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Miura T, Miyake T, Okada H, Oiwa H, Mizuno Y, Kitagawa Y, Fukuta T, Okamoto H, Shiba M, Kanda N, Yoshida T, Yoshida S, Ogura S. Treatment strategy for compartment syndrome at multiple regions due to injuries caused by a tree fall: a case report. Int J Emerg Med 2024; 17:89. [PMID: 39009971 PMCID: PMC11250945 DOI: 10.1186/s12245-024-00675-5] [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: 02/25/2024] [Accepted: 07/05/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Compartment syndrome commonly occurs in patients with forearm and lower leg fractures. Compartment syndromes of the gluteal and thigh muscles are less common. It is imperative that compartment syndrome be diagnosed and treated with fasciotomy as soon as possible. However, there are few reports on the diagnosis and treatment strategies for compartment syndromes that occur simultaneously in multiple anatomical regions or in the ipsilateral gluteal region and thigh. CASE PRESENTATION We report on a 76-year-old man who was obliquely crushed under a tree extending from the right forearm to the left groin. He was brought to our emergency room, where he was diagnosed with compartment syndrome of the right forearm and left lower leg and crush syndrome. Emergency fasciotomy was performed. On the day after admission, swelling and tightness of the left gluteal thigh became apparent, and intracompartmental pressures were elevated, which led to an additional diagnosis of these compartment syndromes. A fasciotomy was performed, the gluteal skin incision was made according to the Kocher-Langenbeck approach (one of the posterior approaches for hip fractures), and the thigh was approached by extending the incision laterally. This surgical approach enabled the decompression of the compartments through a single incision and allowed for easier wound treatment and closure. CONCLUSION This case highlights the diagnosis and treatment of compartment syndrome in four anatomical regions. Extension of the Kocher-Langenbeck approach to the lateral thigh can be a useful surgical approach for ipsilateral gluteal and thigh compartment syndrome.
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Affiliation(s)
- Tomotaka Miura
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan
| | - Takahito Miyake
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan.
| | - Hideshi Okada
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan
| | - Hideaki Oiwa
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan
| | - Yosuke Mizuno
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan
| | - Yuichiro Kitagawa
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan
| | - Tetsuya Fukuta
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan
| | - Haruka Okamoto
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan
| | - Masato Shiba
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan
| | - Norihide Kanda
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan
| | - Takahiro Yoshida
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan
| | - Shozo Yoshida
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan
| | - Shinji Ogura
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan
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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 2024; 49:505-510. [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] [MESH Headings] [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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Okazaki M, Bando H, Terasaki A, Ueda A, Iguchi-Manaka A, Mathis BJ, Hara H. Safety and Efficacy of Compression Therapy to Prevent Chemotherapy-Induced Peripheral Neuropathy in Lower Extremities of Breast Cancer Patients: A Pilot Study. Cureus 2024; 16:e60998. [PMID: 38910688 PMCID: PMC11193973 DOI: 10.7759/cureus.60998] [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: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
Background Chemotherapy-induced peripheral neuropathy (CIPN) is a problematic adverse event for breast cancer patients receiving taxane antimitotic agents. We evaluated the effectiveness of compression therapy against CIPN in the lower extremities of breast cancer patients receiving taxanes. Methods Eligible patients scheduled for perioperative treatment with taxanes for early-stage breast cancer were enrolled. Each patient wore latex-free surgical gloves and compression socks, putting on two layers of each 15 minutes before the administration of taxanes and removing them 15 minutes after administration. Peripheral neuropathy (PN) was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 and the Patient Neurotoxicity Questionnaire (PNQ). The primary endpoint was the incidence of CTCAE version 4.0 grade 2 or higher CIPN in the lower extremities during the entire period of perioperative chemotherapy with taxanes. Results PN assessment by CTCAE in the lower extremities, the primary outcome, showed that 13.3% developed grade 2 sensory disturbances, and 8.3% developed grade 2 motor disturbances. The incidence of CTCAE grade 2 or higher PN in the hands was 26.7% for sensory disturbances and 13.3% for motor disturbances during the entire study period. No patient had grade 3 or higher PN. No adverse events due to compression therapy were observed. Conclusion Compression of the lower extremities with compression socks tended to reduce the incidence of CIPN compared to the general incidence. Compression therapy may help prevent the development of CIPN.
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Affiliation(s)
- Mai Okazaki
- Department of Breast and Endocrine Surgery, University of Tsukuba Hospital, Tsukuba, JPN
| | - Hiroko Bando
- Department of Breast and Endocrine Surgery, University of Tsukuba Hospital, Tsukuba, JPN
| | - Azusa Terasaki
- Department of Breast and Endocrine Surgery, University of Tsukuba Hospital, Tsukuba, JPN
| | - Aya Ueda
- Department of Breast and Endocrine Surgery, University of Tsukuba Hospital, Tsukuba, JPN
| | - Akiko Iguchi-Manaka
- Department of Breast and Endocrine Surgery, University of Tsukuba Hospital, Tsukuba, JPN
| | - Bryan J Mathis
- Department of Cardiology, International Medical Center, University of Tsukuba Hospital, Tsukuba, JPN
| | - Hisato Hara
- Department of Breast and Endocrine Surgery, University of Tsukuba Hospital, Tsukuba, JPN
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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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Lamour D, Bruno TW, Shih RD, Solano JJ, Alter SM. Exogenous Peptide Injection Causing Medical Thigh Compartment Syndrome. J Emerg Med 2024; 66:e526-e529. [PMID: 38461135 DOI: 10.1016/j.jemermed.2023.11.025] [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: 07/12/2023] [Revised: 11/12/2023] [Accepted: 11/23/2023] [Indexed: 03/11/2024]
Abstract
BACKGROUND Acute compartment syndrome can be caused by any condition that increases the pressure of an intracompartmental muscular space, resulting in ischemia, which is a limb-threatening emergency. This case report is the first known documented example of an exogenously injected peptide causing compartment syndrome. The use of natural supplements and holistic therapies is on the rise, specifically, peptide injections. It is important to obtain the history of use and routes of administration of these substances. CASE REPORT We present a case of a 43-year-old man who presented to the Emergency Department with worsening thigh pain. The patient had injected a "peptide cocktail" into his thigh 3 days prior. Physical examination revealed trace pitting edema of the left leg with moderate muscle spasm and tenderness of the medial aspect of the distal thigh with associated numbness along the medial aspect of the knee. Point-of-care ultrasound detected intramuscular edema and free fluid in the leg. He was found to have acute compartment syndrome of the thigh secondary to the peptide cocktail injection, causing a large hematoma posterior to the adductor magnus. The patient required fasciotomy and hematoma evacuation. He ultimately left against medical advice during his hospitalization. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In an age when many patients look for supplements to aid with weight loss and muscle growth, it is essential to be aware of peptide injection therapies and the potential complication of compartment syndrome.
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Affiliation(s)
- Daniella Lamour
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida; Department of Emergency Medicine, Bethesda Hospital East, Boynton Beach, Florida; Department of Emergency Medicine, Delray Medical Center, Delray Beach, Florida
| | - Tony W Bruno
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida; Department of Emergency Medicine, Bethesda Hospital East, Boynton Beach, Florida; Department of Emergency Medicine, Delray Medical Center, Delray Beach, Florida
| | - Richard D Shih
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida; Department of Emergency Medicine, Delray Medical Center, Delray Beach, Florida
| | - Joshua J Solano
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida; Department of Emergency Medicine, Bethesda Hospital East, Boynton Beach, Florida; Department of Emergency Medicine, Delray Medical Center, Delray Beach, Florida
| | - Scott M Alter
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida; Department of Emergency Medicine, Bethesda Hospital East, Boynton Beach, Florida; Department of Emergency Medicine, Delray Medical Center, Delray Beach, Florida.
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Shujauddin M, Hantouly AT, Moghamis I, Alzobi O, Mazhar FV, Mekhaimar MM. Gluteal compartment syndrome secondary to prolonged immobilization following carbon monoxide poisoning associated with leukoencephalopathy: A case report. Heliyon 2024; 10:e26217. [PMID: 38439871 PMCID: PMC10909629 DOI: 10.1016/j.heliyon.2024.e26217] [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: 12/24/2022] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Gluteal compartment syndrome (GCS) is a rare diagnosis that results mostly from a non-traumatic etiology. We describe a case of a gluteal compartment syndrome, complicated with sciatic nerve palsy. Case presentation This paper reported a case of gluteal compartment syndrome caused by prolonged immobilization due to carbon monoxide poisoning. The case was complicated with sciatic nerve palsy and a sequala of leukoencephalopathy. Discussion and conclusion This case report highlighted the importance of having a high suspicion for gluteal compartment syndrome in patients with history of lying down with prolonged immobilization. The diagnosis can be made solely on clinical examination and a fasciotomy must be performed with no delay.
