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Bukhamas Y, Elmasri M, Alasiri AM, Aljawder A. Acute Anterior Thigh Compartment Syndrome in a Young Mixed Martial Arts Fighter. Cureus 2024; 16:e52820. [PMID: 38268991 PMCID: PMC10806383 DOI: 10.7759/cureus.52820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 01/26/2024] Open
Abstract
Acute compartment syndrome (ACS) of the thigh is an uncommon injury, and diagnosis of such cases can be easily delayed or even missed due to the rare nature of this condition. We present a case of ACS of the thigh in a young, healthy mixed martial arts (MMA) semi-professional athlete with no history of previous medical illnesses and normal coagulation. This MMA fighter sustained a direct blow to the anterolateral aspect of his left thigh with a strong kick during a sparring match with his opponent. After early surgical fasciotomy, this athlete returned to his pre-injury state and athletic performance within six to eight months postoperatively. Our literature review asserts that young athletic males with high muscle mass, engaging in contact sports, are at a higher risk of developing ACS of the thigh.
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Affiliation(s)
- Yusuf Bukhamas
- Orthopedic Surgery, King Hamad University Hospital, Busaiteen, BHR
| | - Mohamed Elmasri
- Orthopedic Surgery, King Hamad University Hospital, Busaiteen, BHR
| | - Abdullah M Alasiri
- Orthopedic Surgery, National Guard Health Affairs Hospital Dammam, Dammam, SAU
- Orthopedic Surgery, King Hamad University Hospital, Busaiteen, BHR
| | - Abdulla Aljawder
- Orthopedic Surgery, King Hamad University Hospital, Busaiteen, BHR
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Sousa D, Pita S, Oliveira V, Cardoso P. Ischiopubic Ramus Resection as Treatment for Giant Cell Tumor of the Bone: Surgical Techniques in Two Clinical Cases. Cureus 2023; 15:e45661. [PMID: 37868403 PMCID: PMC10589802 DOI: 10.7759/cureus.45661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Giant cell tumors (GCTs) of the ischium are rare and often diagnosed at an advanced stage. In fact, there is no defined treatment algorithm to treat this lesion. We present two case reports of Campanacci's stage three ischiopubic GCT confirmed with biopsy. They were effectively treated with excision of the ischiopubic ramus, aggressive curettage, drilling, and phenolization at the margins. The surgery was performed in a gynecological position with an approach over the ischiopubic ramus. Both cases present no recurrence (two and 10-year follow-up), and neither has a significant impact on the quality of life. A thorough plan and surgical technique were essential for the success of this intervention.
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Affiliation(s)
- Diogo Sousa
- Orthopaedics and Traumatology, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, PRT
| | - Sérgio Pita
- Orthopaedics and Traumatology, Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Vânia Oliveira
- Musculoskeletal Tumors Unit, Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Pedro Cardoso
- Musculoskeletal Tumors Unit, Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, PRT
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Chen L, Deng H, Houle T, Zhang Y, Ahmed S, Zhang W, Sullivan S, Opalacz A, Roth S, Filatava EJ, Stabach K, Vo T, Malarick C, Kim H, You Z, Shen S, Mao J. Comparison between acupuncture therapy and gabapentin for chronic pain: a pilot study. Acupunct Med 2021; 39:619-628. [PMID: 34325532 DOI: 10.1177/09645284211026683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We examined whether the effect of true electroacupuncture on pain and functionality in chronic pain participants can be differentiated from that of medication (gabapentin) by analyzing quantitative sensory testing (QST). METHODS We recruited chronic back and neck pain participants who received six sessions (twice weekly) of true electroacupuncture versus sham electroacupuncture or 3 weeks of gabapentin versus placebo treatment. QST profiles, pain scores, and functionality profile were obtained at baseline (visit 1) and after three sessions (visit 4) or six sessions (visit 7) of acupuncture or 3 weeks of gabapentin or placebo. RESULTS A total of 50 participants were analyzed. We found no differences in QST profile changes (p = 0.892), pain reduction (p = 0.222), or functionality (p = 0.254) between the four groups. A major limitation of this pilot study was the limited number of study participants in each group. CONCLUSION This pilot study suggests that a large-scale clinical study with an adequate sample size would be warranted to compare acupuncture and medication therapy for chronic pain management. TRIAL REGISTRATION NUMBER NCT01678586 (ClinicalTrials.gov).
