ballon tourniquest to create high intra-compartmental pressure in animal models of Acute Compartment Syndrome (ACS). However, due to the large differences in the modeling methods and the evaluation criteria of ACS, further researches of its pathophysiology and pathogenesis are hindered. Currently, there is no ideal animal model for ACS and this study aimed to establish a reproducible, clinically relevant animal model. METHODS Blunt trauma and fracture were caused by the free falling of weights (0.5 kg, 1 kg, 2 kg) from a height of 40 cm onto the lower legs of rats, and the application of pressures of 100 mmHg, 200 mmHg, 300 mmHg and 400 mmHg to the lower limbs of rats using a modified pressurizing device for 6 h. The intra-compartmental pressure (ICP) and the pressure change (ΔP) of rats with single and combined injury were continuously recorded, and the pathophysiology of the rats was assessed based on serum biochemistry, histological and hemodynamic changes. RESULTS The ΔP caused by single injury method of different weights falling onto the lower leg did not meet the diagnosis criteria for ACS (< 30 mmHg). On the other hand, a combined injury method of a falling weight of 1.0 kg and the use of a pressurizing device with pressure of 300 mmHg or 400 mmHg for 6 h resulted in the desired ACS diagnosis criteria with a ΔP value of less than 30 mmHg. The serum analytes, histological damage score, and fibrosis level of the combined injury group were significantly increased compared with control group, while the blood flow was significantly decreased compared with control group. CONCLUSION We successfully established a new preclinical ACS-like rat model, by the compression of the lower leg of rats with 300 mmHg pressure for 6 h and blunt trauma by 1.0 kg weight falling.
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Affiliation(s)
- Qi Dong
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Research Institute of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yubin Long
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Research Institute of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Orthopaedics Surgery, Baoding No.1 Central Hospital, Baoding, China
| | - Lin Jin
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Research Institute of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | | | - Guoqiang Li
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Research Institute of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tao Wang
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Research Institute of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huiyang Jia
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Research Institute of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingchao Yin
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Research Institute of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Junfei Guo
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Huijie Ma
- Hebei Medical University, Shijiazhuang, China
| | - Sujuan Xu
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Research Institute of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Nephrology, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Research Institute of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
- Orthopaedic Research Institute of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China.
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15
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Benstead TJ. Fibular (peroneal) neuropathy. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:149-164. [PMID: 38697737 DOI: 10.1016/b978-0-323-90108-6.00008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Fibular neuropathy has variable presenting features depending on the site of the lesion. Anatomical features make it susceptible to injury from extrinsic factors, particularly the superficial location of the nerve at the head of the fibula. There are many mechanisms of compression or other traumatic injury of the fibular nerve, as well as entrapment and intrinsic nerve lesions. Intraneural ganglion cysts are increasingly recognized when the mechanism of neuropathy is not clear from the medical history. Electrodiagnostic testing can contribute to the localization as well as the characterization of the pathologic process affecting the nerve. When the mechanism of injury is unclear from the analysis of the presentation, imaging with MRI and ultrasound may identify nerve lesions that warrant surgical intervention. The differential diagnosis of foot drop includes fibular neuropathy and other neurologic conditions, which can be distinguished through clinical and electrodiagnostic assessment. Rehabilitation measures, including ankle splinting, are important to improve function and safety when foot drop is present. Fibular neuropathy is less frequently painful than many other nerve lesions, but when it is painful, neuropathic medication may be required. Failure to spontaneously recover or the detection of a mass lesion may require surgical management.
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16
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O'Neill DC, Steffenson LN, Myhre LA, Kantor AH, Meeks HD, Fraser AM, Marchand LS, Haller JM. Analysis of acute extremity compartment syndrome using a genealogic population database. Arch Orthop Trauma Surg 2024; 144:149-160. [PMID: 37773533 DOI: 10.1007/s00402-023-05074-8] [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: 03/06/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Acute extremity compartment syndrome ("CS") is an under-researched, highly morbid condition affecting trauma populations. The purpose of this study was to analyze incidence rates and risk factors for extremity compartment syndrome using a high-quality population database. Additionally, we evaluated heritable risk for CS using available genealogic data. We hypothesized that diagnosis of extremity compartment syndrome would demonstrate heritability. MATERIALS AND METHODS Adult patients with fractures of the tibia, femur, and upper extremity were retrospectively identified by ICD-9, ICD-10, and CPT codes from 1996 to 2020 in a statewide hospital database. Exposed and unexposed cohorts were created based on a diagnosis of CS. Available demographic data were analyzed to determine risk factors for compartment syndrome using logistic regression. Mortality risk at the final follow-up was evaluated using Cox proportional hazard modeling. Patients with a diagnosis of CS were matched with those without a diagnosis for heritability analysis. RESULTS Of 158,624 fractures, 931 patients were diagnosed with CS. Incidence of CS was 0.59% (tibia 0.83%, femur 0.31%, upper extremity 0.27%). Male sex (78.1% vs. 46.4%; p < 0.001; RR = 3.24), younger age at fracture (38.8 vs. 48.0 years; p < 0.001; RR = 0.74), Medicaid enrollment (13.2% vs. 9.3%; p < 0.001; RR = 1.58), and smoking (41.1% vs. 31.1%; p < 0.001; RR 1.67) were significant risk factors for CS. CS was associated with mortality (RR 1.61, p < 0.001) at mean follow-up 8.9 years in the CS cohort. No significant heritable risk was found for diagnosis of CS. CONCLUSIONS Without isolating high-risk fractures, rates of CS are lower than previously reported in the literature. Male sex, younger age, smoking, and Medicaid enrollment were independent risk factors for CS. CS increased mortality risk at long-term follow-up. No heritable risk was found for CS. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Dillon C O'Neill
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA
| | - Lillia N Steffenson
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA
| | - Luke A Myhre
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA
| | - Adam H Kantor
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA
| | - Huong D Meeks
- Utah Population Database, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Alison M Fraser
- Utah Population Database, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Lucas S Marchand
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA
| | - Justin M Haller
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA.
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17
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Famili DT, Fernandez-Garcia MA, Vanegas M, Goldberg MF, Voermans N, Quinlivan R, Jungbluth H. Recurrent atraumatic compartment syndrome as a manifestation of genetic neuromuscular disease. Neuromuscul Disord 2023; 33:866-872. [PMID: 37919205 DOI: 10.1016/j.nmd.2023.09.007] [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] [Received: 07/11/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023]
Abstract
Compartment syndrome (CS) is a medical emergency that occurs secondary to excessively high pressures within a confined fibro-osseous space, resulting in reduced perfusion and subsequent tissue injury. CS can be divided into acute forms, most commonly due to trauma and considered an orthopaedic emergency, and chronic forms, most commonly presenting in athletes with recurrent exercise-induced pain. Downstream pathophysiological mechanisms are complex but do share commonalities with mechanisms implicated in genetic neuromuscular disorders. Here we present 3 patients with recurrent CS in the context of a RYR1-related disorder (n = 1) and PYGM-related McArdle disease (n = 2), two of whom presented many years before the diagnosis of an underlying neuromuscular disorder was suspected. We also summarize the literature on previously published cases with CS in the context of a genetically confirmed neuromuscular disorder and outline how the calcium signalling alterations in RYR1-related disorders and the metabolic abnormalities in McArdle disease may feed into CS-causative mechanisms. These findings expand the phenotypical spectrum of RYR1-related disorders and McArdle disease; whilst most forms of recurrent CS will be sporadic, above and other genetic backgrounds ought to be considered in particular in patients where other suggestive clinical features are present.
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Affiliation(s)
- Dennis T Famili
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Miguel A Fernandez-Garcia
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Maria Vanegas
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Nicol Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom; Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College London, London, United Kingdom.