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Affiliation(s)
- Mohammad Shujauddin
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf T. Hantouly
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Isam Moghamis
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Osama Alzobi
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fuad Vayalil Mazhar
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Maged Mekhaimar
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Schupbach D, Reindl R, Gill HL, Liberman AS, Harvey EJ. Continuous Compartment Pressure Monitoring Allows the Early Detection of Compartment Syndrome After Arterial Revascularization. Cureus 2024; 16:e55451. [PMID: 38571834 PMCID: PMC10988544 DOI: 10.7759/cureus.55451] [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: 02/22/2024] [Indexed: 04/05/2024] Open
Abstract
Compartment syndrome (CS) occurs in several clinical scenarios. Reperfusion injury and tissue swelling are common causes. This can occur after trauma but also is seen post revascularization of extremities. CS is a difficult diagnosis to make in a timely fashion that avoids permanent tissue damage. The treatment for CS is immediate fasciotomy, but fasciotomy is not a complication-free procedure. Previous care pathways usually resulted in fasciotomy being performed in a disproportionate number of normal legs. These false positives and prophylactic releases are costly to the health system because of protracted hospital stays and increased surgery numbers. The desirable tool for surgeons would be one that decreases false positives and negatives while ensuring a diagnosis in a timely fashion with true positives. A new technology that allows continuous pressure monitoring seems to be the best aid to make a diagnosis. We present our experience in decreasing the time to diagnosis in a CS case post revascularization despite the neurological blockade.
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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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Hobayan CGP, Bates NA, Heyniger J, Alzouhayli K, Piscitani F, Haider CR, Felton C, Groth AT, Martin KD. Stability of One-Step Spray-on Splint for Lower Extremity Fractures During Splinting, MEDEVAC, and Impact. Mil Med 2024:usae001. [PMID: 38294066 DOI: 10.1093/milmed/usae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/26/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION Military transport can induce whole-body vibrations, and combat almost always involves high impact between lower extremities and the ground. Therefore, robust splinting technology is necessary for lower extremity fractures in these settings. Our team compared a novel one-step spray-on foam splint (FastCast) to the current military standard structured aluminum malleable (SAM) splint. MATERIALS AND METHODS Ten cadaveric specimens were subjected to complete tibia/fibula osteotomy. Specimens were fitted with custom accelerometer and gyroscope sensors superior and inferior to the fracture line. Each specimen underwent fracture and splinting from a standard of care SAM splint and an experimental FastCast spray foam splint in a randomized order. Each specimen was manually transported to an ambulance and then released from a 1 meter height to simulate impact. The custom sensors recorded accelerations and rotations throughout each event. Repeated-measures Friedman tests were used to assess differences between splint method within each event and between sensors within each splint method. RESULTS During splinting, overall summation of change and difference of change between sensors for accelerations and rotations were greater for SAM splints than FastCast across all axes (P ≤ 0.03). During transport, the range of acceleration along the linear superior/inferior axis was greater for SAM splint than FastCast (P = 0.02), as was the range of rotation along the transverse plane (P < 0.01). On impact, the summation of change observed was greater for SAM splint than FastCast with respect to acceleration and rotation on the posterior/anterior and superior/inferior axes (P ≤ 0.03), and the cumulative difference between superior and inferior sensors was greater for SAM than FastCast with respect to anterior-axis rotation (P < 0.05). CONCLUSION FastCast maintains stabilization of fractured lower extremities during transport and impacts to a significantly greater extent than SAM splints. Therefore, FastCast can potentially reduce the risk of fracture complications following physical stressors associated with combat and extraction.
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Affiliation(s)
- C Grace P Hobayan
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Nathaniel A Bates
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43201, USA
| | - John Heyniger
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Kenan Alzouhayli
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Franco Piscitani
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43201, USA
| | - Clifton R Haider
- Special Purpose Processor Development Group, Mayo Clinic, Rochester, MN 55905, USA
| | - Christopher Felton
- Special Purpose Processor Development Group, Mayo Clinic, Rochester, MN 55905, USA
| | - Adam T Groth
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43201, USA
| | - Kevin D Martin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43201, USA
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McKenna DP, McCarthy C, Higgins T. Isolated Extensor Hallucis Longus Compartment Syndrome: A Case Report. Cureus 2024; 16:e51772. [PMID: 38192525 PMCID: PMC10772309 DOI: 10.7759/cureus.51772] [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: 01/06/2024] [Indexed: 01/10/2024] Open
Abstract
We present the case of an isolated extensor hallucis longus compartment syndrome following a diaphyseal fibular fracture. Our subject underwent syndesmotic fixation and experienced ongoing pain post-procedure. This was associated with an isolated loss of power in extension of the hallux. A diagnosis of an isolated extensor hallucis longus compartment syndrome followed. Our case highlights the vulnerability of this muscle belly to ischemia and reiterates the value of complete clinical examination in the postoperative patient.
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Affiliation(s)
- Daniel P McKenna
- Surgery, Royal College of Surgeons in Ireland, Dublin, IRL
- Trauma and Orthopaedics, University Hospital Kerry, Tralee, IRL
| | - Cathal McCarthy
- Trauma and Orthopaedics, University Hospital Kerry, Tralee, IRL
| | - Tony Higgins
- Trauma and Orthopaedics, University Hospital Kerry, Tralee, IRL
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11
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Arnold J, Koyfman A, Long B. High risk and low prevalence diseases: Acute limb ischemia. Am J Emerg Med 2023; 74:152-158. [PMID: 37844359 DOI: 10.1016/j.ajem.2023.09.052] [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: 06/05/2023] [Revised: 08/26/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Acute limb ischemia is a rare but serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of acute limb ischemia, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Acute limb ischemia is defined as a sudden decrease in limb perfusion resulting in cessation of blood flow and nutrient and oxygen delivery to the tissues. This leads to cellular injury and necrosis, ultimately resulting in limb loss and potentially systemic symptoms with significant morbidity and mortality. There are several etiologies including native arterial thrombosis, arterial thrombosis after an intervention, arterial embolus, and arterial injury. Patients with acute limb ischemia most commonly present with severe pain and sensory changes in the initial stages, with prolonged ischemia resulting in weakness, sensory loss, and color changes to the affected limb. The emergency clinician should consult the vascular specialist as soon as ischemia is suspected, as the diagnosis should be based on the history and examination. Computed tomography angiography is the first line imaging modality, as it provides valuable information concerning the vasculature and surrounding tissues. Doppler ultrasound of the distal pulses may also be obtained to evaluate for arterial and venous flow. Once identified, management includes intravenous unfractionated heparin and vascular specialist consultation for revascularization. CONCLUSIONS An understanding of acute limb ischemia can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Jacob Arnold
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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12
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Bouklouch Y, Bernstein M, Bosse M, Cota A, Duckworth AD, Dunbar RP, Gamulin A, Guy P, Hak DJ, Haller JM, Hayda R, Jarragh A, Johnstone AJ, Karunakar M, Lawendy AR, Leighton R, Mavrogenis AF, Mauffrey C, Miclau T, Obremskey WT, Renninger C, Sanders DW, Schmidt AH, Schneider P, Sen MK, Taitsman L, Van Lancker H, Harvey EJ. Postfasciotomy Classification System for Acute Compartment Syndrome of the Leg. J Orthop Trauma 2023; 37:581-585. [PMID: 37491711 DOI: 10.1097/bot.0000000000002663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Acute compartment syndrome (ACS) is a true emergency. Even with urgent fasciotomy, there is often muscle damage and need for further surgery. Although ACS is not uncommon, no validated classification system exists to aid in efficient and clear communication. The aim of this study was to establish and validate a classification system for the consequences of ACS treated with fasciotomy. METHODS Using a modified Delphi method, an international panel of ACS experts was assembled to establish a grading scheme for the disease and then validate the classification system. The goal was to articulate discrete grades of ACS related to fasciotomy findings and associated costs. A pilot analysis was used to determine questions that were clear to the respondents. Discussion of this analysis resulted in another round of cases used for 24 other raters. The 24 individuals implemented the classification system 2 separate times to compare outcomes for 32 clinical cases. The accuracy and reproducibility of the classification system were subsequently calculated based on the providers' responses. RESULTS The Fleiss Kappa of all raters was at 0.711, showing a strong agreement between the 24 raters. Secondary validation was performed for paired 276 raters and correlation was tested using the Kendall coefficient. The median correlation coefficient was 0.855. All 276 pairs had statistically significant correlation. Correlation coefficient between the first and second rating sessions was strong with the median pair scoring at 0.867. All surgeons had statistically significant internal consistency. CONCLUSION This new ACS classification system may be applied to better understand the impact of ACS on patient outcomes and economic costs for leg ACS.