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Affiliation(s)
- Lucy Chen
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hao Deng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Public Health Program, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Timothy Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yi Zhang
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shihab Ahmed
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Wei Zhang
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shelly Sullivan
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Arissa Opalacz
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Roth
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Evgenia Jen Filatava
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin Stabach
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Trang Vo
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Charlene Malarick
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hyangin Kim
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Zerong You
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shiqian Shen
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jianren Mao
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
Ultrasound has been described as the "stethoscope" of the radiologist; its ability to aid in clinical diagnosis with both static and dynamic imaging has allowed fast and accurate diagnosis. However, traditionally unlike a stethoscope, a large and bulky ultrasound machine made it difficult to use portably in a hospital environment where patients can be scattered across a hospital. With the development of innovative ultrasound technology, Point of Care Ultrasound (PoCUS) can readily be carried by a clinician to make a quick and timely diagnosis. In this review article we look at the uses of PoCUS within orthopaedic emergencies. Diagnosis in orthopaedics often requires further imaging beyond history taking, clinical examination and plain radiographs. In these cases PoCUS can be useful for ruling out occult fractures, diagnosing joint effusions and tendon ruptures. By aiding a speedy diagnosis, we can reduce unnecessary immobilisation, reduce inpatient stays, introduce early mobilisation and reduce harm to patients. With PoCUS becoming increasingly cheaper and more portable we feel this really can become the stethoscope of an orthopaedic surgeon.
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Affiliation(s)
- Jennifer Oluku
- Trauma and Orthopaedic Surgery, Queen Elizabeth Hospital, London, GBR
| | - Attila Stagl
- Trauma and Orthopaedic Surgery, Queen Elizabeth Hospital, London, GBR
| | | | - Karmen El-Raheb
- Trauma and Orthopaedic Surgery, Queen Elizabeth Hospital, London, GBR
| | - Richard Beese
- Clinical Radiology, Queen Elizabeth Hospital, London, GBR
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Andrzejowski PA, Howard A, Vun JSH, Manzoor N, Patsiogiannis N, Kanakaris NK, Giannoudis PV. COVID-19: The First 30 Days at a UK Level 1 Trauma Centre and Lessons Learnt. Cureus 2020; 12:e11547. [PMID: 33365216 PMCID: PMC7748575 DOI: 10.7759/cureus.11547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 01/08/2023] Open
Abstract
Aims To analyse the learning points from the first 30 days of the COVID-19 lockdown at our institution. Patients & methods Following ethical approval, data were collected prospectively on all patients admitted under orthopaedics between March 23, 2020, and April 22, 2020. This included baseline demographics (sex, age), biochemical (blood tests), radiological (chest X-ray (CXR), computed tomography (CT)), nature and mechanism of injury, comorbidities, regular medication, observations, specific respiratory symptoms of COVID-19, management, operations, time to theatre, and outcome including mortality incidence. The nature of injury and operations performed were compared to the same period of the previous year (2019). Results During the study period, 162 (74 males) patients were admitted, with a mean age of 60.7 (range 1-101, SD 2.1). On admission, 66 (41%) patients were tested for COVID, out of which eight (13.7%) patients tested positive. Subsequently, another four patients tested positive, who developed symptoms after admission. Four out 12 (33%) confirmed COVID patients died. During this period, 4/150 other patients also died of other causes (mortality incidence 2.6%). The average ages of COVID non-survivors vs survivors were 88, SD 1, vs 76, SD 12, respectively; 2/4 had concurrent diabetes and cancer, another cancer alone, and another complex autoimmune disease managed by immunosuppressive medication. Overall admissions significantly reduced by almost 50% compared with the previous year (162 vs 373, p=<0.05), including cases of polytrauma (15 vs 33). Time to surgery was increased by an average of one day, mainly due to time taken for COVID-19 swab results to come back, and in positive patients, this was an average of 2.75 days (0-13). Lymphopenia was a useful biomarker of COVID, with levels significantly different between groups (p=<0.05). Of the clinical symptoms assessed, 8/12 patients experienced positive chest symptoms or pyrexia but only four had positive CXR changes. Discussion & lessons learnt Eight out of 12 patients who contracted COVID-19 survived without needing intensive care. Non-survivors were older with significant comorbidities. Lymphopenia is a good biomarker of the disease, but suspicious CXR was not sensitive for excluding it. Trauma volume reduced. We have highlighted significant changes to expect should there be a second wave of the virus. Key lessons learnt were that reduction in trauma volume and cessation of elective operating allowed for redeployment, including taking over the minor injury unit; more senior, consultant decision-makers 'at the front door' reduced unnecessary admissions. Increased use of conservative practice was effective at reducing operations required. Expedited COVID swab test processing allowed early de-escalation of isolation, reducing time to surgery. We expect approximately 12% of the typical orthopaedic population to be admitted with COVID, and up to 33% of these patients to die within 28 days of contracting the virus. The vast majority of patients, however, can be managed appropriately with ward-level care. An early decision on escalation and resuscitation status in the emergency department improves patient flow significantly. Remote working was effective and could be extended in the future. We have highlighted the significant changes to expect should there be a second wave of the virus and effective solutions for managing the problems that arise, which could be useful for other units.
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Affiliation(s)
| | - Anthony Howard
- Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, GBR
| | | | - Nauman Manzoor
- Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, GBR
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