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Wang H, Liu Y, Xu S, Wang T, Chen X, Jia H, Dong Q, Zhang H, Wang S, Ma H, Hou Z. Proteomics analysis of deep fascia in acute compartment syndrome. PLoS One 2024; 19:e0305275. [PMID: 38950026 PMCID: PMC11216580 DOI: 10.1371/journal.pone.0305275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/27/2024] [Indexed: 07/03/2024] Open
Abstract
Acute compartment syndrome (ACS) is a syndrome in which local circulation is affected due to increased pressure within the compartment. We previously found in patients with calf fractures, the pressure of fascial compartment could be sharply reduced upon the appearance of tension blisters. Deep fascia, as the important structure for compartment, might play key role in this process. Therefore, the aim of the present study was to examine the differences in gene profile in deep fascia tissue in fracture patients of the calf with or without tension blisters, and to explore the role of fascia in pressure improvement in ACS. Patients with lower leg fracture were enrolled and divided into control group (CON group, n = 10) without tension blister, and tension blister group (TB group, n = 10). Deep fascia tissues were collected and LC-MS/MS label-free quantitative proteomics were performed. Genes involved in fascia structure and fibroblast function were further validated by Western blot. The differentially expressed proteins were found to be mainly enriched in pathways related to protein synthesis and processing, stress fiber assembly, cell-substrate adhesion, leukocyte mediated cytotoxicity, and cellular response to stress. Compared with the CON group, the expression of Peroxidasin homolog (PXDN), which promotes the function of fibroblasts, and Leukocyte differentiation antigen 74 (CD74), which enhances the proliferation of fibroblasts, were significantly upregulated (p all <0.05), while the expression of Matrix metalloproteinase-9 (MMP9), which is involved in collagen hydrolysis, and Neutrophil elastase (ELANE), which is involved in elastin hydrolysis, were significantly reduced in the TB group (p all <0.05), indicating fascia tissue underwent microenvironment reconstruction during ACS. In summary, the ACS accompanied by blisters is associated with the enhanced function and proliferation of fibroblasts and reduced hydrolysis of collagen and elastin. The adaptive alterations in the stiffness and elasticity of the deep fascia might be crucial for pressure release of ACS.
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Affiliation(s)
- Haofei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Yan Liu
- Department of Endocrinology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Sujuan Xu
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
- Department of Nephrology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Tao Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Xiaojun Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Huiyang Jia
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Qi Dong
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Heng Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Shuai Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Huijie Ma
- Department of Physiology, Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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Markus D, Bi AS, Neal W, Fiedler B, Tejwani N. Atraumatic Idiopathic Compartment Syndrome Requiring Emergent Fasciotomy: A Case Report and Literature Review. Cureus 2024; 16:e57208. [PMID: 38681317 PMCID: PMC11056228 DOI: 10.7759/cureus.57208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
A 42-year-old male with no past medical history presented to an emergency room with increasing pain and swelling of his left lower extremity over 48 hours with no preceding trauma. A computed tomography scan demonstrated a hematoma (20 cm × 4 cm × 10 cm) present within the gastrocnemius-soleus complex. Acute compartment syndrome (ACS) was diagnosed clinically, confirmed intraoperatively with an arterial line transducer, and treated with emergent fasciotomy. Extensive workup found no evidence of coagulopathy or source of bleeding. This case presents a patient with ACS secondary to an atraumatic gastrocnemius hematoma discovered in the emergency room with no history of coagulopathies or anticoagulation.