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Affiliation(s)
| | | | - Michael Bosse
- Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - Adam Cota
- St Mary's Medical Center-Intermountain Health, Grand Junction, CO
| | | | - Robert P Dunbar
- Harborview Medical Center/University of Washington, Seattle, WA
| | - Axel Gamulin
- University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Guy
- University of British Columbia, Vancouver, BC, Canada
| | - David J Hak
- Hughston Clinic/University of Central Florida, Orlando, FL
| | | | | | - Ali Jarragh
- Kuwait University, Dar Al Shifa Hospital, Kuwait City, Kuwait
| | | | | | | | | | | | | | | | | | | | | | | | - Prism Schneider
- Foothills Orthopaedic Trauma Service, University of Calgary, Calgary, AB, Canada
| | - Milan K Sen
- NYC Health+Hospitals/Jacobi, New York, NY; and
| | - Lisa Taitsman
- Harborview Medical Center/University of Washington, Seattle, WA
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13
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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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14
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Xing G, Wang J, Jiang W, Ge N, Zhu Y, Wang Y. Value of Multimodality Ultrasound in Quantitative Evaluation of the Intra-compartmental Pressure and Perfusion Pressure in Acute Compartment Syndrome in a Rabbit Model. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1837-1844. [PMID: 37268554 DOI: 10.1016/j.ultrasmedbio.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/23/2023] [Accepted: 04/21/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim of the work described here was to investigate the feasibility of using multimodality ultrasound in quantitative evaluation of the intra-compartmental pressure (ICP) and perfusion pressure (PP) changes in acute compartment syndrome (ACS). METHODS Infusion technique was used to increase the ICP of the anterior compartment of 10 rabbits from baseline to 20, 30, 40, 50, 60, 70 and 80 mmHg. The anterior compartment was evaluated with conventional ultrasound, shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS). The shape of the anterior compartment, shear wave velocity (SWV) of the tibialis anterior (TA) muscle and CEUS parameters of the TA muscle were measured. RESULTS When the ICP exceeded 30 mmHg, the shape of the anterior compartment did not expand significantly with increasing ICP. There was a strong correlation between the SWV of TA muscle and measured ICP (ρ = 0.927). Arrival time (AT), time to peak (TTP), peak intensity (PI) and area under the curve (AUC) were significantly correlated with PP (AT, ρ = -0.763; TTP, ρ = -0.900; PI, ρ = 0.665; AUC, ρ = 0.706), whereas mean transit time (MTT) was not. CONCLUSION Multimodality ultrasound can be used to quantitatively evaluate ICP and PP and, thus, could provide more information for the rapid diagnosis and monitoring of ACS.
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Affiliation(s)
- Guanghui Xing
- Chinese People's Liberation Army (PLA) Medical School, Fuxing Road 28, Beijing 100853, China
| | - Jing Wang
- Chinese People's Liberation Army (PLA) Medical School, Fuxing Road 28, Beijing 100853, China
| | - Wenli Jiang
- Chinese People's Liberation Army (PLA) Medical School, Fuxing Road 28, Beijing 100853, China
| | - Naiqiao Ge
- Chinese People's Liberation Army (PLA) Medical School, Fuxing Road 28, Beijing 100853, China
| | - Yaqiong Zhu
- Chinese People's Liberation Army (PLA) Medical School, Fuxing Road 28, Beijing 100853, China
| | - Yuexiang Wang
- Chinese People's Liberation Army (PLA) Medical School, Fuxing Road 28, Beijing 100853, China.
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15
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Farah O, Farah G, Mumuni S, Volchenko E, Hutchinson MR. Acute Compartment Syndrome in the Athlete. Clin Sports Med 2023; 42:525-538. [PMID: 37208063 DOI: 10.1016/j.csm.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In sports, acute compartment syndrome (ACS) develops following lower limb fracture, with subsequent high intracompartmental pressures and pain out of proportion to the physical examination. A prompt diagnosis is the key to a successful outcome in patients with ACS. The goal of treatment of ACS, namely decompressive fasciotomy, is to reduce intracompartmental pressure and facilitate reperfusion of ischemic tissue before onset of necrosis. A delay in diagnosis and treatment may result in devastating complications, including permanent sensory and motor deficits, contractures, infection, systemic organ failure, limb amputation, and death.
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Affiliation(s)
- Omar Farah
- Columbia University Vagelos College of Physicians and Surgeons
| | - Ghassan Farah
- Department of Orthopaedic Surgery, University of Illinois, Chicago, USA
| | - Salma Mumuni
- Department of Orthopaedic Surgery, University of Illinois, Chicago, USA
| | - Elan Volchenko
- Department of Orthopaedic Surgery, University of Illinois, Chicago, USA
| | - Mark R Hutchinson
- Department of Orthopaedic Surgery, University of Illinois, Chicago, USA.
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16
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Benabbouha A, Benyass Y, Sallahi H, Margad O. An exceptional challenging case: Anterior shoulder dislocation with ipsilateral humeral shaft fracture complicated with an upper extremity compartment syndrome. Int J Surg Case Rep 2023; 106:108237. [PMID: 37086505 PMCID: PMC10154735 DOI: 10.1016/j.ijscr.2023.108237] [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: 03/06/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 04/24/2023] Open
Abstract
INTRODUCTION Combination of shoulder dislocation with ipsilateral shaft humeral fracture is extremely rare and the occurrence of upper extremity compartment syndrome as a complication is even rarer. CASE PRESENTATION A 36-year-old male, sustained a road traffic accident as a pedestrian struck by a vehicle. He was diagnosed with an anterior dislocation of the right shoulder with an ipsilateral open transverse fracture of the middle third of the humeral shaft. He was treated with closed reduction and Hackethal bundle nailing. The next day, the patient developed acute compartment syndrome and underwent multiple fasciotomy. DISCUSSION This particular combination represents a great surgical challenge in orthopedics and there is no clear consensus until now regarding its management. We review the mechanism and the appropriate treatment of this injury. CONCLUSION We think it is critical to emphasize the original character of our case, because it is probably the first report to describe this special injury associated with upper extremity compartment syndrome.
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Affiliation(s)
- Abdellatif Benabbouha
- Department of Orthopaedics, Military Training Hospital Avicenne, University Cadi Ayyad, BP 40150 Marrakech, Morocco.
| | - Youssef Benyass
- Department of Orthopaedics, Military Training Hospital Avicenne, University Cadi Ayyad, BP 40150 Marrakech, Morocco
| | - Hicham Sallahi
- Department of Orthopaedics, Military Training Hospital Avicenne, University Cadi Ayyad, BP 40150 Marrakech, Morocco
| | - Omar Margad
- Department of Orthopaedics, Military Training Hospital Avicenne, University Cadi Ayyad, BP 40150 Marrakech, Morocco
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17
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Wang T, Yang S, Guo J, Long Y, Hou Z. Predictors of muscle necrosis in patients with acute compartment syndrome. INTERNATIONAL ORTHOPAEDICS 2023; 47:905-913. [PMID: 36715712 PMCID: PMC9885051 DOI: 10.1007/s00264-023-05699-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE The predictors of muscle necrosis after acute compartment syndrome (ACS) remain debated. This study aimed to investigate the predictors for muscle necrosis in ACS patients. METHODS We collected data on ACS patients following fractures from January 2010 to November 2022. Patients were divided into the muscle necrosis group (MG) and the non-muscle necrosis group (NG). The demographics, comorbidities, and admission laboratory indicators were computed by univariate analysis, logistic regression analysis, and receiver-operating characteristic (ROC) curve analysis. RESULTS In our study, the rate of MN was 37.6% (83 of 221). Univariate analysis showed that numerous factors were associated with muscle necrosis following ACS. Logistic regression analysis indicated that crush injury (p = 0.007), neutrophil (NEU, p = 0.001), creatine kinase myocardial band (CKMB, p = 0.047), and prothrombin time (PT, p = 0.031) were risk factors. Additionally, ROC curve analysis identified 11.415 109/L, 116.825 U/L, and 12.51 s as the cut-off values for NEU, CKMB, and PT to predict muscle necrosis, respectively. Furthermore, the combination of NEU, CKMB, and PT had the highest diagnostic accuracy. CONCLUSIONS Our findings showed that crush injury and the level of NEU, CKMB, and PT were risk factors for muscle necrosis after ACS. Additionally, we also identified the cut-off values of NEU, CKMB, and PT and found the combination of crush injury, PT, and NEU with the highest diagnostic accuracy, helping us individualize the assessment risk of muscle necrosis to manage early targeted interventions.
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Affiliation(s)
- Tao Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Shuo Yang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Yubin Long
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China.
- The Third Department of Orthopedics, Baoding First Central Hospital, Baoding, Hebei, People's Republic of China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China.
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Agrawal P, Girish M, Ramanathan AT, Sudhakaran M, Murali S. Compartment Syndrome and Its Validation in Skeletal Injuries. INTERNATIONAL JOURNAL OF RECENT SURGICAL AND MEDICAL SCIENCES 2023. [DOI: 10.1055/s-0043-1761415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Abstract
Background Compartment syndrome, a potential limb-threatening condition in acute traumatic situations following different modalities of injury, may lead to irreversible damage or even life risk later. Its differential time-bound clinical presentation with added observer bias on available invasive and noninvasive diagnostic modalities influences the decision-making and undue delay for early intervention toward limb salvage procedure.
Results Thirty-two patients were included in our study with mean age of 36; males (18; 56.3%) were more injured than females (14; 43.8%) and left limb (17; 53.1%) was more involved than right (15; 46.9%). Mean calf muscle measurement of total injured limb with relation to immediate time was 39.9 cm, after 1 hour was 40.69 cm, after 2 hours was 41.06 cm, and after 3 hours was 41.40 cm; 95% confidence interval was found to be statistically significant. Three patients (9%) underwent emergency decompression fasciotomy, with an average mean of 41.4 cm for injured limbs against 38.5 cm in control limb.
