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Otayek J, Assi C, Yammine K. An uncommon complication of a common injury: Acute foot compartment syndrome following an ankle sprain: A case report and review of the literature. Medicine (Baltimore) 2023; 102:e35660. [PMID: 37861509 PMCID: PMC10589507 DOI: 10.1097/md.0000000000035660] [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: 06/26/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Acute foot compartment syndrome (FCS) is a rare but potentially devastating complication that can occur following severe trauma of the limbs. In very are cases, such syndrome occurs following minor trauma. We present an exceptional case of acute FCS as a complication of an ankle sprain. CLINICAL FINDINGS A 32-year-old male patient presented with excruciating foot pain and swelling 48 hours following an ankle sprain. Physical examination revealed severe swelling of the right foot, pale and swollen toes, and tense and pale dorsal skin and severe pain upon passive extension of the toes. DIAGNOSIS An acute FCS was considered. INTERVENTION AND OUTCOMES The patient underwent a fasciotomy using a double-dorsal incision technique. The patient's symptoms were controlled, and he was discharged from the hospital 2 days after the surgery. CONCLUSION Acute FCS could occur following minor trauma such as an ankle sprain. Early recognition and timely surgical intervention are crucial to prevent severe complications. The diagnosis is primarily clinical and immediate fasciotomy is needed to reduce intracompartment pressure and prevent muscular necrosis and other complications.
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Affiliation(s)
- Joeffroy Otayek
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Beirut, Lebanon
| | - Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Beirut, Lebanon
- Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Beirut, Lebanon
- Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon
- Foot and Ankle and Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
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2
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Usuda D, Shimozawa S, Takami H, Kako Y, Sakamoto T, Shimazaki J, Inoue J, Nakayama S, Koido Y, Oba J. Crush syndrome: a review for prehospital providers and emergency clinicians. J Transl Med 2023; 21:584. [PMID: 37653520 PMCID: PMC10472640 DOI: 10.1186/s12967-023-04416-9] [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: 04/19/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Disasters and accidents have occurred with increasing frequency in recent years. Primary disasters have the potential to result in mass casualty events involving crush syndrome (CS) and other serious injuries. Prehospital providers and emergency clinicians stand on the front lines of these patients' evaluation and treatment. However, the bulk of our current knowledge, derived from historical data, has remained unchanged for over ten years. In addition, no evidence-based treatment has been established to date. OBJECTIVE This narrative review aims to provide a focused overview of, and update on, CS for both prehospital providers and emergency clinicians. DISCUSSION CS is a severe systemic manifestation of trauma and ischemia involving soft tissue, principally skeletal muscle, due to prolonged crushing of tissues. Among earthquake survivors, the reported incidence of CS is 2-15%, and mortality is reported to be up to 48%. Patients with CS can develop cardiac failure, kidney dysfunction, shock, systemic inflammation, and sepsis. In addition, late presentations include life-threatening systemic effects such as hypovolemic shock, hyperkalemia, metabolic acidosis, and disseminated intravascular coagulation. Immediately beginning treatment is the single most important factor in reducing the mortality of disaster-situation CS. In order to reduce complications from CS, early, aggressive resuscitation is recommended in prehospital settings, ideally even before extrication. However, in large-scale natural disasters, it is difficult to diagnose CS, and to reach and start treatments such as continuous administration of massive amounts of fluid, diuresis, and hemodialysis, on time. This may lead to delayed diagnosis of, and high on-site mortality from, CS. To overcome these challenges, new diagnostic and therapeutic modalities in the CS animal model have recently been advanced. CONCLUSIONS Patient outcomes can be optimized by ensuring that prehospital providers and emergency clinicians maintain a comprehensive understanding of CS. The field is poised to undergo significant advances in coming years, given recent developments in what is considered possible both technologically and surgically; this only serves to further emphasize the importance of the field, and the need for ongoing research.
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Affiliation(s)
- Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-City, Tokyo, 177-8521, Japan.
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-City, Tokyo, 177-8521, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-City, Tokyo, 177-8521, Japan
| | - Yoshinobu Kako
- Department of Sport Management, Faculty of Business Informatics, Jobu University, 634-1, Toya-Chou, Isesaki-City, Gunma, 372-8588, Japan
| | - Taigo Sakamoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-City, Tokyo, 113-8602, Japan
| | - Junya Shimazaki
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, 2-15, Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Junichi Inoue
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, 1-383, Kosugi-Cho, Nakahara-Ku, Kawasaki-City, Kanagawa, 211-8533, Japan
| | - Shinichi Nakayama
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1, Wakinohamakaigandori, Chuo-Ku, Kobe-City, Hyogo, 651-0073, Japan
| | - Yuichi Koido
- National Hospital Organization Headquarters, DMAT Secretariat MHLW Japan, 3256, Midoricho, Tachikawa-City, Tokyo, 190-8579, Japan
| | - Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-City, Tokyo, 177-8521, Japan
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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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Jastifer JR. Intrinsic muscles of the foot: Anatomy, function, rehabilitation. Phys Ther Sport 2023; 61:27-36. [PMID: 36857996 DOI: 10.1016/j.ptsp.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
The intrinsic muscles of the foot are underappreciated structures in evaluating and treating lower extremity dysfunction. These muscles play a crucial role in the proper function of the foot during sport activities. The functions of these muscles are not generally well understood. Intrinsic dysfunction can lead to a variety of problems. Therefore, it is important for clinicians to have a good understanding of the anatomy and function of the intrinsic foot muscles in order to properly diagnose and treat foot injuries in patients. Published research on the rehabilitation of the intrinsic muscles provides insight into the function as well as benefits of treatment. The purpose of this review is to summarize the published research on the anatomy, function, contribution to pathology, as well as rehabilitation options for the intrinsic muscles of the foot.