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18
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Lechtig A, Hanna P, Nagy JA, Wixted J, Nazarian A, Rutkove SB. Electrical impedance myography for the early detection of muscle ischemia secondary to compartment syndrome: a study in a rat model. Sci Rep 2023; 13:18252. [PMID: 37880267 PMCID: PMC10600169 DOI: 10.1038/s41598-023-45209-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023] Open
Abstract
Acute Compartment Syndrome (ACS) is one of the most devastating orthopedic conditions, affecting any of the body's many compartments, which, if sufficiently severe, may result in disability and amputation. Currently, intra-compartmental pressure measurements serve as the gold standard for diagnosing ACS. Diagnosing limbs at risk for ACS before irreversible damage to muscle and nerve is critical. Standard approaches for diagnosing impending compartment syndrome include clinical evaluation of the limb, such as assessment for "tightness" of the overlying skin, reduced pulses distally, and degree of pain, none of which are specific or sensitive. We have proposed a novel method to detect ACS via electrical impedance myography (EIM), where a weak, high-frequency alternating current is passed between one pair of electrodes through a region of tissue, and the resulting surface voltages are measured via a second pair. We evaluated the ability of EIM to detect early muscle ischemia in an established murine model of compression-induced muscle injury, where we collected resistance, reactance, and their dimensionless product, defined as Relative Injury Index (RII) during the study. Our model generated reproducible hypoxia, confirmed by Hypoxyprobe™ staining of endothelial regions within the muscle. Under conditions of ischemia, we demonstrated a reproducible, stable, and significant escalation in resistance, reactance, and RII values, compared to uninjured control limbs. These data make a reasonable argument for additional investigations into using EIM for the early recognition of muscle hypoperfusion and ischemia. However, these findings must be considered preliminary steps, requiring further pre-clinical and clinical validation.
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Affiliation(s)
- Aron Lechtig
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Philip Hanna
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Janice A Nagy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - John Wixted
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
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19
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An M, Jia R, Qi H, Wang S, Ren J, Long Y. Surgical site infection following fasciotomy in patients with acute forearm compartment syndrome: a retrospective analysis of risk factors. Eur J Trauma Emerg Surg 2023; 49:2129-2137. [PMID: 37280480 DOI: 10.1007/s00068-023-02294-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE Fasciotomy, a standard therapy for acute forearm compartment syndrome (AFCS), can prevent serious complications, but there may be significant postoperative consequences. Surgical site infection (SSI) may cause fever, discomfort, and potentially fatal sepsis. This study aimed to identify risk factors for SSI in AFCS patients who had undergone fasciotomy. MATERIALS AND METHODS Patients with AFCS who had fasciotomies between November 2013 and January 2021 were recruited. We collected demographic information, comorbidities, and admission laboratory results. Analyses of continuous data were conducted using the t-test, the Mann-Whitney U test, and logistic regression analysis, while analyses of categorical data were conducted using the Chi-square and Fisher's exact tests. RESULTS Sixteen AFCS patients (13.9%) suffered infections that need further therapy. Using the logistic regression analysis, we identified that patients with a history of diabetes (p = 0.028, OR = 16.353, 95% CI (1.357, 197.001)), open fractures (p = 0.026, OR = 5.239, 95% CI (1.223, 22.438)), and a higher level of TC (p = 0.004, OR = 4.871, 95% CI (1.654-14.350)) were the best predictors of SSI, while ALB levels (p = 0.004, OR = 0.776, 95% CI (0.653-0.924)) were protective for SSI in AFCS patients. CONCLUSIONS Our results showed that open fractures, diabetes, and TC levels were relevent risk factors for SSI following fasciotomy in patients with AFCS, allowing us to personalize the risk assessment and apply early targeted interventions.
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Affiliation(s)
- Ming An
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China
| | - Ruili Jia
- Department of Nephrology, The First Central Hospital of Baoding, Baoding, 071000, China
| | - Hui Qi
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China
| | - Shuai Wang
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China
| | - Jingtian Ren
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China
| | - Yubin Long
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China.
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20
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Chembrovich S, Ihnatsenka B, Smith C, Zasimovich Y, Gunnett A, Petersen TR, Le-Wendling L. Incidence of acute compartment syndrome with routine use of regional anesthesia for patients with long bone fractures: a large single-center retrospective review from a level I trauma tertiary academic institution. Reg Anesth Pain Med 2023:rapm-2023-104460. [PMID: 37696649 DOI: 10.1136/rapm-2023-104460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Traditionally, using peripheral nerve blocks (PNBs) in patients with long bone fractures has been limited due to concerns that it may interfere with the timely diagnosis of acute compartment syndrome (ACS). However, our large academic institution and level I trauma center have been using regional anesthesia routinely for pain management of patients with long bone fractures for more than a decade, with strict adherence to a comprehensive management protocol. The aim of this retrospective review is to present our experience with this practice. METHODS Following Institutional Review Board approval, we performed a retrospective chart review of patients with long bone fractures and ACS over a 10-year period (2008-2018). RESULTS 26 537 patients were included in the review. Approximately 20% of these patients required surgery, and 91.5% of surgically treated patients received regional anesthesia. The incidence of ACS in our cohort was 0.1% or 1.017 per 1000 patients with long bone fractures. CONCLUSION Current recommendations on using PNBs in patients at risk for ACS have been mainly based on expert opinion and dated case reports. Due to the nature of the condition, prospective data are lacking. Our large observational dataset evaluated the risk of missing or delaying ACS diagnosis when PNBs were offered for trauma patients and demonstrated a relatively low incidence of ACS despite the routine use of PNBs under strictly protocolized conditions when patients were managed by a dedicated multidisciplinary care team.
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Affiliation(s)
- Svetlana Chembrovich
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Barys Ihnatsenka
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Cameron Smith
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Yury Zasimovich
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Amy Gunnett
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Timothy R Petersen
- Department of Anesthesiology and Critical Care, University of New Mexico School of Medicine, Albuquerque, USA
| | - Linda Le-Wendling
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
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21
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OBEY MR, SHLYKOV MA, NICKEL KB, KELLER M, HOSSEINZADEH P. Incidence and risk factors for acute compartment syndrome in pediatric tibia fractures. J Pediatr Orthop B 2023; 32:401-404. [PMID: 35502734 PMCID: PMC9630170 DOI: 10.1097/bpb.0000000000000985] [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] [Indexed: 11/26/2022]
Abstract
Acute compartment syndrome (ACS) is a rare complication following traumatic injuries in pediatric patients, and tibia fractures represent the most common cause of ACS. To determine the incidence and risk factors of developing ACS, State Inpatient Databases, State Emergency Department Databases, and State Ambulatory Surgery and Services Databases from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, were used to retrospectively identify patients 1-18 years of age with tibia fractures from 2006 to 2015 (quarter 3). The HCUP Nationwide Emergency Department Sample for nationwide data was also queried. Multivariable generalized estimating equations models were used to determine risk factors associated with development of ACS. A total of 50 640 patients with tibia fractures were studied, and 309 cases of ACS were identified. The incidence of ACS was 0.6 and 5.5% in the all tibia and open tibia fracture groups, respectively. Twenty-three cases of ACS (7.4% of all ACS) were diagnosed after discharge from the index admission, which was more common in teens treated nonoperatively. Predictors of increased ACS risk in the all tibia fracture group included age 13-18 [relative risk (RR): 4.04)], open fractures (RR: 3.83), and motor vehicle crash (MVC) mechanism (RR: 5.69). Nationwide, open and operatively treated fractures had an increased ACS rate (3.98 and 5.51%, respectively). Teenagers, open fractures, and MVC mechanisms were most strongly associated with ACS. ACS can present in a delayed fashion, as evidenced by postindex cases.