Conclusion Compartment syndrome is an acute emergency with potential irreversible damage when undiagnosed. Bias on diagnosis evolves around observer skills and clinical invasive and noninvasive methods, with differential statistical results pertaining to its decision-making for emergency fasciotomy.
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Affiliation(s)
- Prabhat Agrawal
- Associate Prof, Orthopaedics, AIIMS Patna, Phulwari Sharif, Patna, Bihar, India
| | - M Girish
- Asst Prof Orthopaedics, SMMCH&RI, Chennai, Tamil Nadu, India
| | | | - M Sudhakaran
- Constultant Spine Surgeon Royal Care Super Speciality Hospital, Coimbatore, Tamil Nadu, India
| | - S.M Murali
- Asst Prof Orthopaedics, SMMCH&RI, Chennai, Tamil Nadu, India
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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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20
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Yıldırım A, Önal İÖ, Çelik ZE, Vatansev H, Hataysal EP. Early assessment of extremity compartment syndrome by biochemical markers in a rat model. Turk J Med Sci 2023; 53:1-9. [PMID: 36945953 PMCID: PMC10387976 DOI: 10.55730/1300-0144.5552] [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: 10/06/2020] [Accepted: 10/10/2022] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND This experimental study aimed to define a biochemical marker that will enable early diagnosis of acute compartment syndrome (ACS) of extremities, a mortal condition that occurs due to trauma. METHODS A total of 15 Wistar rats were included in the study in which saline infusion technique, a clinically compatible ACS model, was applied. After the rats were anesthetized with ketamine-xylazine, the in-compartment pressure of the hind limb was slowly increased with saline delivered through the angiocatheter, and after reaching the target compartment pressure, the pressure level was kept with a rubber tourniquet. The in-compartment pressure level was continuously monitored with a pressure transducer. The rats were divided into three groups. No intervention was applied to the control group (CG) (n = 3). In study group 1 (SG1) (n = 6), ACS was created using the saline infusion technique, keeping the in-compartment pressure between 30 and 40 mmHg for 45 min. In study group 2 (SG2) (n = 6), ACS was created using the saline infusion technique, keeping the in-compartment pressure between 30 and 40 mmHg for 90 min. Fasciotomy was performed on all rats. Tissue samples were obtained for histopathological examination and blood samples for biochemical analysis. RESULTS Total oxidant status (TOS) (p = 0.004), ischemia-modified albumin (IMA) (p = 0.030), aspartate transferase (AST) (p = 0.003) and neopterin (p = 0.012) levels differed significantly between groups in the early period of muscle ischemia. In fact, TOS levels differed significantly between the groups even in the cellular phase where signs of ischemia were not observed (p = 0.048, p = 0.024). According to histopathological evaluation, there was no significant difference between the groups. DISCUSSION TOS can be detected in the early reversible stage of ischemia, when the histopathological findings of ACS do not occur.
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Affiliation(s)
- Ahmet Yıldırım
- Department of Orthopedics and Traumatology, Medova Private Hospital, Konya, Turkey
| | - İbrahim Özkan Önal
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Zeliha Esin Çelik
- Department of Pathology, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Hüsamettin Vatansev
- Department of Biochemistry, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Esra Paydaş Hataysal
- Department of Biochemistry, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Turkey
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Meyers A, Pandey S, Kopparthy V, Sadeghi P, Clark RC, Figueroa B, Dasarathy S, Brunengraber H, Papay F, Rampazzo A, Bassiri Gharb B. Weight gain is an early indicator of injury in ex vivo normothermic limb perfusion (EVNLP). Artif Organs 2023; 47:290-301. [PMID: 36305734 PMCID: PMC10100395 DOI: 10.1111/aor.14442] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/25/2022] [Accepted: 10/11/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE There are no established criteria for discontinuing ex vivo normothermic limb perfusion (EVNLP) before irreversible damage occurs. This study evaluates weight gain as an indicator of injury during EVNLP. METHODS Sixteen Yorkshire pig forelimbs were procured and preserved using EVNLP with a hemoglobin-based oxygen carrier (HBOC-201) or static cold storage. EVNLP continued until termination criteria were met: arterial pressure ≥ 115 mm Hg, compartment pressure > 30 mm Hg, or 20% reduction of oxygen saturation. Limb weight, contractility, hemodynamics, perfusate electrolytes, metabolites and gases were recorded. Muscles were biopsied 6-h, and muscle injury scores (MIS) calculated. Forearm compartment pressures and indocyanine green (ICG) angiography were recorded at endpoint. Outcomes were compared at 2%, 5%, 10%, and 20% limb weight gain. RESULTS EVNLP lasted 20 ± 3 h. Weight gain was observed after 13 ± 5 h (2%), 15 ± 6 h (5%), 16 ± 6 h (10%), and 19 ± 4 h (20%). Weight correlated positively with MIS (ρ = 0.92, p < 0.0001), potassium (ρ = -1.00, p < 0.0001), pressure (ρ = 0.78, p < 0.0001), and negatively with contractility (ρ = -0.96, p = 0.011). At 5% weight gain, MIS (p < 0.0001), potassium (p = 0.03), and lactate (p < 0.0001) were significantly higher than baseline. Median muscle contractility was 5 [3-5] at 2% weight gain, 4 [1-5] at 5%, 3 [0-4] and 2 [0-2] at 10% and 20%, respectively. At 20% weight gain, contractility was significantly lower than baseline (p = 0.003). Percent weight gain correlated negatively with endpoint ICG hoof fluorescence (r = -0.712, p = 0.047). CONCLUSIONS Weight gain correlated with microscopic muscle injury and was the earliest evidence of limb dysfunction. Weight gain may serve as a criterion for discontinuation of EVNLP.
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Affiliation(s)
- Abigail Meyers
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sonia Pandey
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Varun Kopparthy
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Payam Sadeghi
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Brian Figueroa
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Srinivasan Dasarathy
- Department of Gastroenterology, Hepatology, Pathobiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Henri Brunengraber
- Department of Nutrition and Biochemistry, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Francis Papay
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Antonio Rampazzo
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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22
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Wang T, Long Y, Ma L, Dong Q, Li Y, Guo J, Jin L, Di L, Zhang Y, Wang L, Hou Z. Single-cell RNA-seq reveals cellular heterogeneity from deep fascia in patients with acute compartment syndrome. Front Immunol 2023; 13:1062479. [PMID: 36741388 PMCID: PMC9889980 DOI: 10.3389/fimmu.2022.1062479] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction High stress in the compartment surrounded by the deep fascia can cause acute compartment syndrome (ACS) that may result in necrosis of the limbs. The study aims to investigate the cellular heterogeneity of the deep fascia in ACS patients by single-cell RNA sequencing (scRNA-seq). Methods We collected deep fascia samples from patients with ACS (high-stress group, HG, n=3) and patients receiving thigh amputation due to osteosarcoma (normal-stress group, NG, n=3). We utilized ultrasound and scanning electron microscopy to observe the morphologic change of the deep fascia, used multiplex staining and multispectral imaging to explore immune cell infiltration, and applied scRNA-seq to investigate the cellular heterogeneity of the deep fascia and to identify differentially expressed genes. Results Notably, we identified GZMK+interferon-act CD4 central memory T cells as a specific high-stress compartment subcluster expressing interferon-related genes. Additionally, the changes in the proportions of inflammation-related subclusters, such as the increased proportion of M2 macrophages and decreased proportion of M1 macrophages, may play crucial roles in the balance of pro-inflammatory and anti-inflammatory in the development of ACS. Furthermore, we found that heat shock protein genes were highly expressed but metal ion-related genes (S100 family and metallothionein family) were down-regulated in various subpopulations under high stress. Conclusions We identified a high stress-specific subcluster and variations in immune cells and fibroblast subclusters, as well as their differentially expressed genes, in ACS patients. Our findings reveal the functions of the deep fascia in the pathophysiology of ACS, providing new approaches for its treatment and prevention.
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Affiliation(s)
- Tao Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Yubin Long
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Lijie Ma
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Qi Dong
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Yiran Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Junfei Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Lin Jin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Luqin Di
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China,National Health Commission (NHC) Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ling Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China,Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,*Correspondence: Zhiyong Hou, ; Ling Wang,
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China,National Health Commission (NHC) Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,*Correspondence: Zhiyong Hou, ; Ling Wang,
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23
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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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24
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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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25
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Yang S, Wang T, Long Y, Guo J, Hou Z. Risk Factors of Deep Vein Thrombosis in Adults with Acute Compartment Syndrome Following Lower Extremity Fractures. Clin Appl Thromb Hemost 2023; 29:10760296231165053. [PMID: 36941784 PMCID: PMC10034347 DOI: 10.1177/10760296231165053] [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: 03/23/2023] Open
Abstract
This study aimed to identify the risk factors of deep vein thrombosis (DVT) in adults with acute compartment syndrome (ACS) following lower extremity fractures. We collected data on adults with ACS following lower extremity fractures in our hospital from November 2013 to January 2021. Patients were divided into the DVT group and the non-DVT group according to whether they had DVT or not. The demographics, comorbidities, and admission laboratory examinations were computed by univariate analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis. In our study, the rate of DVT (26 of 110) was 23.6%. Univariate analysis showed that numerous factors were associated with the formation of DVT. Logistic regression analysis showed that patients with multiple fractures (P = .015, OR = 5.688), patients with a history of hypertension (P = .011, OR = 16.673), and patients with a higher BMI (P = .008, OR = 1.950) and FDP (P = .013, OR = 1.031) were relevant predictors of DVT. ROC curve analysis indicated 24.73 kg/m2 and 28.33 μg/mL were the cutoff values of BMI and FDP to predict the DVT, respectively. Furthermore, the combination of BMI and FDP had the highest diagnostic accuracy. Our findings identified multiple fractures, BMI, and FDP as independent risk factors for DVT in patients with ACS following lower extremity fractures and determined the cutoff values of BMI and FDP, helping us individualize the assessment of the risk of DVT to manage early targeted interventions.