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Affiliation(s)
- James R Jastifer
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker MD School of Medicine, USA; Department of Mechanical and Aeronautical Engineering, Western Michigan University, USA; Ascension Borgess Orthopedics, 2490 S 11th St, Kalamazoo, MI, 49008, USA.
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Laverdiere C, Montreuil J, Bouklouch Y, Lorange JP, Dion CA, Harvey EJ. Predictors of Foot Acute Compartment Syndrome: Big Data analysis. J Foot Ankle Surg 2022; 62:27-30. [PMID: 35473922 DOI: 10.1053/j.jfas.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/07/2022] [Indexed: 02/03/2023]
Abstract
Acute compartment syndrome (ACS) in the foot is a challenging diagnosis and can lead to significant disabilities to patients. The present study aims to investigate the incidence, risk factors, demographics and association in the analysis of acute compartment syndrome (ACS) of the foot. We performed a retrospective review of the Trauma Quality Programs data from the American College of Surgeons including 70,525 patients who sustained a fracture of the foot from 2015 to 2018 (4 calendar years). Fasciotomies were performed in 0.7% of all foot fractures. Open fractures, crush injuries and multiple foot fractures were the strongest predictors of fasciotomies, with odds ratios of 2.38, 2.38 and 2.33 respectively. Being a male was associated with an increased likelihood of fasciotomies of 64% (p < .0001 O.R. = [1.42-1.90]), while a dislocation in the foot increased likelihood of fasciotomies by 48% (p = .0008 O.R. = [1.18-1.86]). Trauma centre level III had higher rate of fasciotomy than Tertiary Trauma centers. Multiple other factors were addressed while controlling for cofounders. This big data analysis provided information not previously reported on the risk factors, demographics, and clinical association of ACS in the foot.
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Affiliation(s)
- Carl Laverdiere
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada.
| | - Julien Montreuil
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada
| | | | | | - Charles-Antoine Dion
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Edward J Harvey
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada
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Kim GB, Park JJ, Park CH. Intra-articular Calcaneal Fracture Treatment With Staged Medial External Fixation. Foot Ankle Int 2022; 43:1084-1091. [PMID: 35590469 DOI: 10.1177/10711007221092761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To compare the clinical and radiographic outcomes between the conventional delayed and staged approaches for intra-articular calcaneus fractures in which early definite fixation could not be performed because of severe soft tissue injury. METHODS From January 2015 to May 2019, a total of 32 cases with acute intra-articular calcaneal fractures met criteria and were enrolled in the study. We compared the outcomes of intra-articular calcaneal fractures that underwent delayed internal fixation between groups treated with a conventional delayed approach (non-EF group) vs a temporary medial external fixation (EF group). Clinical outcome measures included a 10-point visual analog scale score, the AOFAS score, and the Foot Function Index. Radiographic outcome measures included Böhler angle, talar declination angle, and calcaneal width. Reduction of the posterior facet was assessed on CT scans. RESULTS The first 15 (46.9%) were treated with a conventional delayed approach, and the latter 17 (53.1%) were treated with a staged approach with temporary medial external fixation. Clinical outcomes were not different between the groups at the last follow-up. The time from injury to definite internal fixation was shorter by an average of 3.8 days in the EF group (P = .001). The Böhler angle, talar declination angle, and calcaneal width were not different between the groups before surgery and at the last follow-up. Reduction of the posterior facet on CT scans was significantly better in the EF group than in the non-EF group (good/excellent = 94% vs 60%, respectively, P = .033). CONCLUSION The staged approach using medial external fixation for displaced intra-articular calcaneus fractures could be an effective method to decrease the time to definitive internal fixation and obtain optimal reduction of the posterior facet. LEVEL OF EVIDENCE Level III, retrospective case-control study.