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Affiliation(s)
- Mitchel R. OBEY
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
| | - Maksim A. SHLYKOV
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
| | - Katelin B. NICKEL
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
| | - Matthew KELLER
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
| | - Pooya HOSSEINZADEH
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
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22
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Yang S, Wang T, Long Y, Jin L, Zhao K, Zhang J, Guo J, Hou Z. The impact of both-bone forearm fractures on acute compartment syndrome: An analysis of predisposing factors. Injury 2023:110904. [PMID: 37394329 DOI: 10.1016/j.injury.2023.110904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES Acute compartment syndrome (ACS) is a severe medical condition that, if left untreated, can cause permanent nerve and muscle damage, and may even require amputation. The objective of this study was to identify the risk factors associated with the development of ACS in patients with both-bone fractures of the forearm. METHODS Between November 2013 and January 2021, a retrospective data collection was conducted on 611 individuals who experienced both-bone forearm fractures at a level 1 trauma center. Among these patients, 78 patients were diagnosed with ACS, while the remaining 533 patients did not have ACS. Based on this division, the patients were categorized into two groups: the ACS group and the non-ACS group. Demographics (including factors such as age, gender, body mass index, crush injury, etc.), comorbidities (including conditions such as diabetes, hypertension, heart disease, anemia, etc.), and admission lab results (including complete blood count, comprehensive metabolic panel, and coagulation profiles, etc.) were analyzed using univariate analysis, logistic regression, and ROC curve analysis. RESULTS Predictors of ACS were identified through the final multivariable logistic regression analysis, which revealed that crush injury (p < 0.001, OR = 10.930), the levels of neutrophils (NEU) (p < 0.001, OR = 1.338) and the levels of creatine kinase (CK) (p < 0.001, OR = 1.001) were significant risk factors. Additionally, age (p = 0.045, OR = 0.978) and albumin (ALB) level (p < 0.001, OR = 0.798) were found to provide protective effects against ACS. Furthermore, the receiver operating characteristic (ROC) curve analysis determined cut-off values for NEU and CK to predict ACS: 7.01/L and 669.1 U/L respectively. CONCLUSIONS Our study identified crush injury, NEU, and CK as significant risk factors for ACS in patients with both-bone forearm fractures. We also determined the cut-off values of NEU and CK, allowing for the individualized evaluation of ACS risk and the implementation of early targeted treatments.
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Affiliation(s)
- Shuo Yang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Tao Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Yubin Long
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China; The Third Department of Orthopedics, Baoding First Central Hospital, Baoding, Hebei, China
| | - Lin Jin
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Kuo Zhao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Jiaqi Zhang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Junfei Guo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China; NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, Hebei, China.
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23
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Tejiram S, Tranchina SP, Travis TE, Shupp JW. The First 24 Hours: Burn Shock Resuscitation and Early Complications. Surg Clin North Am 2023; 103:403-413. [PMID: 37149377 DOI: 10.1016/j.suc.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Resuscitation is required for the management of patients with severe thermal injury. Some of the initial pathophysiologic events following burn injury include an exaggerated inflammatory state, injury to the endothelium, and increased capillary permeability, which all culminate in shock. Understanding these processes is critical to the effective management of patients with burn injuries. Formulas predicting fluid requirements during burn resuscitation have evolved over the past century in response to clinical experience and research efforts. Modern resuscitation features individualized fluid titration and monitoring along with colloid-based adjuncts. Despite these developments, complications from over-resuscitation still occur.
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Affiliation(s)
- Shawn Tejiram
- The Burn Center, MedStar Washington Hospital Center, 110 Irving Street, Northwest Suite 3B-55, Washington, DC 20010, USA; Department of Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA
| | - Stephen P Tranchina
- Georgetown University School, 3900 Reservoir Road NW, Washington, DC 20007, USA
| | - Taryn E Travis
- The Burn Center, MedStar Washington Hospital Center, 110 Irving Street, Northwest Suite 3B-55, Washington, DC 20010, USA; Department of Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA
| | - Jeffrey W Shupp
- The Burn Center, MedStar Washington Hospital Center, 110 Irving Street, Northwest Suite 3B-55, Washington, DC 20010, USA; Department of Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA; Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, 37th and O Street, Northwest, Washington, DC 20057, USA.
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24
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Samet RE, Torrie AM, Chembrovich SV, Ihnatsenka BV. Pro-Con Debate: Peripheral Nerve Blockade Should Be Provided Routinely in Extremity Trauma, Including in Patients At Risk for Acute Compartment Syndrome. Anesth Analg 2023; 136:855-860. [PMID: 37058722 DOI: 10.1213/ane.0000000000006394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
In this Pro-Con commentary article, we discuss the controversial debate of whether to provide peripheral nerve blockade (PNB) to patients at risk of acute extremity compartment syndrome (ACS). Traditionally, most practitioners adopt the conservative approach and withhold regional anesthetics for fear of masking an ACS (Con). Recent case reports and new scientific theory, however, demonstrate that modified PNB can be safe and advantageous in these patients (Pro). This article elucidates the arguments based on a better understanding of relevant pathophysiology, neural pathways, personnel and institutional limitations, and PNB adaptations in these patients.
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Affiliation(s)
- Ron E Samet
- From the Department of Anesthesiology, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Arissa M Torrie
- From the Department of Anesthesiology, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Svetlana V Chembrovich
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Barys V Ihnatsenka
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
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25
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Alsaedi O, Alshahir AA, Alsuhaibani O, Beek A, Alduheim M, Alzahim A, Alzolaibani SM, Alhusaini B. Etiology of Trauma-Related Acute Compartment Syndrome of the Hand: A Systematic Review. Cureus 2023; 15:e38218. [PMID: 37252461 PMCID: PMC10224738 DOI: 10.7759/cureus.38218] [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: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Hand compartment syndrome is a limb-threatening emergency. Although it is a relatively uncommon condition, early diagnosis, and urgent fasciotomy can prevent irreversible ischemia, myonecrosis, nerve dysfunction, and subsequently permanent loss of hand functions. The occurrence of hand compartment syndrome is relatively infrequent, resulting in a limited amount of literature on its causes. As a result, we conducted a systematic review to provide the most comprehensive data regarding the etiology of traumatic hand compartment syndrome. This systematic review was conducted and reported in light of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. We searched among Medline, and EBSCO Database, with no restriction on the dates (last date of the systematic search was done on April 28, 2022). We included all studies containing data regarding traumatic hand compartment syndrome. A total of 29 articles with 129 patients constituted the basis of this review. The etiology of traumatic hand compartment syndrome was classified into three groups: soft tissue injury-related, fracture-related, and vascular injury-related causes. The most common etiology of hand compartment was related to soft tissue injuries which constituted 86.8% of all etiologies, followed by fracture-related (5.4%), then vascular injury-related (1.5%). Further, burns were the most likely injury to lead to hand compartment syndrome which made up 63.4% of soft-tissue injuries, followed by animal bites (8.9%). Hand compartment syndrome can be caused by multiple etiologies that affect people of different ages. Therefore, identifying the most prevalent causes can help in early detection of compartment syndrome by frequent assessment of patients that present with the most prevalent causes like burn among soft tissue injuries and metacarpal bone fracture among fractures.
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Affiliation(s)
| | - Alwaleed A Alshahir
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Asem Beek
- College of Medicine, Taibah University, Medina, SAU
| | - Mohammad Alduheim
- College of Medicine, University of Hail College of Medicine, Hail, SAU
| | | | | | - Basem Alhusaini
- Department of Plastic and Reconstructive Surgery, King Fahad General Hospital, Medina, SAU
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26
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Porcine Model of Acute Compartment Syndrome. J Orthop Trauma 2023; 37:e122-e127. [PMID: 36219778 DOI: 10.1097/bot.0000000000002505] [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] [Accepted: 10/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Acute compartment syndrome is a devastating condition associated with lasting consequences or even death if not treated in a timely fashion. Current preclinical modeling is inadequate. Ideally a model should mimic human disease. There should be a trauma-induced reperfusion or direct muscle event that causes gradual increased pressure and is amenable to release with fasciotomy. We have attempted to reproduce this mechanism and outcome in a porcine model. METHODS Anterior tibial musculature was injured with vascular occlusion plus exterior tourniquet crush or direct intracompartmental crush through balloon inflation. The injury was maintained for over 5 hours. At that time, the tourniquet or balloon was removed. The injuries were continuously monitored with an intramuscular continuous pressure sensor. Pressure changes were recorded and after 2 hours of postinjury observation, a fasciotomy was performed for the muscle compartment. RESULTS Pressures were brought to 100 mm Hg during the injury phase. During the two-hour observation period, the balloon catheter technique achieved an average pressure of 25.1 ± SD 8.8 mm Hg with a maximum reading of 38.2 mm Hg and minimum reading of 14.1 mm Hg. During this same period, the ischemia-reperfusion + direct crush technique achieved an average pressure of 33.7 ± SD 7.3 mm Hg, with a maximum reading of 43.5 mm Hg and minimum reading of 23.5 mm Hg. Average pressure postfasciotomy for the balloon catheter technique was 2.4 ± SD 2.5 mm Hg; and for the crush technique, average value postfasciotomy was 4.9 ± SD 3.7 mm Hg-both representing a return to physiologic levels. CONCLUSION This is the first preclinical model that shows the same response to injury and treatment as is observed in human physiology. Surgical and nonsurgical therapies for compartment syndrome can now be tested reliably.