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Affiliation(s)
- 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
| | - Tao Wang
- 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
| | - 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, 592469Baoding First Central Hospital, Baoding, Hebei, P.R. China
| | - Junfei Guo
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, P.R. 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)
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26
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Gong DC, Patel V, Farrar N, Hake ME, Perdue AM, Ahn J. Compartment Syndrome After Tibial Intramedullary Nail Removal and Intramedullary Debridement: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00064. [PMID: 36927886 DOI: 10.2106/jbjs.cc.22.00365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
CASE A 45-year-old man who sustained an open tibial shaft fracture treated with intramedullary (IM) nailing 9 years earlier presented with persistent pain and concern for occult infection. He underwent tibial nail removal and debridement with reamer-irrigator-aspirator. Postoperative course was complicated by acute compartment syndrome. CONCLUSION This is a unique case of postoperative compartment syndrome after IM debridement and tibial hardware removal. A high index of suspicion should be prioritized in patients who complain of severe or unexpected pain to mitigate delays in diagnosis and aid in early treatment.
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Affiliation(s)
- Davin C Gong
- Department of Orthopaedic Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
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27
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Liu S, Wang C, Song W, Wang J, Zhao S. A case report of delayed treatment of acute exertional osteofascial compartment syndrome in the anterior compartment of the calf. Medicine (Baltimore) 2022; 101:e32449. [PMID: 36596050 PMCID: PMC9803468 DOI: 10.1097/md.0000000000032449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Acute exertional osteofascial compartment syndrome (OCS) is a rare cause of lower-leg pain and is often associated with delayed diagnosis, which can lead to irreversible muscle and nerve damage. PATIENT CONCERNS A 23-year-old man presented with acute-onset anterior calf pain and ankle dorsiflexion after hiking. DIAGNOSIS The patient's pain was initially diagnosed as muscle strain at a county hospital, but was eventually diagnosed as OCS at our hospital 8 days after the injury. This case presents several challenges in the diagnosis and treatment phases. INTERVENTIONS Three surgeries were performed in total. On the day after admission (9 days after injury), fasciotomy was performed, followed by vacuum sealing drainage (VSD). Six days after the first surgery, necrotic muscle debridement was performed and VSD was reperformed. Ten days after the second surgery, the covering foam material was removed and the incision was sutured. OUTCOMES Satisfactory postoperative results were achieved. The erythrocyte sedimentation rate, C-reactive protein level, and white blood cell count were within normal ranges. The skin healed well, and nerve damage and muscle strength improved significantly 3 months after surgery. LESSONS OCS in the absence of trauma or fracture is rare, but treatment delays can have devastating consequences. Acute nontraumatic OCS requires prompt diagnosis and surgical intervention to prevent adverse outcomes. VSD is an effective surgical treatment for this disease.
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Affiliation(s)
- Shiwei Liu
- Joint Surgery Department, the First Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Congcong Wang
- Joint Surgery Department, the First Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Wenjing Song
- Oncology Department, the First Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Jun Wang
- Joint Surgery Department, the First Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Shibo Zhao
- Joint Surgery Department, the First Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
- *Correspondence: Shibo Zhao, Joint Surgery Department, the First Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261000, China (e-mail: )
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28
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Acute compartment syndrome after restarting warfarin therapy following polyethylene exchange in unicompartmental knee arthroplasty: case report. Heliyon 2022; 8:e11838. [DOI: 10.1016/j.heliyon.2022.e11838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/01/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
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29
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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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30
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Novak M, Penhaker M, Raska P, Pleva L, Schmidt M. Extremity compartment syndrome: A review with a focus on non-invasive methods of diagnosis. Front Bioeng Biotechnol 2022; 10:801586. [PMID: 35923576 PMCID: PMC9340208 DOI: 10.3389/fbioe.2022.801586] [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: 10/25/2021] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
The article deals with an overview of acute extremity compartment syndrome with a focus on the option of non-invasive detection of the syndrome. Acute extremity compartment syndrome (ECS) is an urgent complication that occurs most often in fractures or high-energy injuries. There is still no reliable method for detecting ECS. The only objective measurement method used in clinical practice is an invasive measurement of intramuscular pressure (IMP). The purpose of this paper is to summarize the current state of research into non-invasive measurement methods that could allow simple and reliable continuous monitoring of patients at risk of developing ECS. Clinical trials are currently underway to verify the suitability of the most studied method, near-infrared spectroscopy (NIRS), which is a method for measuring the local oxygenation of muscle compartments. Less explored methods include the use of ultrasound, ultrasound elastography, bioimpedance measurements, and quantitative tissue hardness measurements. Finding a suitable method for continuous non-invasive monitoring of the syndrome would greatly improve the quality of care for patients at risk. ECS must be diagnosed quickly and accurately to prevent irreversible tissue damage that can occur within hours of syndrome onset and may even warrant amputation if neglected.
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Affiliation(s)
- Martin Novak
- Trauma Surgery Clinic, University Hospital Ostrava, Ostrava, Czechia
| | - Marek Penhaker
- Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB—Technical University of Ostrava, Ostrava, Czechia
| | - Pavel Raska
- Department of Occupational and Process Safety, Faculty of Safety Engineering, VSB—Technical University of Ostrava, Ostrava, Czechia
| | - Leopold Pleva
- Trauma Surgery Clinic, University Hospital Ostrava, Ostrava, Czechia
| | - Martin Schmidt
- Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB—Technical University of Ostrava, Ostrava, Czechia
- *Correspondence: Martin Schmidt,
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Alssaggaf AA, Alzahrani RA, Alquzi AS, Alghamdi MS, Alhamdan AA. A Case of Acute Compartment Syndrome Resolved Without Surgical Intervention. Cureus 2022; 14:e26761. [PMID: 35967176 PMCID: PMC9365711 DOI: 10.7759/cureus.26761] [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] [Accepted: 07/11/2022] [Indexed: 11/05/2022] Open
Abstract
Acute compartment syndrome (ACS) is often a result of a traumatic event or fractures. Nevertheless, other non-traumatic etiologies may rarely cause ACS. We present a case of a male patient who presented with unilateral below-the-knee pain without trauma or any external factor and was treated conservatively. A diagnosis of idiopathic compartment syndrome was made by MRI.
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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: 10] [Impact Index Per Article: 5.0] [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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Is the Presence of a Psychiatric Disorder Associated With More Aggressive Management of Compartment Syndrome? J Orthop Trauma 2022; 36:e283-e288. [PMID: 34962234 DOI: 10.1097/bot.0000000000002333] [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: 12/20/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether pre-existing psychiatric disorder is associated with potentially unnecessary fasciotomy. DESIGN Retrospective cohort study. SETTING Academic Level-1 trauma center. PATIENTS All the patients with orthopaedic trauma undergoing leg fasciotomy at an academic Level I trauma center from 2006 to 2020. INTERVENTION Pre-existing diagnosis of psychiatric disorder. MAIN OUTCOME MEASUREMENTS Early primary wound closure and delayed primary wound closure. RESULTS In total, 116 patients were included. Twenty-seven patients (23%) had a pre-existing diagnosis of psychiatric disorder with 13 having anxiety, 14 depression, 5 bipolar disorder, and 2 ADHD. Several patients had multiple diagnoses. Fifty-one patients (44%) had early primary closure (EPC), and 65 patients (56%) had delayed primary closure. Of patients with a psychiatric disorder, 52% received EPC compared with 42% of patients without a disorder, P = 0.38. This lack of a strong association did not seem to vary across specific psychiatric conditions. After adjusting for sex, age, injury type, and substance abuse, there was still no significant association between a psychiatric disorder and EPC with an odds ratio of 1.08 (95% CI, 0.43-2.75). CONCLUSIONS Among patients with orthopaedic trauma undergoing emergent fasciotomy for acute compartment syndrome, a psychiatric disorder was not associated with a significantly increased rate of possibly unnecessary fasciotomy. Given the potential for a psychiatric condition to complicate the diagnosis of acute compartment syndrome, this data is somewhat reassuring; however, there remains a need for continued vigilance in treating patients with psychiatric conditions and research in this area. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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34
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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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Nilsson A, Ibounig T, Lyth J, Alkner B, von Walden F, Fornander L, Rämö L, Schmidt A, Schilcher J. BioFACTS: biomarkers of rhabdomyolysis in the diagnosis of acute compartment syndrome - protocol for a prospective multinational, multicentre study involving patients with tibial fractures. BMJ Open 2022; 12:e059918. [PMID: 35501102 PMCID: PMC9062790 DOI: 10.1136/bmjopen-2021-059918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The ischaemic pain of acute compartment syndrome (ACS) can be difficult to discriminate from the pain linked to an associated fracture. Lacking objective measures, the decision to perform fasciotomy is based on clinical findings and performed at a low level of suspicion. Biomarkers of muscle cell damage may help to identify and monitor patients at risk, similar to current routines for patients with acute myocardial infarction. This study will test the hypothesis that biomarkers of muscle cell damage can predict ACS in patients with tibial fractures. METHODS AND ANALYSIS Patients aged 15-65 years who have suffered a tibial fracture will be included. Plasma (P)-myoglobin and P-creatine phosphokinase will be analysed at 6-hourly intervals after admission to the hospital (for 48 hours) and-if applicable-after surgical fixation or fasciotomy (for 24 hours). In addition, if ACS is suspected at any other point in time, blood samples will be collected at 6-hourly intervals. An independent expert panel will assess the study data and will classify those patients who had undergone fasciotomy into those with ACS and those without ACS. All primary comparisons will be performed between fracture patients with and without ACS. The area under the receiver operator characteristics curves will be used to identify the success of the biomarkers in discriminating between fracture patients who develop ACS and those who do not. Logistic regression analyses will be used to assess the discriminative abilities of the biomarkers to predict ACS corrected for prespecified covariates. ETHICS AND DISSEMINATION The study has been approved by the Regional Ethical Review Boards in Linköping (2017/514-31) and Helsinki/Uusimaa (HUS/2500/2000). The BioFACTS study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology recommendations. TRIAL REGISTRATION NUMBER NCT04674592.