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Affiliation(s)
- Gi Beom Kim
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Nam-gu, Daegu, Republic of Korea.,Department of Orthopedic Surgery, Yeungnam University College of Medicine, Nam-gu, Daegu, Republic of Korea
| | - Jeong Jin Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Nam-gu, Daegu, Republic of Korea
| | - Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Nam-gu, Daegu, Republic of Korea.,Department of Orthopedic Surgery, Yeungnam University College of Medicine, Nam-gu, Daegu, Republic of Korea
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Jastifer JR. Contemporary Review: The Foot and Ankle in Long-Distance Running. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221125455. [PMID: 36185350 PMCID: PMC9520164 DOI: 10.1177/24730114221125455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Distance runners represent a unique patient population. The cyclic activity associated with distance running leads to a high incidence of injury. Gait patterns, the extrinsic and intrinsic muscles of the foot and ankle, foot strike pattern, shoe wear considerations, alignment, and orthotics are also all important considerations that must be considered by the treating provider. The purpose of this work is to review relevant functional anatomy, recent studies on gait patterns in running, orthotics, and theory on how the body moves through space during running in order to better equip the clinician to treat long distance runners.
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Affiliation(s)
- James R. Jastifer
- Department Orthopaedic Surgery, Ascension Borgess Orthopedics, Kalamazoo, MI, USA
- Department of Orthopaedic Surgery, Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
- Department of Mechanical and Aerospace Engineering, Western Michigan University, Kalamazoo, MI, USA
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8
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Chen JS, Tejwani NC. Compartment Syndrome of the Foot. Orthop Clin North Am 2022; 53:83-93. [PMID: 34799026 DOI: 10.1016/j.ocl.2021.08.005] [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: 02/02/2023]
Abstract
Foot compartment syndrome is an uncommon condition that should be recognized by all orthopedic surgeons. The clinical presentation is often less clear than other limb compartment syndromes and requires high clinical suspicion with a low threshold for direct measurement of compartment pressure. Controversy exists regarding the number of anatomic compartments and the most effective treatment. Both acute surgical intervention and delayed management can result in significant morbidity and long-term sequelae.
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Affiliation(s)
- Jeffrey S Chen
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, 14th Floor, New York, NY 10003, USA
| | - Nirmal C Tejwani
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, 14th Floor, New York, NY 10003, USA.
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9
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Vazquez-Zorrilla D, Millan-Alanis JM, Alvarez-Villalobos NA, Elizondo-Omaña RE, Guzman-Lopez S, Vilchez-Cavazos JF, Fernandez-Rodarte BA, Quiroga-Garza A. Anatomy of foot Compartments: a systematic review. Ann Anat 2020; 229:151465. [PMID: 31978573 DOI: 10.1016/j.aanat.2020.151465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/29/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There are discrepancies regarding the anatomy of the foot which complicate standardizing foot compartment treatment. We synthesized the existing evidence regarding the compartmental anatomy of the foot MATERIALS AND METHODS: A systematic review was performed evaluating the anatomy of the foot compartments in non-pathologic specimens. The search strategy was performed in MEDLINE, Scopus, Web of Science, and EMBASE. Three reviewers worked independently and in duplicate to screen all references via a title/abstract and full-text phase. The risk of bias was assessed with the Anatomical Quality Assurance (AQUA) checklist. RESULTS Ten studies were included. All were performed in cadavers except one. Half of them evaluated the plantar section of the foot and the other half evaluated the whole foot. Methods employed across studies tended to vary: anatomical dissections, dye infusion, imaging studies, or a combination of these. Five studies directly addressed the anatomic limits of each compartment and eight addressed the anatomical structures inside each of them. There seems to be an agreement regarding the number of compartments in the plantar region (three major compartments divided by the medial and lateral intermuscular septum), nevertheless, disagreements across authors tend to arise when describing its dorsal section. Only two studies were ranked with an overall low risk of bias, agreeing on nine compartments. CONCLUSION This review provides the best available anatomical evidence regarding the anatomy of the foot compartments for compartment syndrome management. Future research should focus on settling the discrepancies highlighted to reach a more accurate anatomical description.
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Affiliation(s)
| | - Juan Manuel Millan-Alanis
- Universidad Autónoma de Nuevo León, School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Mexico
| | - Neri Alejandro Alvarez-Villalobos
- Universidad Autónoma de Nuevo León, School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Mexico
| | | | - Santos Guzman-Lopez
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, Mexico
| | - Jose Felix Vilchez-Cavazos
- Universidad Autónoma de Nuevo León, University Hospital "Dr. José Eleuterio González", Orthopedics and Traumatology Service, Mexico
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10
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Lufrano R, Nies M, Ebben B, Hetzel S, O'Toole RV, Doro CJ. Comparison of Dorsal Dermal Fascial Fenestrations With Fasciotomy in an Acute Compartment Syndrome Model in the Foot. Foot Ankle Int 2019; 40:853-858. [PMID: 30929469 DOI: 10.1177/1071100719839944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment of compartment syndrome of the foot with fasciotomy remains controversial because of the theoretical risk of infection and soft tissue coverage issues. The purpose of this study was to evaluate the efficacy of compartment decompression with dorsal dermal fascial fenestration compared with fasciotomy in a cadaveric foot compartment syndrome model. We hypothesized that fasciotomies and dorsal dermal fenestrations would provide equivalent compartment decompression. METHODS Intracompartmental pressure was monitored in the first dorsal interosseous (FDIO), abductor (ABD), and superficial plantar (SP) compartments of 10 fresh frozen cadaveric limbs. A compartment syndrome model was created. Pressure measurements were obtained after dorsal dermal fascial fenestrations and after formal fasciotomies. Primary outcome variables were intracompartmental pressure in the FDIO, ABD, and SP compartments for 4 specific conditions: (1) baseline pressure, (2) pressure after compartment syndrome, (3) pressure after dermal fascial fenestrations, and (4) pressure after fasciotomies. RESULTS Fasciotomies decreased compartment pressures to within 10 mm Hg of baseline in all compartments (P < .001). Compared with fasciotomies, dorsal dermal fascial fenestrations decreased the average pressure only in the FDIO compartment. Pressure decreases after fasciotomies compared with dorsal dermal fascial fenestrations were significantly greater (P < .005). CONCLUSION Fasciotomies were more effective than dorsal dermal fascial fenestrations at decreasing intracompartmental pressure. It seems that dermal fascial fenestrations were unable to provide effective decompression of the ABD and SP compartments of the foot and could provide only partial decompression of the dorsal compartments. CLINICAL RELEVANCE The findings of this study indicate the need for caution in using fenestrations alone to treat acute compartment syndrome of the foot.