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27
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Yang S, Long Y, Wang T, Guo J, Hou Z. Predictors for surgical site infection after fasciotomy in patients with acute leg compartment syndrome. J Orthop Surg Res 2023; 18:98. [PMID: 36782284 PMCID: PMC9926640 DOI: 10.1186/s13018-023-03589-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common complications of orthopedic surgery, which can result in fever, pain, and even life-threatening sepsis. This study aimed to determine the predictors of SSI after fasciotomy in patients with acute leg compartment syndrome (ALCS). METHODS We collected information on 125 ALCS patients who underwent fasciotomy in two hospitals between November 2013 and January 2021. Patients with SSI were considered as the SSI group and those without SSI as the non-SSI group. Univariate analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analyses were used to evaluate patient demographics, comorbidities, and admission laboratory examinations. RESULTS In our research, the rate of SSI (26 of 125) was 20.8%. Several predictors of SSI were found using univariate analysis, including body mass index (BMI) (p = 0.001), patients with open fractures (p = 0.003), and patients with a history of smoking (p = 0.004). Besides, the levels of neutrophil (p = 0.022), glucose (p = 0.041), globulin (p = 0.010), and total carbon dioxide were higher in the SSI group than in the non-SSI group. According to the results of the logistic regression analysis, patients with open fractures (p = 0.023, OR 3.714), patients with a history of smoking (p = 0.010, OR 4.185), and patients with a higher BMI (p = 0.014, OR 1.209) were related predictors of SSI. Furthermore, ROC curve analysis indicated 24.69 kg/m2 as the cut-off value of BMI to predict SSI. CONCLUSIONS Our results revealed open fractures, BMI, and smoking history as independent risk factors for SSI following fasciotomy in patients with ALCS and determined the cut-off value of BMI, enabling us to individualize the evaluation of the risk for SSI to implement early targeted treatments.
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Affiliation(s)
- Shuo Yang
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Yubin Long
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei People’s Republic of China ,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051 Hebei People’s Republic of China ,The Third Department of Orthopedics, Baoding First Central Hospital, Baoding, Hebei People’s Republic of China
| | - Tao Wang
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei People’s Republic of China ,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China. .,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China. .,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, People's Republic of China.
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28
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Aslanabadi A, Zare Z, Aslanabadi M. The First Description of Acute Compartment Syndrome, by Al-Zahrawi. J Bone Joint Surg Am 2023; 105:e1. [PMID: 35926179 DOI: 10.2106/jbjs.22.00079] [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] [Indexed: 02/01/2023]
Abstract
ABSTRACT Acute compartment syndrome (ACS) is defined as increased pressure within a confined compartmental space, leading to a decline in the perfusion pressure of the tissue within that compartment. To date, the commonly held belief has been that ACS was first described by Richard von Volkmann in 1881. However, we propose that ACS was originally described by Abul Qasim Al-Zahrawi approximately 900 years earlier.
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Affiliation(s)
- Arash Aslanabadi
- Division of Orthopedic Surgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zakieh Zare
- Division of Orthopedic Surgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Aslanabadi
- Department of Basic Sciences, Faculty of Paramedicine, Tabriz University of Medical Sciences, Tabriz, Iran
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29
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Lam D, Pierson D, Salaria O, Wardhan R, Li J. Pain Control with Regional Anesthesia in Patients at Risk of Acute Compartment Syndrome: Review of the Literature and Editorial View. J Pain Res 2023; 16:635-648. [PMID: 36891457 PMCID: PMC9987529 DOI: 10.2147/jpr.s397428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/15/2023] [Indexed: 03/05/2023] Open
Abstract
Acute compartment syndrome (ACS) is a devastating complication that can happen in almost every part of the human body, most noticeably after long bone fractures. The cardinal symptom of ACS is pain in excess of what would otherwise be expected from the underlying injury and unresponsive to routine analgesia treatment. There is paucity of literature on major analgesic management strategies including opioid analgesia, epidural anesthesia, and peripheral nerve blocks with regard to their differential efficacy and safety of pain management in patients at risk of developing ACS. The lack of quality data has led to recommendations that are perhaps more conservative than they should be, particularly when it comes to peripheral nerve blocks. In this review article, we attempt to make recommendations in favor of regional anesthesia in this vulnerable group of patients and strategies that will optimize adequate pain control and improve surgical outcome without jeopardizing patient safety.
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Affiliation(s)
- David Lam
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Doris Pierson
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Osman Salaria
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Richa Wardhan
- Department of Anesthesiology, Florida University College of Medicine, Gainesville, FL, USA
| | - Jinlei Li
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
- Correspondence: Jinlei Li, Department of Anesthesiology, Yale University School of Medicine, 20 York Street, New Haven, CT, 06510, USA, Tel +1-203-785-2802, Fax +1-203-785-6664, Email
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30
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Zheng T, Huang Z, Ling H, Li J, Cheng H, Chen D, Lu Q, Zhao J, Su W. The mechanism of the Nfe2l2/Hmox1 signaling pathway in ferroptosis regulation in acute compartment syndrome. J Biochem Mol Toxicol 2023; 37:e23228. [PMID: 36193742 PMCID: PMC10078270 DOI: 10.1002/jbt.23228] [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: 10/30/2021] [Revised: 07/30/2022] [Accepted: 09/16/2022] [Indexed: 01/18/2023]
Abstract
Acute compartment syndrome (ACS) is a life-threatening orthopedic emergency, which can even result in amputation. Ferroptosis is an iron-dependent form of nonapoptotic cell death. This study investigated the mechanism of ferroptosis in ACS, explored candidate markers, and determined effective treatments. This study identified pathways involved in the development of ACS through gene set enrichment analysis (GSEA), Gene Ontology, Kyoto Encyclopedia of Genes and Genomes (KEGG), and GSEA of heme oxygenase 1 (Hmox1). Bioinformatics methods, combined with real-time quantitative polymerase chain reaction, western blot analysis, and iron staining, were applied to determine whether ferroptosis was involved in the progression of ACS and to explore the mechanism of nuclear factor erythroid-2-related factor 2 (Nfe2l2)/Hmox1 in ferroptosis regulation. Optimal drugs for the treatment of ACS were also investigated using Connectivity Map. The ferroptosis pathway was enriched in GSEA, KEGG of DEGs, and GSEA of Hmox1. After ACS, the reactive oxygen species content, tissue iron content, and oxidative stress level increased, whereas glutathione peroxidase 4 protein expression decreased. The skeletal muscle was swollen and necrotized; the number of mitochondrial cristae became fewer or even disappeared, and Nfe2l2/Hmox1 expression increased at the transcriptional and protein levels. Hmox1 was highly expressed in ACS, indicating that Hmox1 is a possible marker for ACS. we could predict 12 potential target drugs for the treatment of ACS. In conclusion, Hmox1 was a potential candidate marker for ACS diagnosis. Ferroptosis was involved in the progression of ACS. It was speculated that ferroptosis is inhibited by the Nfe2l2/Hmox1 signaling pathway.