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Affiliation(s)
- Abraham Nilsson
- Department of Orthopaedics and Department of Biomedical and Clinical Sciences, Faculty of Health Science, Linköping University Hospital, Linkoping, Sweden
| | - Thomas Ibounig
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, and, University of Helsinki, Helsinki, Finland
| | - Johan Lyth
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Björn Alkner
- Department of Orthopaedics, Eksjö, Region Jönköping County and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ferdinand von Walden
- Division of Pediatric Neurology, Department of Women's and Children's health, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Fornander
- Department of Orthopaedics, Norrköping, Östergötland County and Department of Biomedical and Clinical Sciences in Norrköping, Linköping University, Linköping, Sweden
| | - Lasse Rämö
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, and, University of Helsinki, Helsinki, Finland
| | - Andrew Schmidt
- Department of Orthopaedics, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Jörg Schilcher
- Department of Orthopaedics and Department of Biomedical and Clinical Sciences, Faculty of Health Science, Linköping University Hospital, Linkoping, Sweden
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Comparison of the Effects of Intramedullary Nailing and Plate Fixation on Lower-Extremity Deep Vein Thrombosis after Tibial Fractures. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4852201. [PMID: 35401776 PMCID: PMC8993547 DOI: 10.1155/2022/4852201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 11/18/2022]
Abstract
Lower-extremity deep vein thrombosis (DVT) is prone to occur after internal fixation of tibial fractures. This study analyzed the effect of intramedullary nailing (IMN) and plate fixation (PF) on lower-extremity DVT, providing reliable reference and guidance for future clinical treatment of tibial fractures. Sixty-eight patients with tibial fractures admitted to Honghui Hospital, Xi’an Jiaotong University, between February 2019 and October 2020 were selected as research participants, of which 32 cases treated with open reduction and locking-compression plate fixation were assigned to the FP group and 36 cases treated with closed reduction and interlocking IMN were included in the FN group. The two groups were compared regarding the following items: clinical efficacy, operation, rehabilitation, joint function, pain, inflammatory factors (IFs), incidence of adverse reactions (ARs), blood loss, prognosis, and quality of life (QoL). The related factors affecting the occurrence of DVT were analyzed. The results identified no evident difference in the overall response rate between the two groups (
). The FN group showed longer operation time, higher incidence of ARs, and better rehabilitation, while there were lower incision length, VAS score, and IF levels (
). The results revealed no significant difference in estnimated blood volume(EBV) and the incidence of DVT between the two groups(
); however, the total blood loss (TBL), hidden blood loss (HBL), and blood transfusion rates in FN group were higher while the visible blood loss (VBL) was lower compared to the FP group (
). Logistic regression analysis identified that blood transfusion, VBL, HBL, TBL, and treatment methods were independent risk factors affecting the occurrence of lower-extremity DVT (
). In addition, the prognostic QoL was better in the FN group (
). Therefore, closed reduction and interlocking IMN are more effective than open reduction and locking-compression plate fixation in the treatment of tibial fractures, but patients are more likely to suffer from lower-extremity DVT. In the future, it is necessary to carefully choose the treatment method in the treatment of tibial fracture patients to ensure their rehabilitation.
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Etemad-Rezaie A, Yang S, Kirklys M, Higginbotham DO, Zalikha AK, Nasr K. Single incision fasciotomy for acute compartment syndrome of the leg: A systematic review of the literature. J Orthop 2022; 31:134-139. [PMID: 35586149 PMCID: PMC9108328 DOI: 10.1016/j.jor.2022.04.014] [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] [Received: 01/23/2022] [Revised: 03/29/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022] Open
Abstract
Purpose To review published literature assessing clinical outcomes and complication rates of single incision fasciotomy in fractures of the lower leg. Methods We searched PubMed and EMBASE for articles published through July 5, 2021, using the terms "single incision fasciotomy", "acute compartment syndrome of the limbs", "compartment syndrome fasciotomy", and "(compartment syndrome fasciotomy) AND (incision)". The inclusion criteria were studies of Level I to IV evidence in English, published in 1970 or later, involving human subjects, reporting clinical outcomes of single incision fasciotomy performed in cases of acute compartment syndrome in lower leg fractures, including at least 1 patient. Results Among the 3040 combined total results, 11 primary studies met our inclusion criteria. Adequate and safe compartment release was achieved with single-incision technique. No significant difference was found in terms of complications such as infection and non-union. Conclusions The comparative efficacy and safety of single-incision fasciotomy is relatively equal to the two-incision techniques when evaluated in the literature. However, double-incision fasciotomy remains the predominant surgical technique, widely preferred by surgeons due to the familiarity with the technique and ease of full compartment release. In addition to the actual fasciotomy procedure, data suggests that operative timing, closure and fixation techniques can significantly impact patient outcomes. These findings may be used to guide the orthopedic community when determining the optimal incision-type to use in acute compartment syndrome emergencies for lower-extremity fracture cases in conjunction with closure and fixation techniques.
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A compound presentation resulting in compartment syndrome in a newborn. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Schupbach DE, Nasser Eddine M, Honjol Y, Merle G, Harvey EJ. Percutaneous Forefoot Decompression in a Foot Compartment Syndrome Model. JB JS Open Access 2021; 6:JBJSOA-D-21-00040. [PMID: 34841190 PMCID: PMC8613368 DOI: 10.2106/jbjs.oa.21.00040] [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] [Indexed: 11/23/2022] Open
Abstract
Acute compartment syndrome of the foot is a controversial topic. Release of the foot has been seen as complicated because of large incisions and postoperative morbidity, and there has been debate over whether this procedure is actually effective for releasing all areas of increased pressure. New sensor technology affords the opportunity to advance our understanding of acute compartment syndrome of the foot and its treatment. The purpose of the present study was to determine whether percutaneous decompression could be performed for the treatment of compartment syndrome in a forefoot model.
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Affiliation(s)
- Drew E Schupbach
- Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mohamad Nasser Eddine
- Department of Surgery, Division of Orthopedic Surgery, McGill University, Montreal, Quebec, Canada
| | - Yazan Honjol
- Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Geraldine Merle
- Department of Surgery, Division of Orthopedic Surgery, McGill University, Montreal, Quebec, Canada.,Department of Chemical Engineering, Polytechnique Montréal, Montreal, Quebec, Canada
| | - Edward J Harvey
- Department of Surgery, Division of Orthopedic Surgery, McGill University, Montreal, Quebec, Canada.,Injury Repair and Recovery Program, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
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Developing an in-vivo physiological porcine model of inducing acute atraumatic compartment syndrome towards a non-invasive diagnosis using shear wave elastography. Sci Rep 2021; 11:21891. [PMID: 34750470 PMCID: PMC8576040 DOI: 10.1038/s41598-021-01405-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/20/2021] [Indexed: 12/01/2022] Open
Abstract
Compartment syndrome (CS) is a pathological event caused by elevated intracompartmental pressure (ICP); however, changes from the onset of inducing atraumatic CS remained unclear. The study aimed to investigate the physiological changes in a newly developed in vivo porcine acute atraumatic CS model. CS was induced by ischemia–reperfusion injury in the left hind leg of fourteen pigs divided into an echogenicity group (EG) and a shear wave elastography group (SEG). Echogenicity was measured in EG, and shear elastic modulus (SEM) was measured in SEG seven times before, at the onset of inducing CS, and every 30 min after the onset over eight hours. Simultaneously, ICP, blood pressure, and muscle perfusion pressure (MPP) were also measured in both groups. Our results indicate that SEM of the experimental leg in SEG significantly increased as CS developed compared to the control leg (p = 0.027), but no statistical difference in the echogenicity in EG was found between the experimental leg and control leg. There were also significant correlations between SEM and ICP (p < 0.001) and ICP and MPP (p < 0.001). Our method and findings can be a basis to develop a non-invasive diagnostic tool using a shear wave elastography for atraumatic CS.