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Affiliation(s)
- Reuben Lufrano
- 1 University of Wisconsin, Department of Orthopedics and Rehabilitation, Madison, WI, USA
| | - Matt Nies
- 1 University of Wisconsin, Department of Orthopedics and Rehabilitation, Madison, WI, USA
| | - Beau Ebben
- 1 University of Wisconsin, Department of Orthopedics and Rehabilitation, Madison, WI, USA
| | - Scott Hetzel
- 2 University of Wisconsin-Madison, Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Robert V O'Toole
- 3 R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher J Doro
- 1 University of Wisconsin, Department of Orthopedics and Rehabilitation, Madison, WI, USA
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Lutter C, Schöffl V, Hotfiel T, Simon M, Maffulli N. Compartment Syndrome of the Foot: An Evidence-Based Review. J Foot Ankle Surg 2019; 58:632-640. [PMID: 31256897 DOI: 10.1053/j.jfas.2018.12.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Indexed: 02/03/2023]
Abstract
Compartment syndrome of the foot (CSF) is a surgical emergency, with high risk of morbidity and poor outcome, including persistent neurologic deficits or amputation. Uncertainty remains regarding surgical approaches, pressure monitoring values, and the extent of surgical treatment. This review provides a summary of the current knowledge and reports evidence-based diagnostic and therapeutic management options for CSF. Articles describing CSF were identified from MEDLINE, PubMed, and Cochrane databases up until February 2018. Experimental and original articles, systematic and nonsystematic reviews, case reports, and book chapters, independent of their level of evidence, were included. Crush injuries are the leading cause of CSF, but CSF can present after fractures of the tarsal or metatarsal bones and dislocations of the Lisfranc or Chopart joints. CSF is often associated with persistent neurologic deficits, claw toes, amputations, and skin healing problems. Diagnosis is made after accurate clinical evaluation combined with intracompartmental pressure monitoring. A threshold value of <20 mmHg difference between the diastolic blood pressure and the intracompartmental pressure is considered diagnostic. Management consists of surgery, whereby 2 dorsal incisions are combined with a medioplantar incision to the calcaneal compartment. The calcaneal compartment can serve as an "indicator compartment," as the highest-pressure values can regularly be measured within this compartment. Appropriately powered studies of CSF are necessary to further evaluate and compare diagnostic and therapeutic options.
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Affiliation(s)
- Christoph Lutter
- Orthopedic Surgeon, Department of Orthopedics, University Medical Center, Rostock, Germany; Orthopedic Surgeon, Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Klinikum Bamberg, Germany
| | - Volker Schöffl
- Professor of Trauma and Orthopaedic Surgery, Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Klinikum Bamberg, Germany; Professor of Trauma and Orthopaedic Surgery, Department of Trauma and Orthopedic Surgery, Friedrich Alexander University Erlangen-Nuremberg, Germany
| | - Thilo Hotfiel
- Orthopedic Surgeon, Department of Orthopedic Surgery, Friedrich Alexander University Erlangen-Nuremberg, Germany; Orthopedic Surgeon, Department of Orthopedic, Trauma and Hand Surgery, Klinikum Osnabrück, Germany
| | - Michael Simon
- Orthopedic Surgeon, Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Klinikum Bamberg, Germany
| | - Nicola Maffulli
- Professor of Trauma and Orthopaedic Surgery and Consultant Trauma and Orthopaedic Surgeon, Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Italy; Professor of Trauma and Orthopaedic Surgery and Consultant Trauma and Orthopaedic Surgeon, Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, London, UK; Professor of Trauma and Orthopaedic Surgery and Consultant Trauma and Orthopaedic Surgeon, Institute of Science and Technology in Medicine, Keele University School of Medicine, UK.
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12
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Godoy-Santos AL, Schepers T. SOFT-TISSUE INJURY TO THE FOOT AND ANKLE: LITERATURE REVIEW AND STAGED MANAGEMENT PROTOCOL. ACTA ORTOPEDICA BRASILEIRA 2019; 27:223-229. [PMID: 32788854 PMCID: PMC7405111 DOI: 10.1590/1413-785220192704221240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Complex trauma of the foot and ankle is characterized by fractures with severe
soft tissue damage associated with neurovascular injury and joint involvement.