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Affiliation(s)
- Tiejun Zheng
- Department of Orthopaedic Traumatology and Hand Surgery, The First Affiliated Hospital to Guangxi Medical University, Nanning, Guangxi, China
| | - Zhao Huang
- Department of Orthopaedic Traumatology and Hand Surgery, The First Affiliated Hospital to Guangxi Medical University, Nanning, Guangxi, China
| | - He Ling
- Department of Orthopaedic Traumatology and Hand Surgery, The First Affiliated Hospital to Guangxi Medical University, Nanning, Guangxi, China
| | - Junfeng Li
- Department of Orthopaedic Traumatology and Hand Surgery, The First Affiliated Hospital to Guangxi Medical University, Nanning, Guangxi, China
| | - Hong Cheng
- Department of Orthopaedic Traumatology and Hand Surgery, The First Affiliated Hospital to Guangxi Medical University, Nanning, Guangxi, China
| | - Dingquan Chen
- Department of Orthopaedic Traumatology and Hand Surgery, The First Affiliated Hospital to Guangxi Medical University, Nanning, Guangxi, China
| | - Qinzhen Lu
- Department of Orthopaedic Traumatology and Hand Surgery, The First Affiliated Hospital to Guangxi Medical University, Nanning, Guangxi, China
| | - Jinmin Zhao
- Department of Orthopaedic Traumatology and Hand Surgery, The First Affiliated Hospital to Guangxi Medical University, Nanning, Guangxi, China.,Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Wei Su
- Department of Orthopaedic Traumatology and Hand Surgery, The First Affiliated Hospital to Guangxi Medical University, Nanning, Guangxi, China
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[Acute compartment syndrome of the extremities]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:93-102. [PMID: 35352147 PMCID: PMC9849316 DOI: 10.1007/s00104-022-01624-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 01/22/2023]
Abstract
Acute compartment syndrome of the extremities is a surgical emergency and a rapid diagnosis and immediate surgical treatment are essential for the outcome. The cause is an increase in the tissue pressure inside a muscle compartment enclosed by fasciae and the resulting disruption of microperfusion. This can have potentially disastrous consequences, such as loss of the extremity due to extensive tissue necrosis or a threat to life due to infectious complications. Although mostly triggered by trauma, a multitude of other causes can lead to the formation of a compartment syndrome, so that a basic knowledge of this condition is of great importance not only for trauma surgeons. This is particularly true because a timely treatment necessitates rapid diagnosis and evaluation of the indications. This article provides an overview of the underlying pathophysiology, the causes, the symptoms and the treatment of acute compartment syndrome.
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Bodrozic J, Lekovic D, Koncar I, Dzelatović NS, Miljić P. Rapid development of lower leg compartment syndrome following firearm injury in a patient with moderate hemophilia B. Blood Res 2022; 57:281-284. [PMID: 36348636 PMCID: PMC9812729 DOI: 10.5045/br.2022.2022112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 10/07/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jelena Bodrozic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Danijela Lekovic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Igor Koncar
- Clinic of Vascular and Endovascular Surgery, University Clinical Centre of Serbia, Belgrade, Serbia,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Natasa Sulović Dzelatović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Predrag Miljić
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia,Faculty of Medicine, University of Belgrade, Belgrade, Serbia,Correspondence to: Predrag Miljić, M.D. Clinic of Haematology, University Clinical Centre of Serbia, Koste Todorovica No 2, 11000 Belgrade, Serbia, E-mail:
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Laverdiere C, Montreuil J, Bouklouch Y, Lorange JP, Dion CA, Harvey EJ. Predictors of Foot Acute Compartment Syndrome: Big Data analysis. J Foot Ankle Surg 2022; 62:27-30. [PMID: 35473922 DOI: 10.1053/j.jfas.2022.03.006] [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: 11/21/2021] [Accepted: 03/07/2022] [Indexed: 02/03/2023]
Abstract
Acute compartment syndrome (ACS) in the foot is a challenging diagnosis and can lead to significant disabilities to patients. The present study aims to investigate the incidence, risk factors, demographics and association in the analysis of acute compartment syndrome (ACS) of the foot. We performed a retrospective review of the Trauma Quality Programs data from the American College of Surgeons including 70,525 patients who sustained a fracture of the foot from 2015 to 2018 (4 calendar years). Fasciotomies were performed in 0.7% of all foot fractures. Open fractures, crush injuries and multiple foot fractures were the strongest predictors of fasciotomies, with odds ratios of 2.38, 2.38 and 2.33 respectively. Being a male was associated with an increased likelihood of fasciotomies of 64% (p < .0001 O.R. = [1.42-1.90]), while a dislocation in the foot increased likelihood of fasciotomies by 48% (p = .0008 O.R. = [1.18-1.86]). Trauma centre level III had higher rate of fasciotomy than Tertiary Trauma centers. Multiple other factors were addressed while controlling for cofounders. This big data analysis provided information not previously reported on the risk factors, demographics, and clinical association of ACS in the foot.
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Affiliation(s)
- Carl Laverdiere
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada.
| | - Julien Montreuil
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada
| | | | | | - Charles-Antoine Dion
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Edward J Harvey
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada
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Steadman W, Wu R, Hamilton ATM, Richardson MD, Wall CJ. Review article: A comprehensive review of unusual causes of acute limb compartment syndrome. Emerg Med Australas 2022; 34:871-876. [PMID: 36192364 PMCID: PMC9828535 DOI: 10.1111/1742-6723.14098] [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] [Received: 02/15/2022] [Revised: 08/27/2022] [Accepted: 09/14/2022] [Indexed: 01/12/2023]
Abstract
Acute limb compartment syndrome (ALCS) is a surgical emergency that can have serious consequences unless promptly diagnosed and treated, which is particularly challenging when there is an unusual cause. This is a comprehensive review of reported causes of ALCS. From 1068 included articles, we found 299 discrete causes of ALCS including toxins, infections, endocrine pathology, haematological emergencies, malignancy and iatrogenic ALCS. Familiarity with this wide range of ALCS causes may assist in early diagnosis of this limb-threatening condition.
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Affiliation(s)
- William Steadman
- Orthopaedic DepartmentToowoomba HospitalToowoombaQueenslandAustralia,Rural Clinical SchoolThe University of QueenslandToowoombaQueenslandAustralia
| | - Rui Wu
- Orthopaedic DepartmentToowoomba HospitalToowoombaQueenslandAustralia
| | - Alistair TM Hamilton
- Rural Clinical SchoolThe University of QueenslandToowoombaQueenslandAustralia,Emergency DepartmentToowoomba HospitalToowoombaQueenslandAustralia
| | - Martin D Richardson
- Epworth Clinical SchoolThe University of MelbourneMelbourneVictoriaAustralia
| | - Christopher J Wall
- Orthopaedic DepartmentToowoomba HospitalToowoombaQueenslandAustralia,Rural Clinical SchoolThe University of QueenslandToowoombaQueenslandAustralia
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35
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Sonawane K, Dhamotharan P, Dixit H, Gurumoorthi P. Coping With the Fear of Compartment Syndrome Without Compromising Analgesia: A Narrative Review. Cureus 2022; 14:e30776. [DOI: 10.7759/cureus.30776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
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36
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Rodriguez J, Suneja N, von Keudell A, Zhang D. Surgical demographics of acute thigh compartment syndrome. Injury 2022; 53:3481-3485. [PMID: 35906118 DOI: 10.1016/j.injury.2022.07.035] [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: 07/01/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The objective of this study was to identify demographic, injury-related, and treatment-related characteristics of patients who underwent decompressive fasciotomies for acute thigh compartment syndrome. METHODS A cohort of 38 adult patients with acute thigh compartment syndrome treated with fasciotomy at two tertiary care referral centers over a 10-year time period from January 1, 2006 to June 30, 2015 were retrospectively identified. We searched the electronic medical record for patient-related variables (e.g., age, sex, race, smoking status, diabetes mellitus), injury-related variables (e.g., mechanism of injury, associated fractures, other traumatic injuries), treatment-related variables (e.g., delay to treatment, compartments released, number of debridements, use of split-thickness grafts), and outcomes (e.g., amputation, death, sensory/motor impairments at final follow-up). RESULTS The mean age of our cohort was 47 years, and 35 patients (92%) were male. There were various mechanisms of injury, but the most common mechanisms were spontaneous hematoma (21%), followed by motor vehicle accidents (16%). Associated leg fractures were present in 15 (39%) patients. Delay between time of injury and fasciotomy was greater than 24 hours in 27 patients (71%), 12 to 24 hours in 6 patients (16%), and less than 6 hours in 3 patients (8%). The most frequently released compartment was the anterior compartment only (68%), followed by both the anterior and posterior compartments (16%) and the posterior compartment only (11%). Six patients (16%) had motor impairment, and 2 patients (5%) had sensory impairment at final follow-up. There were 2 deaths (5%) recorded in the hospital course for this cohort, none of which were directly related to compartment syndrome of the thigh. CONCLUSION Delays to fasciotomy are frequent in the treatment of acute thigh compartment syndrome. The demographics of acute thigh compartment syndrome demonstrate a strong male predominance. Treating providers should recognize spontaneous hematoma and motor vehicle accidents as the most common causes of acute thigh compartment syndrome.