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41
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A dual-sensor ultrasound based method for detecting elevated muscle compartment pressures: A prospective clinical pilot study. Injury 2021; 52:2166-2172. [PMID: 33640161 DOI: 10.1016/j.injury.2021.02.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acute compartment syndrome (ACS) is a limb-threatening condition associated with elevated muscle compartment pressures (MCPs). The only existing treatment of ACS is to reduce MCP by fasciotomy; however, a reliable clinical method for detecting elevated MCPs is lacking. A dual-sensor (ultrasound and pressure) technology to detect elevated MCPs was previously tested on cadavers. Our goal was to examine the use of this technology in the clinical setting. METHODS Patients with tibia fractures were prospectively enrolled. Observers used a dual-sensor probe to measure the amount of pressure required to flatten the anterior compartment fascia (CFFP). Direct-MCP measurements and 4-compartment fasciotomy were done for suspected ACS. RESULTS Fifty-two patients were enrolled into the study. Nine patients underwent fasciotomy for a clinical diagnosis of ACS. Both CFFP (p-value = 8.395e-08) and delta-CFFP (p-value = 4.114e-05) were significantly larger in the fasciotomy group compared to the non-fasciotomy group. CFFP measurements showed very strong correlations to the direct MCP measurements (p-value = 0.006746, rho = 0.9285714), and delta-CFFP showed strong correlation (p-value = 0.06627, rho = 0.75). CFFP measurements had good inter-observer variability, with an interclass correlation (ICC) of 0.814 (95%-Confidence Interval: 0.631-0.907) and excellent intra-observer variability with an ICC of 0.942 (95%-Confidence Interval: 0.921-0.958). CONCLUSION The results of this pilot study suggest that the proposed ultrasound-based method is useful in detecting elevated MCPs and may be helpful in the diagnosing ACS or ruling out the need for urgent fasciotomy. Large-scale clinical trials are needed to validate these claims.
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Zare P, Ghoraishian M, Faghih Khorasani A. A three-dimensional model of transient bioheat transfer in the lower extremity during cryotherapy. Proc Inst Mech Eng H 2021; 235:1413-1420. [PMID: 34320861 DOI: 10.1177/09544119211035855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this research was to create a computational model of the human thigh undergoing cryotherapy. The tissue temperatures were measured for five cold pack temperatures of -8°C, -4°C, 0°C, 4°C, and 8°C in addition to six different time intervals of cold application and ice removal. The depth of cold penetration and duration of local tissue cooling were investigated at 10 points during 30 min of application and 7 h of post-application. The model was created in CATIA, using a mid-axial cut of the human thigh MRI without pathology. After validation by the available clinical data, this research applied the finite-volume discretization method to solve bioheat transfer equations. A 16°C decrease in the cold pack temperature reduced the tissue temperatures located 1 and 2 cm below the fat by almost 3.34°C and 1.4°C, respectively, after 30 min of cold application. It took the tissues 10-15 min to start cooling down, and the temperature reached its plateau after 100 min. Thirty minutes of cold application declined the superficial tissue and deep tissue temperatures near the bone by 22.59°C and 0.48°C, respectively. Intense cryotherapy led to an insignificant change in the deep tissue temperature at 2 cm and deeper below the fat tissue. After ice removal, tissues continued cooling down for about 8 min until 40 min, depending on the tissue depth. This study proposed a 100-min cold therapy with 10 min of ice removal to optimize tissue cooling.
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Affiliation(s)
- Parvaneh Zare
- Department of Mechanical Engineering, Yazd University, Yazd, Iran
| | - Mohammad Ghoraishian
- Department of Orthopaedic Surgery, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
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Dwyer T, Burns D, Nauth A, Kawam K, Brull R. Regional anesthesia and acute compartment syndrome: principles for practice. Reg Anesth Pain Med 2021; 46:1091-1099. [PMID: 34187911 DOI: 10.1136/rapm-2021-102735] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/10/2021] [Indexed: 11/04/2022]
Abstract
Acute compartment syndrome (ACS) is a potentially reversible orthopedic surgical emergency leading to tissue ischemia and ultimately cell death. Diagnosis of ACS can be challenging, as neither clinical symptoms nor signs are sufficiently sensitive. The cardinal symptom associated with ACS is pain reported in excess of what would otherwise be expected for the underlying injury, and not reasonably managed by opioid-based analgesia. Regional anesthesia (RA) techniques are traditionally discouraged in clinical settings where the development of ACS is a concern as sensory and motor nerve blockade may mask symptoms and signs of ACS. This Education article addresses the most common trauma and elective orthopedic surgical procedures in adults with a view towards assessing their respective risk of ACS and offering suggestions regarding the suitability of RA for each type of surgery.
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Affiliation(s)
- Tim Dwyer
- Department of Surgery, University of Toronto Division of Orthopaedics, Toronto, Ontario, Canada .,Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada.,Department of Surgery, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - David Burns
- University of Toronto Division of Orthopaedics, Toronto, Ontario, Canada
| | - Aaron Nauth
- Department of Surgery, University of Toronto Division of Orthopaedics, Toronto, Ontario, Canada.,Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Kaitlin Kawam
- University of Toronto Division of Orthopaedics, Toronto, Ontario, Canada
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Tan L, Xia Y, Su Z, Wen Q, Zhang J, Yu T. Brachial muscle injury resulting in acute compartment syndrome of the upper arm: a case report and literature review. BMC Musculoskelet Disord 2021; 22:545. [PMID: 34126979 PMCID: PMC8204510 DOI: 10.1186/s12891-021-04318-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background Acute compartment syndrome (ACS) is a potentially devastating condition. ACS is rare in the upper arm. Case presentation We report a case of acute compartment syndrome of the anterior compartment of the upper arm due to brachial muscle injury. The patient experienced abnormal progressive swelling and pain in his right upper arm, and passive pulling pain of the right wrist and right hand. It was highly suspected to be right upper arm compartment syndrome, and was confirmed by surgery. The patient transferred to the emergency operating room for fasciotomy that was performed under general anesthesia using the anterolateral approach. The brachial muscle was found to be heavily swollen and had the greatest tension. The brachial muscle fibers were split lengthwise, and a large amount of hematoma was cleared. The brachial muscles were injured and partly ruptured. After full decompression, a negative pressure drainage device was used to cover the wound in the first stage. Ten days after injury, the swelling of the affected limb subsided and the wound was sutured. The patient’s limbs completely recovered to normal. The shoulder and elbow joints could move freely and the patient resumed normal farming work ability. Conclusion Clinicians should fully recognize the fact that acute compartment syndrome can occur in the upper arm, rather than only the forearm and leg, and therefore avoid serious consequences caused by missed diagnosis and misdiagnosis.
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Affiliation(s)
- Lei Tan
- Department of Orthopedic Trauma, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Yongning Xia
- Department of Orthopedic Trauma, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Zilong Su
- Department of Orthopedic Trauma, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Qiangqiang Wen
- Department of Orthopedic Trauma, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Jiting Zhang
- Department of Orthopedic Trauma, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China.
| | - Tiecheng Yu
- Department of Orthopedic Trauma, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China.
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Asmar S, Bible L, Chehab M, Obaid O, Castanon L, Yaghi M, Ditillo M, Joseph B. Traumatic Femoral Artery Injuries and Predictors of Compartment Syndrome: A Nationwide Analysis. J Surg Res 2021; 265:159-167. [PMID: 33940239 DOI: 10.1016/j.jss.2021.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The femoral artery is commonly injured following lower extremity trauma. If not identified early and addressed properly, it can lead to compartment syndrome (CS) and limb amputation. The aim of this study is to examine traumatic femoral artery injuries and identify risk factors for the development of lower extremity CS. METHODS Adult (≥18 years) patients who presented with traumatic femoral artery injuries were identified in the Trauma Quality Improvement Program 2017. Patients were stratified into two groups, those with evidence of lower extremity compartment syndrome (CS) and those without CS (NCS), for comparison. Multivariate regression analysis was performed. RESULTS A total of 1,297 adult trauma patients with femoral artery injury were identified. Mean age was 36 ± 15 y, 86% were male, and 68% had penetrating injuries. Median extremity abbreviated injury scale (AIS) was 3 [3,4], and median injury severity score (ISS) was 27 [22-41]. 68 (5.2%) patients were diagnosed with CS of the lower extremity, 66 (97.1%) of those patients underwent fasciotomy and one (1.5%) patient eventually had an amputation. On multivariate regression analysis, concomitant femoral vein, femoral nerve, and popliteal artery injuries and early need for blood transfusions were independent risk factors for the development of CS (OR 3.1, 3.8, 4.3, and 2.5 respectively). CONCLUSIONS CS following traumatic femoral artery injury is a relatively common finding. Physicians must maintain a high index of suspicion and should consider prophylactic fasciotomy in the setting of combined femoral vein and nerve injuries, combined popliteal artery injury, and multiple blood transfusions.