These injuries are frequently present in the polytraumatized patient and are a
predictor of unfavorable clinical outcome. In the initial approach to a patient
with complex foot and ankle trauma, the decision between amputation and
reconstruction is crucial. The various existing classification systems are of
limited effectiveness and should serve as tools to assist and support a clinical
decision rather than as determinants of conduct. In the emergency department,
one of two treatment options must be adopted: early complete treatment or staged
treatment. The former consists of definitive fixation and immediate skin
coverage, using either primary closure (suturing) or flaps, and is usually
reserved for less complex cases. Staged treatment is divided into initial and
definitive. The objectives in the first phase are: prevention of the progression
of ischemia, necrosis and infection. The principles of definitive treatment are:
proximal-to-distal bone reconstruction, anatomic foot alignment, fusions in
severe cartilage lesions or gross instabilities, stable internal fixation and
adequate skin coverage. Level of evidence III, Systematic review of
level III studies.
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13
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Brandão RA, St John JM, Langan TM, Schneekloth BJ, Burns PR. Acute Compartment Syndrome of the Foot Due To Frostbite: Literature Review and Case Report. J Foot Ankle Surg 2018; 57:382-387. [PMID: 29478482 DOI: 10.1053/j.jfas.2017.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Indexed: 02/03/2023]
Abstract
Acute compartment syndrome of the foot and ankle is a relatively rare clinical finding. Lower extremity compartment syndrome is customarily due to vascular or orthopedic traumatic limb-threatening pathologic issues. Clinical correlation and measurement of intracompartmental pressure are paramount to efficient diagnosis and treatment. Delayed treatment can lead to local and systemically adverse consequences. Frostbite, a comparatively more common pathologic entity of the distal extremities, occurs when tissues are exposed to freezing temperatures. Previously found in military populations, frostbite has become increasingly prevalent in the general population, leading to more clinical presentations to foot and ankle specialists. We present a review of the published data of acute foot compartment syndrome and pedal frostbite, with pathogenesis, treatment, and subsequent sequelae. A case report illustrating 1 example of bilateral foot, atraumatic compartment syndrome, is highlighted in the present report. The patient presented with changes consistent with distal bilateral forefoot frostbite, along with gangrenous changes to the distal tuft of each hallux. At admission and evaluation, the patient had increasing rhabdomyolysis with no other clear etiology. Compartment pressures were measured in the emergency room and were >100 mm Hg in the medial compartment and 50 mm Hg dorsally. The patient was taken to the operating room urgently for bilateral pedal compartment release. Both pathologic entities have detrimental outcomes if not treated in a timely and appropriate manner, with amputation rates increasing with increasing delay.
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Affiliation(s)
- Roberto A Brandão
- Resident, Podiatric Medicine and Surgery Residency Program, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA
| | - Jason M St John
- Resident, Podiatric Medicine and Surgery Residency Program, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA
| | - Travis M Langan
- Resident, Podiatric Medicine and Surgery Residency Program, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA
| | - Brian J Schneekloth
- Fellow, Podiatric Medicine and Surgery Residency Program, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA.
| | - Patrick R Burns
- Director and Assistant Professor, Podiatric Medicine and Surgery Residency, University of Pittsburgh Medical Center Mercy, Department of Orthopedic Surgery, University Pittsburgh School of Medicine, Pittsburgh, PA
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14
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Park YH, Choi WS, Choi GW, Kim HJ. Role of Antiplatelet/Anticoagulant Medications and Blood-Clotting Tests in Prediction of Traumatic Foot Compartment Syndrome. Foot Ankle Int 2018; 39:725-730. [PMID: 29506396 DOI: 10.1177/1071100718757956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although intracompartmental bleeding is one cause of traumatic compartment syndrome, no previous studies have defined the role of hemostatic stability in the development of traumatic compartment syndrome. Therefore, to investigate this issue, we identified the relationship between antiplatelet/anticoagulant medications and the development of traumatic foot compartment syndrome. In addition, as a possible predictor of compartment syndrome, we evaluated the utility of blood-clotting tests in the prediction of traumatic foot compartment syndrome. METHODS Retrospective review of patients diagnosed with isolated foot injury in our institution between 2008 and 2016 was used to identify patients who had traumatic foot compartment syndrome. Potential predictors, including medication history for antiplatelet/anticoagulant agents and blood-clotting test results, were analyzed using logistic regression analysis. The present study included 789 feet, and 29 (3.7%) had traumatic foot compartment syndrome. RESULTS The antiplatelet medication and the blood-clotting test results were not significantly associated with the development of traumatic foot compartment syndrome. Among other variables, damage caused by heavy objects as the injury mechanism was the only significant predictor in the development of traumatic foot compartment syndrome ( P < .05). CONCLUSION Our results showed that antiplatelet medication and blood-clotting tests did not predict the development of traumatic foot compartment syndrome. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Young Hwan Park
- 1 Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Won Seok Choi
- 1 Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Gi Won Choi
- 2 Department of Orthopaedic Surgery, Korea University Ansan Hospital, Seoul, Korea
| | - Hak Jun Kim
- 1 Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea
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15
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16
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Abstract
Joint disruptions to the tarsometatarsal (TMT) joint complex, also known as the Lisfranc joint, represent a broad spectrum of pathology from subtle athletic sprains to severe crush injuries. Although injuries to the TMT joint complex are uncommon, when missed, they may lead to pain and dysfunction secondary to posttraumatic arthritis and arch collapse. An understanding of the appropriate anatomy, mechanism, physical examination, and imaging techniques is necessary to diagnose and treat injuries of the TMT joints. Nonsurgical management is indicated in select patients who maintain reduction of the TMT joints under physiologic stress. Successful surgical management of these injuries is predicated on anatomic reduction and stable fixation. Open reduction and internal fixation remains the standard treatment, although primary arthrodesis has emerged as a viable option for certain types of TMT joint injuries.