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Affiliation(s)
- Danielle Markus
- Orthopedic Surgery, New York University (NYU) Langone Orthopedic Hospital, New York, USA
| | - Andrew S Bi
- Orthopedic Surgery, New York University (NYU) Langone Orthopedic Hospital, New York, USA
| | - William Neal
- Orthopedic Surgery, New York University (NYU) Langone Orthopedic Hospital, New York, USA
| | - Benjamin Fiedler
- Orthopedic Surgery, New York University (NYU) Langone Orthopedic Hospital, New York, USA
| | - Nirmal Tejwani
- Orthopedics, New York University (NYU) Langone Orthopedic Hospital, New York, USA
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Adeclat GJ, Hayes M, Amick M, Kahan J, Halim A. Acute forearm compartment syndrome in the setting of acquired hemophilia A. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2022; 9:140-144. [PMID: 35601981 PMCID: PMC9116254 DOI: 10.1080/23320885.2022.2071274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with acquired or congenital hemophilia are at risk for Acute Compartment Syndrome (ACS) and pose a diagnostic challenge and a treatment risk with post-fasciotomy hemostasis of critical importance. We present the case of a woman with ACS of the forearm in the setting of newly diagnosed acquired hemophilia A.
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Affiliation(s)
- Giscard Joel Adeclat
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Monique Hayes
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Michael Amick
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph Kahan
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Andrea Halim
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
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Fernandes JMA, Gondim FDAA, Dias AMN, Ribeiro RDA, Ferreira Filho LIP, Pinto VDPT. Factor VIII prophylactic therapy reduces neurological complications in patients with Hemophilia A. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:1116-1122. [PMID: 34852070 DOI: 10.1590/0004-282x-anp-2020-0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/09/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bleeding in hemophiliacs can cause complications in the central and peripheral nervous system (CNS and PNS). The incidence of intracranial hemorrhage has reduced after the introduction of prophylactic treatment with factor VIII or IX, but the benefits of this therapy have not yet been evaluated on PNS complications. OBJECTIVE The aim of this study was to determine the prevalence of neurological complications in hemophiliacs and verify the effect of prophylactic therapy in these patients, including PNS disorders. METHODS We retrospectively evaluated the prevalence of CNS and PNS disorders caused by bleeding in hemophiliacs seen at the Hemocentro Regional Norte, Ceará, Brazil, from 1992 to 2018, and we compared the incidence in different periods (before and after the introduction of prophylactic treatment in 2011). RESULTS Of 75 hemophilia A patients evaluated (4.61/100.000 population), 13.3% (n=10) had either CNS (n=5) or PNS (n=5) disorders secondary to bleeding. Patients submitted to factor VIII replacement prophylactic therapy were less likely to have CNS events: from 1992 to 2011, 5 of 63 patients had CNS disease, while from 2011 to 2018, there were no new cases (p=0.0181). From 2011 to 2018, 5 PNS events occurred in patients without prophylactic therapy, whereas none occurred in those covered by prophylactic therapy (5/20 versus 0/29, p=0.0081). CONCLUSIONS The prevalence of neurological complications in hemophiliacs in our cohort is similar to other studies. Similar to CNS, prophylactic therapy also reduces the risk of PNS complications. This is the first report in the literature showing this benefit.
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Affiliation(s)
- José Marcelino Aragão Fernandes
- Universidade Federal do Ceará, Programa de Pós-Graduação em Ciências da Saúde, Sobral CE, Brazil.,Centro de Hematologia e Hemoterapia do Ceará, Fortaleza CE, Brazil
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Abstract
Haemophilia A and B are rare congenital, recessive X-linked disorders caused by lack or deficiency of clotting factor VIII (FVIII) or IX (FIX), respectively. The severity of the disease depends on the reduction of levels of FVIII or FIX, which are determined by the type of the causative mutation in the genes encoding the factors (F8 and F9, respectively). The hallmark clinical characteristic, especially in untreated severe forms, is bleeding (spontaneous or after trauma) into major joints such as ankles, knees and elbows, which can result in the development of arthropathy. Intracranial bleeds and bleeds into internal organs may be life-threatening. The median life expectancy was ~30 years until the 1960s, but improved understanding of the disorder and development of efficacious therapy based on prophylactic replacement of the missing factor has caused a paradigm shift, and today individuals with haemophilia can look forward to a virtually normal life expectancy and quality of life. Nevertheless, the potential development of inhibitory antibodies to infused factor is still a major hurdle to overcome in a substantial proportion of patients. Finally, gene therapy for both types of haemophilia has progressed remarkably and could soon become a reality.