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Affiliation(s)
| | - Nishant Suneja
- Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Arvind von Keudell
- Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Rigshospitalet, Department of Orthopedic Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Dafang Zhang
- Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
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Gamulin A, Wuarin L, Zingg M, Belinga P, Cunningham G, Gonzalez AI. Association between open tibia fractures and acute compartment syndrome: A retrospective cohort study. Orthop Traumatol Surg Res 2022; 108:103188. [PMID: 34929394 DOI: 10.1016/j.otsr.2021.103188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/10/2021] [Accepted: 02/25/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Studies on the association of open tibia fractures and acute compartment syndrome (ACS) show confusing results, with some papers highlighting a positive association, and others failing to do so. The aim of this study was to determine if an open tibia fracture is at increased risk of ACS occurrence, when compared to a closed fracture. HYPOTHESIS Skin injury in the setting of an open tibia fracture does not prevent from ACS occurrence, because the energy transmitted to the limb during trauma may lead to soft tissue lesions, including skin lacerations and ACS. PATIENTS AND METHODS In total, 711 consecutive adult patients (mean age 44.6 years; 65.8% males) sustaining 725 tibia fractures between 01.01.2005 and 31.12.2009 were included in this retrospective study. The outcome measure was ACS. The following variables were assessed: soft tissue condition, age, sex, low- vs. high-energy injury, type of fracture, associated contiguous skeletal injury. A logistic regression model was used and adjustment was performed for age and sex. RESULTS ACS occurred in 10.4% of proximal intra-articular fractures, 10.4% of extra-articular fractures and 3.3% of distal intra-articular fractures, and in 8.7% of closed fractures, 7.8% of open Gustilo 1 fractures and 13.3% of open Gustilo 2 and 3 fractures. Open lesions were not associated with ACS when tibia fractures were considered as a whole. When stratifying by types of fractures, open Gustilo 2 and 3 lesions were associated with ACS in proximal intra-articular fractures (p=0.048). There was no association with closed or any type of open lesions for extra-articular fractures. There were not enough ACS cases among distal intra-articular fractures to draw conclusions. DISCUSSION As ACS may occur with any type of open tibia fractures, clinicians should not be wrongly reassured by an open fracture, assuming that the wound would relieve the pressure inside the muscle compartments. There is a weak association between open Gustilo 2 and 3 lesions and ACS in proximal intra-articular fractures only. These findings are important for surgeons treating these injuries, especially by intubated, sedated or obtunded patients. LEVEL OF EVIDENCE III; retrospective diagnostic study.
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Affiliation(s)
- Axel Gamulin
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland.
| | - Lydia Wuarin
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland
| | - Matthieu Zingg
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland
| | - Patrick Belinga
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland
| | - Gregory Cunningham
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland
| | - Amanda I Gonzalez
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland
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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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Etiology of trauma-related acute compartment syndrome of the forearm: a systematic review. J Orthop Surg Res 2022; 17:342. [PMID: 35794574 PMCID: PMC9258104 DOI: 10.1186/s13018-022-03234-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Acute compartment syndrome (ACS) can be caused by multiple causes that affect people of different ages. It is considered an orthopedic emergency condition that requires immediate diagnosis and surgical intervention to avoid devastating complications and irreversible damages. This systematic review aimed to present the etiology of trauma-related forearm ACS. Methods A systematic review was performed on four different databases: Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of systematic review register databases via Ovid, with no restriction on dates (last date was June 30, 2021). It included all the studies containing data about the etiology of trauma-related forearm ACS. Results A total of 4893 articles were retrieved: 122 met the inclusion criteria, 39 were excluded, 25 were out of scope and 14 had insufficient details. Hence, this review constituted 83 articles and 684 patients. The etiology of ACS causing forearm ACS was classified into three groups: fracture-related, soft tissue injury-related and vascular injury-related. The fracture-related group was the most common group (65.4%), followed by soft tissue injury (30.7%), then vascular injuries (3.9%). Furthermore, supracondylar humerus fractures were the most common cause of fractures related to forearm ACS. Blunt traumas were the most common cause of soft tissue injuries-related forearm ACS, and brachial artery injuries were the most common cause of vascular-related forearm ACS. Conclusion Frequent assessment of patients with the most prevalent etiologies of forearm ACS is recommended for early detection of forearm ACS and to save limbs.
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Bouklouch Y, Schmidt AH, Obremskey WT, Bernstein M, Gamburg N, Harvey EJ. Big data insights into predictors of acute compartment syndrome. Injury 2022; 53:2557-2561. [PMID: 35249740 DOI: 10.1016/j.injury.2022.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/16/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND There remain gaps in knowledge regarding the pathophysiology, initial diagnosis, treatment, and outcome of acute compartment syndrome (ACS). Most reported clinical outcomes are from smaller studies of heterogeneous patients. For a disease associated with a financial burden to society that represents billions of dollars worldwide the literature does not currently establish baseline diagnostic parameters and risk factors that may serve to predict treatment and outcomes. METHODS This study looks at a very large cohort of trauma patients obtained from four recent years of the Trauma Quality Programs data from the American College of Surgeons. From 3,924,127 trauma cases - 203,500 patients with tibial fractures were identified and their records examined for demographic information, potential risk factors for compartment syndrome, an associated coded diagnosis of muscle necrosis, and presence of other outcomes associated with compartment syndrome. A recurrent multiple logistic regression model was used to identify factors predictive of fasciotomy. The results were compared to the reported results from the literature to validate the findings. RESULTS The rate of fasciotomy treatment for ACS was 4.3% in the cohort of identified patients. The analysis identified several clinical predictors of fasciotomy. Proximal and midshaft tibial fractures (P <0.0001) showed highest increases in the likelihood of ACS. Open fractures were twice (O.R [2.20-2.42]) as likely to have ACS. Having a complex fracture (P<0.0001), substance abuse disorder (P<0.0002), cirrhosis (P = 0.002) or smoking (P<0.0051) all increased the likelihood of ACS. Age decreased the likelihood by 1% per year (OR= [0.99-0.993]). Crush and penetrating injuries showed an important increase in the likelihood of ACS (O.R of 1.83 and 1.37 respectively). Additionally, sex, BMI, cirrhosis, tobacco smoking and fracture pattern as defined by OTA group and OTA subgroup had predictive value on actual myonecrosis. Fasciotomies for open tibial fractures were more likely to uncover significant muscle necrosis compared to closed fractures. Amputation resulted after 5.4% of fasciotomies. CONCLUSION This big data approach shows us that ACS is primarily linked to the extent of soft tissue damage. However, newfound effect of some comorbidities like cirrhosis and hypertension on the risk of ACS imply other mechanisms.