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17
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Zuchelli D, Divaris N, McCormack JE, Huang EC, Chaudhary ND, Vosswinkel JA, Jawa RS. Extremity compartment syndrome following blunt trauma: a level I trauma center's 5-year experience. J Surg Res 2017; 217:131-136. [PMID: 28595814 DOI: 10.1016/j.jss.2017.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/01/2017] [Accepted: 05/02/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Extremity compartment syndrome is a recognized complication of trauma. We evaluated its prevalence and outcomes at a suburban level 1 trauma center. METHODS The trauma registry was reviewed for all blunt trauma patients aged ≥18 years, admitted between 2010 and 2014. Chart review of patients with extremity compartment syndrome was performed. RESULTS Of 6180 adult blunt trauma admissions, 83 patients developed 86 extremity compartment syndromes; two patients had compartment syndromes on multiple locations. Their (n = 83) median age was 44 years (interquartile range: 31.5-55.5). The most common mechanism of injury was motor vehicle/motor cycle accident (45.8%) followed by a fall (21.7%). The median injury severity score was 9 (interquartile range: 5-17); 65.1% had extremity abbreviate injury score ≥3. Notably, 15 compartment syndromes did not have an underlying fracture. Among patients with fractures, the most commonly injured bone was the tibia, with tibial plateau followed by tibial diaphyseal fractures being the most frequent locations. Fasciotomies were performed, in order of frequency, in the leg (n = 53), forearm (n = 15), thigh (n = 9), foot (n = 5), followed by multiple or other locations. CONCLUSIONS Extremity compartment syndrome was a relatively uncommon finding. It occurred in all extremity locations, with or without an associated underlying fracture, and from a variety of mechanisms. Vigilance is warranted in evaluating the compartments of patients with extremity injuries following blunt trauma.
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Affiliation(s)
- Daniel Zuchelli
- Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York
| | - Nicholas Divaris
- Department of Orthopedic Surgery, Stony Brook University School of Medicine, Stony Brook, New York
| | - Jane E McCormack
- Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York
| | - Emily C Huang
- Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York
| | - Neeta D Chaudhary
- Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York
| | - James A Vosswinkel
- Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York
| | - Randeep S Jawa
- Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York.
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18
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Bedigrew KM, Stinner DJ, Kragh JF, Potter BK, Shawen SB, Hsu JR. Effectiveness of foot fasciotomies in foot and ankle trauma. J ROY ARMY MED CORPS 2017; 163:324-328. [PMID: 28341786 DOI: 10.1136/jramc-2016-000734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Foot compartment syndrome (FCS) has been reported to cause neuropathic pain, claw or hammer toes, and motor and sensory disturbances. The optimal treatment of FCS is controversial. The purpose of this study was to determine if foot fasciotomies improve patient outcomes in high-energy, combat-related lower extremity trauma. METHODS Medical records of patients with documented FCS from May 2007 to January 2009 were retrospectively reviewed. Consecutive, matched control patients were identified based on similar hindfoot, mid-foot and/or forefoot injuries who did not undergo foot fasciotomy during the same period. The primary outcomes analysed were the development of claw or hammer toes and neuropathic pain. RESULTS 19 patients with foot fasctiotomies were identified and matched with 19 controls. Median follow-up was 19.5 months (range, 3.5-47.5 months) for the combined cohorts. The most common mechanism of injury was an explosive blast. Nine fasciotomy and nine control patients sustained open foot fractures. Significantly more patients with foot fasciotomies developed claw toes (50% vs 17%, p=0.03). There were no significant differences in the development of neuropathic pain, sensory deficits, motor deficits, chronic pain, stiffness or infection. The fasciotomy patients underwent an average of 5.5 surgeries per patient versus 4 surgeries per patient in the control group. CONCLUSIONS Fasciotomy of the foot did not prevent neuropathic pain and deformities in patients with FCS in this study.