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Lassandro G, Amoruso A, Palladino V, Palmieri VV, Giordano P. The risk of venipuncture in newborn with severe hemophilia: Case report of a large elbow hemorrhage and literature review of compartment syndrome. Hematol Rep 2021; 13:8967. [PMID: 34221293 PMCID: PMC8215530 DOI: 10.4081/hr.2021.8967] [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] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/26/2021] [Indexed: 12/20/2022] Open
Abstract
Hemophilias are hemorrhagic congenital rare diseases. The gold standard of therapy in hemophilics is the intravenously replacement therapy. We can infuse intravenously plasma derived factors (FVIII for Hemophilia A and FIX for Hemophilia B) or recombinant products (i.e. clotting factor synthetically produced). Venipuncture is not a safe procedure in subjects with hemorrhagic diseases. It is considered an invasive technique with potential massive bleeding and it requires standardized procedures to prevent complications. Local pressure after the procedure (with eventually ice rest) must be always done. In case of bleeding a rapid replacement therapy must be conducted. A severe complication in hemophilia is compartment syndrome. We report a case of massive bleeding in a hemophilic newborn after venipuncture and a literature review of compartment syndrome in hemophiliacs. The aim of this paper is to help physicians in the clinical management to prevent the evolution of a massive bleeding in compartment syndrome.
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Affiliation(s)
| | | | | | | | - Paola Giordano
- Pediatric Section, Department of Biomedical Science and Human Oncology, University “Aldo Moro”, Bari, Italy
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Rodriguez-Merchan EC. Complications of Muscle Hematomas in Hemophilia. Cardiovasc Hematol Disord Drug Targets 2021; 20:242-248. [PMID: 32294050 DOI: 10.2174/1871529x20666200415121409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 11/22/2022]
Abstract
Prevention is essential for avoiding the complications of muscle hematomas (compartment syndrome, pseudotumors and peripheral nerve lesions) in hemophilic patients. This is achieved through early diagnosis of muscle hematomas and proper long-term hematological treatment until they have resolved (confirmed by image studies). Ultrasound-guided percutaneous drainage could be beneficial in terms of achieving better and faster symptom relief. Acute compartment syndrome (ACS) requires emergency surgical treatment (decompression fasciotomy). As for pseudotumors, the biopsy will help us confirm the diagnosis and rule out true tumors (chondrosarcoma, liposarcoma, synovial sarcoma) that sometimes mimic hemophilic pseudotumors. Surgical removal of hemophilic pseudotumors is the best solution. As alternatives, there are curettage and filling with cancellous bone and radiotherapy (when surgery is contraindicated). Preoperative arterial embolization (ideally 2 weeks before surgery) helps control intraoperative bleeding during surgery for giant pelvic pseudotumors. Peripheral nerve injuries, which are rare, almost always occur due to compression of hematomas in the vicinity. In most cases, they usually resolve with hematological treatment only. If such treatment fails, surgery would be indicated.
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Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Paseo de la Castellana 261, 28046-Madrid, Spain
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Patra PC, Mandal PK, Gantait D, Bhowmik A, Chakrabarti P. Price of PRICE (Protection, Rest, Ice, Compression, and Elevation) redefined: a case of entrapment neuropathy in an individual with hemophilia. Blood Res 2018; 53:333-334. [PMID: 30588473 PMCID: PMC6300675 DOI: 10.5045/br.2018.53.4.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/16/2018] [Accepted: 09/04/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Debasis Gantait
- Department of Hematology, NRS Medical College, Kolkata, India
| | - Amrita Bhowmik
- Department of Hematology, NRS Medical College, Kolkata, India
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