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Affiliation(s)
| | | | - William T Obremskey
- Department of Orthopaedic Surgery Vanderbilt Medical Center, Vanderbilt Center for Musculoskeletal Research
| | - Mitchell Bernstein
- McGill University Health Center - Research Institute; McGill University Department of Surgery, Division of Orthopaedic Surgery
| | | | - Edward J Harvey
- McGill University Health Center - Research Institute; McGill University Department of Surgery, Division of Orthopaedic Surgery.
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Kowalski B, Wagner J, Gogos A, Wonerow M. [Load induced compartment syndrome of the supraspinatus muscle : Case report of an unusual diagnosis]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:580-582. [PMID: 34324035 DOI: 10.1007/s00113-021-01064-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Benedikt Kowalski
- Orthopädie/Sportmedizin, Regionalspital Surselva AG, Spitalstraße 6, 7130, Ilanz, Schweiz.
| | - Julia Wagner
- Department Chirurgie, GZO Spital Wetzikon, Spitalstraße 66, 8620, Wetzikon, Schweiz
| | - Alexander Gogos
- Department Chirurgie, GZO Spital Wetzikon, Spitalstraße 66, 8620, Wetzikon, Schweiz
| | - Martin Wonerow
- Orthopädie/Sportmedizin, Regionalspital Surselva AG, Spitalstraße 6, 7130, Ilanz, Schweiz
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Ang A, Michaelides A, Hallworth S, Kocher HM. Intraoperative acute compartment syndrome of the upper limb secondary to extravasation. BMJ Case Rep 2022; 15:e248454. [PMID: 35580941 PMCID: PMC9114956 DOI: 10.1136/bcr-2021-248454] [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] [Accepted: 04/24/2022] [Indexed: 11/03/2022] Open
Abstract
A woman in her 50s was undergoing a repeat liver resection surgery for recurrence of liver metastasis when the intravenous fluid flow was noted to be sluggish on multiple occasions. On the third examination of the right hand where the intravenous cannula was located, surgery was halted as there was extensive swelling from the hand to the biceps and the hand had started turning blue. A diagnosis of acute upper limb compartment syndrome secondary to extravasation exacerbated by metaraminol was made by the anaesthetist and surgeon. Fasciotomies of the right upper limb were performed, and perfusion was restored. A hand surgeon arrived shortly after and completed decompressing the upper limb compartments.A literature review revealed risk factors such as communication barriers, age and chemotherapy were present in this case. Enhanced monitoring is needed in the context of unsatisfactory infusion flow rates perioperatively.
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Affiliation(s)
- Andrew Ang
- Barts and the London HPB Centre, Barts Health NHS Trust, London, London, UK
| | - Athena Michaelides
- Barts and the London HPB Centre, Barts Health NHS Trust, London, London, UK
| | - Stephen Hallworth
- Department of Anaesthetics, Barts Health NHS Trust, London, London, UK
| | - Hemant M Kocher
- Barts and the London HPB Centre, Barts Health NHS Trust, London, London, UK
- Barts Cancer Institute, Queen Mary University of London, London, London, UK
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Honda A, Michihata N, Iizuka Y, Uda K, Morita K, Mieda T, Takasawa E, Ishiwata S, Tajika T, Matsui H, Fushimi K, Yasunaga H, Chikuda H. Risk factors for severe lower extremity ischemia following venoarterial extracorporeal membrane oxygenation: an analysis using a nationwide inpatient database. Trauma Surg Acute Care Open 2022; 7:e000776. [PMID: 35505909 PMCID: PMC9014081 DOI: 10.1136/tsaco-2021-000776] [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] [Received: 05/24/2021] [Accepted: 03/31/2022] [Indexed: 11/03/2022] Open
Abstract
Objectives Venoarterial extracorporeal membrane oxygenation is increasingly being used as a life-saving modality in critically ill patients. Despite its necessity, severe lower extremity ischemia associated with venoarterial extracorporeal membrane oxygenation remains a potentially devastating complication. We aimed to investigate the incidence and risk factors for severe lower extremity ischemia requiring fasciotomy or amputation following venoarterial extracorporeal membrane oxygenation. Methods All patients who received venoarterial extracorporeal membrane oxygenation during hospitalization were identified in a Japanese national inpatient database from July 1, 2010 to March 31, 2018. The primary outcome was occurrence of severe lower extremity ischemia that required fasciotomy or amputation. We used cause-specific proportional hazard models to examine the associations between potential risk factors and outcomes. We also performed a competing-risk analysis to estimate the cause-specific HR for severe lower extremity ischemia using a multivariable competing-risk Cox proportional hazard model with adjustment for potential risk factors. Results A total of 29 231 patients who underwent venoarterial extracorporeal membrane oxygenation during hospitalization were identified. Of these, 98 patients (0.3%) had lower extremity ischemia requiring fasciotomy or amputation. The young group (≤18 years) had a significantly higher proportion of severe lower extremity ischemia cases than the adult (19-59 years) and elderly (≥60 years) groups (1.4%, 0.5%, and 0.2%, respectively; p<0.001). In a multivariable competing-risk Cox proportional hazards regression model, younger age (HR 3.06; 95% CI 1.33 to 7.02; p<0.008) and consciousness disturbance on admission (HR 2.53; 95% CI 1.60 to 3.99; p<0.001) were significantly associated with higher likelihood of severe lower extremity ischemia. Conclusion In this study using a nationwide database, younger age and consciousness disturbance on admission were associated with higher risk of severe lower extremity ischemia following venoarterial extracorporeal membrane oxygenation. Level of evidence Level Ⅲ-prognostic and epidemiological.
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Affiliation(s)
- Akira Honda
- Orthopaedic Surgery, Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine, Gunma, Japan
| | - Nobuaki Michihata
- Health Services Research, Graduate School of Medicine, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Tokyo, Japan
| | - Yoichi Iizuka
- Orthopaedic Surgery, Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine, Gunma, Japan
| | - Kazuaki Uda
- Health Services Research and Development Center, University of Tsukuba Graduate School of Medicine Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Kojiro Morita
- Global Nursing Research Center, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Tokyo, Japan
| | - Tokue Mieda
- Orthopaedic Surgery, Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine, Gunma, Japan
| | - Eiji Takasawa
- Orthopaedic Surgery, Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine, Gunma, Japan
| | - Sho Ishiwata
- Orthopaedic Surgery, Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine, Gunma, Japan
| | - Tsuyoshi Tajika
- Orthopaedic Surgery, Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine, Gunma, Japan
| | - Hiroki Matsui
- Clinical Epidemiology and Health Economics, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Tokyo, Japan
| | - Kiyohide Fushimi
- Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Hideo Yasunaga
- Clinical Epidemiology and Health Economics, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Tokyo, Japan
| | - Hirotaka Chikuda
- Orthopaedic Surgery, Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine, Gunma, Japan
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44
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Schupbach D, Honjol Y, Bouklouch Y, Merle G, Harvey EJ. Acute Compartment Syndrome Modeling with Sequential Infusion Shows the Deep Posterior Compartment Is Not Functionally Discrete. J Bone Joint Surg Am 2022; 104:813-820. [PMID: 35041625 DOI: 10.2106/jbjs.21.00291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical case series have indicated that 1 or 2-compartment decompression of the anterior or lateral leg may be sufficient for release, but, currently, no cadaveric model has verified that approach. The objective of this study was to investigate the functional relationship between compartments by alternating sequences of infusion and fasciotomy release. METHODS This study utilized multicompartment sequential pressurization with simultaneous monitoring by continuous pressure sensors to model compartment syndrome in a human cadaver leg. Subsequent sequential release of compartments and continuous streaming of pressure readings permitted unique insights. RESULTS A leg model allowed the examination of pressure changes in all 4 compartments as treated with sequential fasciotomies. The successful modeling of lower-leg pressures consistent with compartment syndrome showed that discrepancies relative to accepted concepts were seen when the deep posterior compartment was pressurized in isolation. Also, release of 1 of the 2 of either the anterior or lateral compartments seems to be sufficient for decompression to acceptable pressure levels. CONCLUSIONS The deep posterior compartment does not appear to be completely discrete and instead follows the pressurization curve of the posterior muscle group. This indicates that release of the deep posterior compartment may not be needed in all acute compartment syndrome scenarios. CLINICAL RELEVANCE Surgical techniques can be modified for treatment of acute compartment syndrome to avoid large scar lengths, deep dissection, and multiple exposures that could improve patient outcomes.