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Affiliation(s)
- Katherine M Bedigrew
- Department of Orthopaedics, San Antonio Military Medical Center, Ft. Sam Houston, Texas, USA
| | - D J Stinner
- Department of Orthopaedics, San Antonio Military Medical Center, Ft. Sam Houston, Texas, USA.,Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Ft. Sam Houston, Texas, USA
| | - J F Kragh
- Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Ft. Sam Houston, Texas, USA
| | - B K Potter
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - S B Shawen
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - J R Hsu
- Department of Orthopaedics, San Antonio Military Medical Center, Ft. Sam Houston, Texas, USA.,Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Ft. Sam Houston, Texas, USA
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19
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Weatherford BM, Bohay DR, Anderson JG. Open Reduction and Internal Fixation Versus Primary Arthrodesis for Lisfranc Injuries. Foot Ankle Clin 2017; 22:1-14. [PMID: 28167055 DOI: 10.1016/j.fcl.2016.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Management of injuries to the tarsometatarsal (Lisfranc) joint complex continues to generate heated debate. Arthrodesis of the Lisfranc joint complex has historically been reserved as a salvage procedure for failed treatment. Recently, primary arthrodesis has emerged as a viable treatment alternative to open reduction and internal fixation for these injuries. The objective of this article was to examine the current literature regarding open reduction and internal fixation versus primary arthrodesis of Lisfranc injuries.
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Affiliation(s)
- Brian M Weatherford
- Illinois Bone and Joint Institute, 2401 Ravine Way, Glenview, IL 60025, USA.
| | - Donald R Bohay
- Orthopaedic Associates of Michigan, Foot and Ankle Division, 1111 Leffingwell Avenue Northeast, Grand Rapids, MI 60025, USA
| | - John G Anderson
- Orthopaedic Associates of Michigan, Foot and Ankle Division, 1111 Leffingwell Avenue Northeast, Grand Rapids, MI 60025, USA
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20
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Acute compartment syndrome of the foot following open reduction and internal fixation of an ankle fracture. Injury 2015; 46:2064-8. [PMID: 26190633 DOI: 10.1016/j.injury.2015.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 05/26/2015] [Accepted: 06/01/2015] [Indexed: 02/02/2023]
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21
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von Keudell AG, Weaver MJ, Appleton PT, Bae DS, Dyer GSM, Heng M, Jupiter JB, Vrahas MS. Diagnosis and treatment of acute extremity compartment syndrome. Lancet 2015; 386:1299-1310. [PMID: 26460664 DOI: 10.1016/s0140-6736(15)00277-9] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute compartment syndrome of the extremities is well known, but diagnosis can be challenging. Ineffective treatment can have devastating consequences, such as permanent dysaesthesia, ischaemic contractures, muscle dysfunction, loss of limb, and even loss of life. Despite many studies, there is no consensus about the way in which acute extremity compartment syndromes should be diagnosed. Many surgeons suggest continuous monitoring of intracompartmental pressure for all patients who have high-risk extremity injuries, whereas others suggest aggressive surgical intervention if acute compartment syndrome is even suspected. Although surgical fasciotomy might reduce intracompartmental pressure, this procedure also carries the risk of long-term complications. In this paper in The Lancet Series about emergency surgery we summarise the available data on acute extremity compartment syndrome of the upper and lower extremities in adults and children, discuss the underlying pathophysiology, and propose a clinical guideline based on the available data.
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Affiliation(s)
| | - Michael J Weaver
- Orthopedic Trauma Initiative at Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul T Appleton
- Orthopedic Trauma Initiative at Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA, USA
| | - Donald S Bae
- Orthopedic Trauma Initiative at Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - George S M Dyer
- Orthopedic Trauma Initiative at Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marilyn Heng
- Orthopedic Trauma Initiative at Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jesse B Jupiter
- Orthopedic Trauma Initiative at Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark S Vrahas
- Orthopedic Trauma Initiative at Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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22
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Abstract
BACKGROUND Forklift-related crush injuries of the foot and ankle are relatively common in cities with shipping and construction industries. There is a paucity of literature on the incidence and sequelae of such injuries. We aimed to describe the incidence, patterns of injuries, sequelae, and morbidity associated with this type of injury. METHODS A retrospective review of all patients with forklift-related crush injuries of the foot and ankle for 4 years was conducted. Patients' demographics, mechanisms and patterns of injury, fracture type, compartment syndrome, number of reconstructive operations, operative details, length of hospital stay, medical leave, repeat evaluation in emergency room, and complications were recorded and analyzed. RESULTS There were 113 (2.17%) patients with forklift-related crush injuries out of 5209 patients seen in our institution for injuries of the foot and ankle. Crush injury from the wheels of the forklift truck was the most common mechanism at 71 (62.8%) patients. The forefoot was the most commonly injured region, followed by the midfoot, hindfoot, and ankle, with almost one-third (28.3%) of the patients having multiple injuries to the foot. Nine (8%) had open fractures, while 5 (4.4%) had compartment syndromes. Forty (35.4%) patients required hospitalization, and 35 (87.5%) of those hospitalized required operative intervention. Those who had surgery were more likely to have complications compared with those who did not require operative intervention (16 [45.7%] of 35 patients vs 7 [9%] of 78 patients; P < .05) and more likely to require longer medical leave (mean, 183 vs 30 days, P < .05). CONCLUSION Forklift-related crush injuries of the foot and ankle are increasingly common in industrialized cities. The forefoot is commonly affected with involvement of multiple regions. Up to one-third of affected patients required hospitalization and multiple operative interventions resulting in loss of productivity, income, and significant morbidity. The possibility of residual disabilities must be clearly defined to the patients and their employers to manage potential workplace limitations and long-term expectations. LEVEL OF EVIDENCE Level IV retrospective case series.
