Popliteal vein thrombosis causing compartment syndrome: a case report

Compartment syndrome as a result of venous thrombosis is an uncommon occurrence. Generally, phlegmasia cerulea dolens or proximal venous thrombosis results in elevated compartment pressures. Distal venous occlusion rarely is reported as a cause of compartment syndrome. This is a case report of an otherwise healthy patient in whom popliteal vein thrombosis developed and resulted in elevation > 40 mm Hg of 3 leg muscle compartments requiring fasciotomies.

Early results of continuous passive motion after rotator cuff repair: a prospective, randomized, blinded, controlled study

PURPOSE

To determine the effect of continuous passive motion (CPM) on rotator cuff repair (RCR).

METHODS

A prospective, randomized, blinded, controlled study was performed on all patients undergoing primary RCR between December 1992 and January 1994. A preoperative "shoulder score" was calculated for each patient based on four scales: function (50%), pain (20%), muscle strength (15%), and range-of-motion (ROM) (15%). A standard questionnaire and single blinded physical therapist were employed. At the time of operation, patients were randomized into the control group (postoperative physical therapy [PT]) or the study group (PT plus CPM). Postoperative shoulder scores were then calculated by repeat questionnaires and physical examinations at 3-month follow-up.

RESULTS

Twenty-six patients (12 control, 14 study; 24/26 tears were full thickness) underwent RCR and completed 3-month follow-up. Both groups had similar age and sex distributions; the study group had larger tears than the control group. All patients underwent RCR and subacromial decompression. No statistically significant difference in shoulder score increases was seen between the two groups at follow-up. A statistically significant (P = 0.0138) increase in ROM subscore was seen in the study group. Other subscores showing improvement with CPM included pain relief in female patients (P = 0.0185), and pain relief in patients > or = 60 years of age (P = 0.0364).

CONCLUSIONS

CPM has no effect on overall shoulder score at 3-month follow-up. CPM has a beneficial effect on ROM for all patients, as well as on pain relief in female patients and patients > or = 60 years of age.

Postoperative toxic shock syndrome

We conducted a retrospective review of all cases of postoperative toxic shock syndrome (PTSS) occurring in two community hospitals from 1981-1993, during which time 390,000 surgical procedures were performed. The incidence was 0.003% (12 cases). All wounds in these 12 cases, from those with scant superficial exudates to those with gross purulence, yielded Staphylococcus aureus. All tested isolates were susceptible to methicillin or cephalothin. Patients had a mean maximal temperature of 40 degrees C. All patients had a rash, most in a truncal, "sunburn" pattern. Eleven patients had desquamation. Mean time from surgery to onset of symptoms was 4 days. All patients required vigorous fluid resuscitation. No correlation could be demonstrated between the development of toxic shock syndrome and a patient's age, sex, preoperative skin preparation or administration of antibiotics, members of the surgical team, or duration of procedure. All patients with PTSS survived. PTSS should be considered in the differential diagnosis for the acutely febrile, systemically ill postoperative patient, even when surgical wounds are deceptively benign in appearance. Early recognition and treatment of PTSS is essential for successful outcome.

Sideswipe elbow fractures

A retrospective review of all cases of sideswipe elbow fractures (SSEFs) treated at two community hospitals from 1982 to 1992 was conducted to determine the functional outcome of the operative treatment of SSEFs. All five injuries involved the left elbow, and they included open fractures of the olecranon, the radius and ulna, the ulna and humerus, the humerus, and traumatic amputation of the arm. Concomitant injuries included three radial nerve palsies and two injuries each to the median nerve, ulnar nerve, and brachial artery. Treatment included irrigation, debridement (repeated if necessary), open reduction and internal fixation, external fixation (one case), and delayed amputation (one case). An average of 130/-10 degrees elbow flexion/extension, and 60/60 degrees supination/pronation was obtained for the three of four patients with reconstructions who returned for follow-up.

Postoperative toxic shock syndrome

PURPOSE

To determine risk factors for postoperative toxic shock syndrome (PTSS), a rare, rapidly progressive, and potentially fatal syndrome associated with postoperative wound infections. Components of PTSS include fever, rash, desquamation, hypotension, and multisystem organ dysfunction.

METHODS

We conducted a retrospective review of all cases of PTSS occurring in 2 community hospitals from 1981 to 1993, following 390,000 surgical procedures.

RESULTS

There were 12 cases of PTSS among the procedures reviewed (0.003%). Orthopedic procedures included excision of accessory navicular and patellar realignment. Wounds ranged from those with scant superficial exudates to those with gross purulence; all cultures yielded Staphylococcus aureus. All tested isolates were susceptible to methicillin or cephalothin. Mean time from surgery to onset of symptoms was 4 days. All patients had sudden onset of fever; mean maximal temperature was 40 degrees C. All patients displayed a rash, most in a truncal "sunburn" pattern. Eleven of 12 patients desquamated. All patients required vigorous fluid resuscitation. All patients survived. No correlation could be demonstrated between PTSS and patient age, sex, preoperative skin preparation or antibiotics, members of surgical team, or duration of procedure.

CONCLUSIONS

Early recognition and treatment of PTSS are essential. No risk factors for PTSS have been identified. PTSS should be considered in the postoperative, acutely febrile, systemically ill patient, though surgical wounds may be deceptively benign in appearance.

A method of pediatric short arm cast application

A method for comfortable and efficient application of pediatric short arm casts is described.

Eikenella corrodens vertebral osteomyelitis. A case report and literature review

A debilitated 73-year-old white man was diagnosed with back pain secondary to acute hematogenous Eikenella corrodens vertebral osteomyelitis on the basis of history and physical examination, radiographs, computed tomography, magnetic resonance imaging, and open biopsy of the L3 vertebral body. A rare cause of vertebral osteomyelitis, possibly reported only once before in the world literature, E. corrodens is a facultative anaerobic gram-negative bacillus and a normal oral inhabitant. E. corrodens should be considered in the differential diagnosis of vertebral osteomyelitis and can be managed with immobilization and long-term intravenous antibiotics.