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Affiliation(s)
- Drew Schupbach
- Department of Surgery, Injury Repair Recovery Program, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada.,Experimental Surgery Program, McGill University, Montreal, Quebec, Canada
| | - Yazan Honjol
- Experimental Surgery Program, McGill University, Montreal, Quebec, Canada
| | - Yasser Bouklouch
- Department of Surgery, Injury Repair Recovery Program, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada
| | - Geraldine Merle
- Department of Surgery, Injury Repair Recovery Program, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada
| | - Edward J Harvey
- Department of Surgery, Injury Repair Recovery Program, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada
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45
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Pritchard M, Baggott P, Donnelly L, Jacob J. Acute compartment syndrome of the thigh in a body builder following open reduction and internal fixation for proximal femur fracture. BMJ Case Rep 2022; 15:e247241. [PMID: 35414574 PMCID: PMC9006800 DOI: 10.1136/bcr-2021-247241] [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] [Accepted: 04/03/2022] [Indexed: 11/04/2022] Open
Abstract
Acute compartment syndrome (ACS) of the thigh following femoral fracture has been rarely reported in previous literature. This condition must be diagnosed quickly to prevent the affected limb becoming ischaemic. We document the management of ACS of the thigh in a healthy male patient who suffered a proximal femur fracture following a high-speed road traffic accident. Early identification of characteristic clinical signs allowed for a diagnosis of ACS to be made and then managed with an emergency fasciotomy. The patient is a bodybuilder with an exceptionally large muscle mass. This made ACS more difficult to identify and wound closure a complex process over a period of 13 days. We aimed to highlight the importance of maintaining a high index of suspicion for ACS following traumatic injuries, recognising that ACS in larger patients can be mistaken for an increased analgesia requirement and closing fasciotomies slowly using mass tension sutures.
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Affiliation(s)
- Matthew Pritchard
- Emergency Department, Kingston Hospital NHS Foundation Trust, Kingston upon Thames, UK
| | - Paul Baggott
- Trauma and Orthopaedics, Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
| | - Liam Donnelly
- Emergency Department, Ealing Hospital NHS Trust, Southall, London, UK
| | - Joshua Jacob
- Trauma and Orthopaedics, Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
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Finneran JJ, Schwartz AK, Gabriel RA. Regional Anesthesia and Compartment Syndrome: A Matter of Timing. Anesth Analg 2022; 134:e24-e25. [PMID: 35299225 DOI: 10.1213/ane.0000000000005934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- John J Finneran
- Department of Anesthesiology, University of California, San Diego, San Diego, California
| | - Alexandra K Schwartz
- Department of Orthopedic Surgery, University of California, San Diego, San Diego, California
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California, San Diego, San Diego, California
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47
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Mueller JW, Mcleod CB, Rabenhorst BM. Isolated Acute Lateral Compartment Syndrome in an Adolescent Athlete: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00054. [PMID: 35703162 DOI: 10.2106/jbjs.cc.22.00088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 17-year-old adolescent boy presented with anterolateral, right leg pain and numbness of his right foot 2 days after participating in football practice. He denied a traumatic event, and radiographs were negative for fracture. His imaging and physical examination raised suspicion for acute compartment syndrome (ACS). Single-incision fasciotomy with anterior and lateral compartment release was performed. The peroneus longus muscle was detached at the musculotendinous junction. The peroneus longus was then debrided and transferred to the peroneus brevis. CONCLUSION Atraumatic ACS, although rare, is a diagnostic challenge. Prompt recognition of this atypical presentation is important for proper treatment.
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Affiliation(s)
- Joshua W Mueller
- Division of Pediatric Surgery, Department of Orthopedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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48
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Swallow C, Walton D. Acute anterior thigh compartment syndrome in Premiership rugby. BMJ Case Rep 2022; 15:e247307. [PMID: 35292543 PMCID: PMC8928295 DOI: 10.1136/bcr-2021-247307] [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] [Accepted: 02/08/2022] [Indexed: 11/03/2022] Open
Abstract
A case study of acute compartment syndrome in the anterior lateral thigh of a professional Rugby Union Flanker with no history of trauma is presented. The report covers all details from initial occurrence; medical history; investigations and surgical treatment; manual stimulus and rehabilitation; return to play; challenges and considerations-resulting in a positive outcome. Resultant observations/recommendations are that investigations should be swift and carefully considered to facilitate surgical intervention via decompressive fasciotomy as required.
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Affiliation(s)
- Christopher Swallow
- School of Sport and Exercise Science, University of Worcester, Worcester, UK
| | - Daniel Walton
- School of Sport and Exercise Science, University of Worcester, Worcester, UK
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49
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A Case of Recurrent Compartment Syndrome with Concomitant Use of Eliquis. Case Rep Orthop 2022; 2022:1863538. [PMID: 35295815 PMCID: PMC8920639 DOI: 10.1155/2022/1863538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 02/21/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction. Acute compartment syndrome (ACS) occurs secondary to increasing pressure within a fascial compartment that exceeds perfusion pressure. This can be caused by spontaneous hematomas, which can be secondary to prolonged anticoagulation therapy. Eliquis® has not been associated with ACS of the thigh in any of the currently published literature. Identifying ACS early is important because it can reduce the risk of permanent structural damage, limb amputations, and mortality rates. Case Report. A 43-year-old male with past medical history of unprovoked Deep Vein Thrombosis (DVT) eight months prior to presentation on Eliquis® presented to the emergency department for significant right thigh pain after riding a roller coaster. There was increased tone/firmness of the anterior compartment and tenderness on palpation of the proximal two-thirds of the anterior thigh. Imaging, clinical findings, and Stryker needle measurements confirmed ACS secondary to hematoma, which required fasciotomy and evacuation of the hematoma. The patient was temporarily switched to aspirin for DVT prophylaxis postoperatively to prevent new hematoma formation. Six weeks later, the patient arrived at the ED with a DVT that was treated with Eliquis®. Eight months later, the same patient presented with acute right thigh pain that started while lying in bed. A diagnosis of recurrent ACS in the right anterior thigh was made, requiring a fasciotomy. Surgery was successful without any complications. Discussion. Eliquis® is associated with an increased risk of hematoma formation, which can lead to ACS. This is a rare adverse effect that providers should be aware of because it requires early management to prevent ACS-associated complications. This is significant because no currently published literature has identified an association of Eliquis® with ACS in the thigh. In cases of atraumatic ACS, we were unable to find any protocols advocating for or against the use of DVT prophylaxis postfasciotomy in the literature.
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Baseball Related Injuries: A Case Report on Acute Compartment Syndrome of the Forearm. Case Rep Orthop 2022; 2022:5449913. [PMID: 35295816 PMCID: PMC8918371 DOI: 10.1155/2022/5449913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/28/2022] [Indexed: 11/20/2022] Open
Abstract
Acute compartment syndrome is a difficult diagnosis to make due to its wide range of clinical presentations. Delay or misdiagnosis can cause devastating consequences such as Volkmann's ischemic contracture, permanent nerve damage, amputation, and death. Lower extremity compartment syndrome is more common than upper extremity compartment syndrome, with the forearm being the most common location for upper extremity compartment syndrome. Acute compartment syndrome is most caused by acute fracture trauma but can also be due to soft tissue crush injuries or vascular problems. We report a unique case of a male umpire being struck on the forearm by a baseball with subsequent progression to an acute compartment syndrome that required emergent fasciotomies. The patient made a full recovery with no known long-term sequelae.
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