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Affiliation(s)
- Samer Asmar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Letitia Bible
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Mohamad Chehab
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Omar Obaid
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Lourdes Castanon
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Marita Yaghi
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Michael Ditillo
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
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Guenther TM, Sherazee EA, Curtis BC, Riojas RA. Acute Exercise Induced Compartment Syndrome in an 22-Year-Old Active-Duty Man and Review of the Literature. Mil Med 2021; 185:e1829-e1832. [PMID: 32666081 DOI: 10.1093/milmed/usz432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/14/2019] [Accepted: 10/30/2019] [Indexed: 11/14/2022] Open
Abstract
Acute exercise induced compartment syndrome is a rare clinical diagnosis with serious long-term ramifications if not diagnosed in a timely fashion. We present a case of acute exercise induced compartment syndrome of the right lower extremity in a 22-year-old active-duty man that occurred during a physical fitness assessment. He was treated with a two incision four compartment fasciotomy, however required debridement of muscle from the anterior compartment on subsequent washouts of the wound that led to significant foot drop postoperatively. We reviewed the literature for published cases of acute exercise induced compartment syndrome and provide some information from the 47 patients identified in our review. This case highlights a unique pathology for which military providers should have a strong index of suspicion. It additionally stresses the importance of adequate hydration and musculoskeletal conditioning in the setting of military fitness assessments.
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Affiliation(s)
- Timothy M Guenther
- Department of Surgery, University of California Davis, 2315 Stockton Blvd, Sacramento, CA 95817.,Department of General Surgery, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, Fairfield, CA 94533
| | - Elan A Sherazee
- Department of Surgery, University of California Davis, 2315 Stockton Blvd, Sacramento, CA 95817.,Department of General Surgery, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, Fairfield, CA 94533
| | - Bryan C Curtis
- Department of Plastic Surgery, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, Fairfield, CA 94533
| | - Ramon A Riojas
- Department of General Surgery, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, Fairfield, CA 94533
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47
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Sellei RM, Warkotsch U, Kobbe P, Weber CD, Reinhardt N, de la Fuente M, Radermacher K, Hildebrand F. Non-invasive and reliable assessment of compartment elasticity by pressure related ultrasound: An in-vitro study. Injury 2021; 52:724-730. [PMID: 33902865 DOI: 10.1016/j.injury.2020.10.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/26/2020] [Accepted: 10/15/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The development of acute compartment syndrome is a serious threat to trauma patients. The clinical assessment alone is not reliable enough to determine the need for fasciotomy in many cases. The Physician´s assessment of the elasticity of the muscle compartment might be particularly important to objectively evaluate the pressure in this enclosed space. The purpose of this study was to determine the observer´s reproducibility, of compartment elasticity measurements by a novel ultrasonic approach. METHODS Increasing intra-compartmental pressures (ICP) were simulated in a water filled in-vitro model. Pressure related ultrasound was used to determine the relative elasticity (RE) of soft tissue compartments. A pressure transducing probe head was combined with the ultrasonic probe to obtain cross section views of the simulated compartment and to detect the amount of applied pressure by the observer. In this model, the compartment depth without compression (P0) was set to be 100%. Changes of the compartment depth due to a probe pressure of 80 mmHg (P80) were correlated to P0 and an elasticity quotient as a value for RE (%) was calculated. Twelve blinded observers performed measurements for RE determination (%) under three pressure conditions. Reproducibility was calculated using intraclass correlation coefficient (ICC). RESULTS Measurements (n = 432) revealed that the RE (%) in the control group was 17,06% (SD+/-2,13), whereas the RE of the group ICP30 significantly decreased to 12,66% (SD+/- 1,19) (p<0,001). The ICP50 group revealed a further significant decrease to 8,43% (SD+/- 0,67) (p<0,001). Repeated measurement of RE and ICP showed a high level of correlation (spearman correlation coefficient: roh=0,922). A RE <14% resulted in a sensitivity of 96% and a specificity of 90,3% for diagnosis of an ICP >30 mmHg. ICCinter was 0,986; 95%, CI: 0,977-0,992 (p<0,001). DISCUSSION The presented ultrasound-based approach reliably assesses the elasticity in a simulated compartment model. In this pioneer study investigating the inter- and intra-observer reproducibility, this method of measurement appears to be of low cost in addition to being an easy and secure approach that may have the potential to substitute invasive measurement. Further investigations are required to improve its feasibility and to confirm the reliability under clinical conditions.
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Affiliation(s)
- R M Sellei
- Department of Orthopaedic Trauma, Sana Hospital Offenbach, Offenbach am Main, Germany; Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany.
| | - U Warkotsch
- Department of Vascular Surgery, Sana Hospital Offenbach, Offenbach am Main, Germany
| | - P Kobbe
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany
| | - C D Weber
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany
| | - N Reinhardt
- Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - M de la Fuente
- Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - K Radermacher
- Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - F Hildebrand
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Aachen, Germany
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48
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Li C, Du F, Zhou H, Lu H. Photoacoustic imaging in monitoring of compartmental syndrome in rat extremities. APPLIED OPTICS 2021; 60:2912-2918. [PMID: 33798173 DOI: 10.1364/ao.418517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
Muscle ischemia injury is the essence of compartment syndrome (CS). Photoacoustic (PA) imaging can monitor hemoglobin concentration changes in ischemic tissue by determining the state of light-absorbing molecules. This study investigated whether PA imaging can provide accurate CS monitoring. Rats received compression on the lower hind limb for 3 h to induce ischemia injury, followed by PA imaging of desired muscles for 24 h. PA intensities of the injured group were significantly lower than that in the control group. Histology findings correlated well with the PA findings. The results demonstrated that PA imaging could be a noninvasive and timely tool for clinically monitoring CS.
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49
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Osuka A, Miyao D, Kuge Y, Nakajima S, Kuroki Y, Ueyama M. Good recovery without decompression fasciotomy for crush syndrome caused by using a Japanese-style toilet. Trauma Case Rep 2021; 32:100411. [PMID: 33659604 PMCID: PMC7890425 DOI: 10.1016/j.tcr.2021.100411] [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] [Accepted: 02/06/2021] [Indexed: 11/29/2022] Open
Abstract
We report a case of crush syndrome that developed while the patient was squatting to use a Japanese-style toilet. The patient was a 61-year-old male with an obese body. He was sitting on the toilet and couldn't stand up, and after a few hours, the landlord found him and called the emergency services. On presentation, the patient was hyperkalemic and in shock, and his serum creatine kinase levels rose to a maximum of 287,600 U/L. He was diagnosed with postural crush syndrome in both lower extremities due to squatting position in a Japanese-style toilet. Subjective symptoms, physical examination, and blood tests were monitored and the patient was observed. As a result, the patient could be treated conservatively without fasciotomy. Dialysis was not necessary because the fluid infusion maintained adequate urine output and corrected the hyperkalemia. Magnetic resonance imaging of both lower extremities showed multiple high-signal areas in the muscles of the bilateral thighs and lower legs. This case suggested that if the wound is closed, the peripheral pulse is palpable, and the patient's symptoms have improved, a fasciotomy should not be performed. People who are too heavy to squat may need to be careful when using this kind of toilet.
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Affiliation(s)
- Akinori Osuka
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Daiki Miyao
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Yuji Kuge
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Shinji Nakajima
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Yuichi Kuroki
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Masashi Ueyama
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
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50
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Agius C, Cole E. Acute compartment syndrome (ACS) - a case of delayed diagnosis. Int J Orthop Trauma Nurs 2021; 42:100845. [PMID: 34010742 DOI: 10.1016/j.ijotn.2021.100845] [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: 10/08/2020] [Revised: 12/16/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
Acute Compartment Syndrome (ACS) is a potential limb and life-threatening complication following trauma. ACS is characterised by increased pressure within a defined fascial compartment which diminishes perfusion pressure, leading to local tissue ischaemia. Timely diagnosis of ACS is crucial to prevent serious complications or irreversible damage which may lead to amputation or death. Even though the most common aetiology for ACS is major trauma, routine examination for ACS is rarely ennforced in patients with minor trauma or soft-tissue injuries which puts patients at risk of a detrimental delay in treatment. Trauma nurses and other clinicians should therefore avoid relying solely on specific clinical presentations to detect or suspect the development of ACS. This paper will present a case of ACS with an unusual presentation, and critically evaluate the diagnostic challenges of ACS in atypical presentations.
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Affiliation(s)
- Christabel Agius
- Department of Orthopaedics, Trauma & Sports Medicine, Mater Dei Hospital, Msida, Malta; MSc Orthopaedic Trauma Science, Blizard Institute, Queen Mary University of London, London, UK.
| | - Elaine Cole
- Trauma Sciences, Centre for Trauma Sciences, Blizard Institute, Queen Mary University London, London, UK
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