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Affiliation(s)
- Choon Chiet Hong
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Nazrul Nashi
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, Singapore
| | - Jing Wen Daniel Teh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ken Jin Tan
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
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23
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Barshes NR, Pisimisis G, Kougias P. Compartment syndrome of the foot associated with a delayed presentation of acute limb ischemia. J Vasc Surg 2015; 63:819-22. [PMID: 25752690 DOI: 10.1016/j.jvs.2015.01.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/26/2015] [Indexed: 10/23/2022]
Abstract
Compartment syndrome of the leg is a well-recognized complication known to follow urgent revascularization done for acute limb ischemia, but compartment syndrome of the foot has not been reported after the ischemia-reperfusion sequence. Herein we report a case of foot fasciotomy done for compartment syndrome that occurred after urgent revascularization. We suggest that foot fasciotomies should be considered in particular circumstances of acute lower leg ischemia, such as infrapopliteal thromboembolic events, prolonged ischemia, and persistent or worsening foot symptoms that follow revascularization and calf fasciotomies.
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Affiliation(s)
- Neal R Barshes
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex.
| | - George Pisimisis
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex
| | - Panos Kougias
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex
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25
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Abstract
BACKGROUND Injuries around the foot and ankle are challenging. There is a paucity of literature, outside that of specialist orthopedic journals, that focuses on this subject in the pediatric population. DATA SOURCES In this review, we outline pediatric foot and ankle fractures in an anatomically oriented manner from the current literature. Our aim is to aid the emergency department doctor to manage these challenging injuries more effectively in the acute setting. RESULTS These injuries require a detailed history and examination to aid the diagnosis. Often, plain radiographs are sufficient, but more complex injuries require the use of magnetic resonance imaging. Treatment is dependent on the proximity to skeletal maturity and the degree of displacement of fracture. Children have a marked ability to remodel after fractures and therefore mainstay treatment is immobilization by a cast or splint. Operative fixation, although uncommon in this population, may be necessary with adolescents, certain unstable injuries or in cases with displaced articular surface. In the setting of severe foot trauma, skin compromise and compartment syndrome of the foot must be excluded. CONCLUSION The integrity of the physis, articular surface and soft tissues are all equally important in treating these injuries.
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Garner MR, Taylor SA, Gausden E, Lyden JP. Compartment syndrome: diagnosis, management, and unique concerns in the twenty-first century. HSS J 2014; 10:143-52. [PMID: 25050098 PMCID: PMC4071472 DOI: 10.1007/s11420-014-9386-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 03/19/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Compartment syndrome is an elevation of intracompartmental pressure to a level that impairs circulation. While the most common etiology is trauma, other less common etiologies such as burns, emboli, and iatrogenic injuries can be equally troublesome and challenging to diagnose. The sequelae of a delayed diagnosis of compartment syndrome may be devastating. All care providers must understand the etiologies, high-risk situation, and the urgency of intervention. QUESTIONS/PURPOSES This study was conducted to perform a comprehensive review of compartment syndrome discussing etiologies, risk stratification, clinical progression, noninvasive and invasive monitoring, documentation, medical-legal implication, and our step-by-step approach to compartment syndrome prevention, detection, and early intervention. METHODS A literature search was performed using the PubMed Database and the following search terms: "Compartment syndrome AND Extremity," "Compartment syndrome AND Gluteal," and Compartment syndrome AND Paraspinal." A total of 2,068 articles were identified. Filters allowed for the exclusion of studies not printed in English (359) and those focusing on exertional compartment syndrome (84), leaving a total of 1,625 articles available for review. RESULTS The literature provides details regarding the etiologies, risk stratification, clinical progression, noninvasive and invasive monitoring, documentation, medical-legal implication, and our step-by-step approach to compartment syndrome prevention, detection, and early intervention. The development and progression of compartment syndrome is multifactorial, and as complexity of care increases, the opportunity for the syndrome to be missed is increased. Recent changes in the structure of in-hospital medical care including resident work hour restrictions and the incorporation of midlevel providers have increased the frequency of "signouts" or "patient handoffs" which present opportunities for the syndrome to be mismanaged. CONCLUSION The changing dynamics of the health care team have prompted the need for a more explicit algorithm for managing patients at risk for compartment syndrome to ensure appropriate conveyance of information among team members.
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Affiliation(s)
- Matthew R. Garner
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Samuel A. Taylor
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Elizabeth Gausden
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - John P. Lyden
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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