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Shankar DS, Blaeser AM, Gillinov LA, Vasavada KD, Fariyike BB, Mojica ES, Borowski LE, Jazrawi LM, Cardone DA. Paresthesia Is Predictive of Symptom Recurrence After Fasciotomy for Exertional Compartment Syndrome of the Leg. Sports Health 2024; 16:396-406. [PMID: 36951383 PMCID: PMC11025501 DOI: 10.1177/19417381231160164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Exertional compartment syndrome (ECS) is an underdiagnosed cause of lower extremity pain among athletes. The condition can be managed operatively by fasciotomy to relieve excess compartment pressure. However, symptom recurrence rates after fasciotomy are considerable, ranging from 3% to 17%. HYPOTHESIS Leg paresthesia and its distribution during ECS episodes would be a significant predictor of outcomes after fasciotomy. STUDY DESIGN Retrospective cohort study. LEVEL OF EVIDENCE Level 4. METHODS We conducted a retrospective chart review of patients who underwent fasciotomy for ECS at our center from 2010 to 2020 (institutional review board no. 21-00107). We measured postoperative outcomes including pain frequency and severity, Tegner activity level, and return to sport. Significant predictors of outcomes were identified using multivariable linear and logistic regression. P values <0.05 were considered significant. RESULTS A total of 78 legs (from 42 male and 36 female participants) were included in the study with average follow-up of 52 months (range, 3-126 months); 33 participants (42.3%) presented with paresthesia. Paresthesia was an independent predictor of worse outcomes, including more severe pain at rest (P = 0.05) and with daily activity (P = 0.04), reduced postoperative improvement in Tegner scores (P = 0.04), and lower odds of return to sport (P = 0.05). Those with paresthesia symptoms in the tibial nerve distribution had worse outcomes than those without paresthesia in terms of preoperative-to-present improvement in pain frequency (P < 0.01), pain severity at rest (P < 0.01) and with daily activity (P = 0.04), and return to sport (P = 0.04). CONCLUSION ECS patients who present with paresthesia have worse pain and activity outcomes after first-time fasciotomy, but prognosis is worst among those with tibial nerve paresthesia. CLINICAL RELEVANCE Paresthesia among ECS patients is broadly predictive of more severe recurrent leg pain, reduced activity level, and decreased odds of return to sport after fasciotomy.
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Affiliation(s)
- Dhruv S. Shankar
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Anna M. Blaeser
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Lauren A. Gillinov
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Kinjal D. Vasavada
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Babatunde B. Fariyike
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Edward S. Mojica
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Lauren E. Borowski
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Laith M. Jazrawi
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Dennis A. Cardone
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
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Leković A, Nikolić S. Commentary on: Ali Z, Troncoso JC, Redding-Ochoa J. Fat embolism syndrome associated with atraumatic compartment syndrome of the bilateral upper extremities: An unreported etiology. J Forensic Sci. 2024;69(2):718-24. J Forensic Sci 2024; 69:1117-1119. [PMID: 38558196 DOI: 10.1111/1556-4029.15515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Aleksa Leković
- Institute of Forensic Medicine, University of Belgrade - Faculty of Medicine, Belgrade, Serbia
| | - Slobodan Nikolić
- Institute of Forensic Medicine, University of Belgrade - Faculty of Medicine, Belgrade, Serbia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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An M, Jia R, Wu L, Ma L, Qi H, Long Y. Identifying key risk factors for acute compartment syndrome in tibial diaphysis fracture patients. Sci Rep 2024; 14:8913. [PMID: 38632464 PMCID: PMC11024173 DOI: 10.1038/s41598-024-59669-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
Acute compartment syndrome (ACS) is a severe orthopedic issue that, if left untreated, can result in lasting nerve and muscle damage or even necessitate amputation. The association between admission laboratory blood test indicators and the occurrence of ACS in patients with tibial diaphysis fractures is currently a subject of debate. The objective of this research was to identify the contributing factors for ACS in individuals suffering from tibial diaphysis fractures. In this retrospective study, we collected data on a total of 705 individuals from our hospital, comprising 86 ACS patients and 619 non-ACS patients with tibial diaphysis fractures. These participants were categorized into two distinct groups: the ACS group and the non-ACS group. Despite the inherent limitations associated with retrospective analyses, such as potential biases in data collection and interpretation, we conducted a comprehensive analysis of demographics, comorbidities, and admission lab results. Our analytical approach included univariate analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis techniques, aiming to mitigate these limitations and provide robust findings. The statistical analysis revealed several predictors of ACS, including gender (p = 0.011, OR = 3.200), crush injuries (p = 0.004, OR = 4.622), lactic dehydrogenase (LDH) levels (p < 0.001, OR = 1.003), and white blood cell (WBC) count (p < 0.001, OR = 1.246). Interestingly, the study also found that certain factors, such as falls on the same level (p = 0.007, OR = 0.334) and cholinesterase (CHE) levels (p < 0.001, OR = 0.721), seem to provide a degree of protection against ACS. In order to better predict ACS, the ROC curve analysis was employed, which determined threshold values for LDH and WBC. The established cut-off points were set at 266.26 U/L for LDH and 11.7 × 109 cells per liter for WBC, respectively. Our research has successfully pinpointed gender, crush injuries, LDH levels, and white blood cell (WBC) count as crucial risk factors for the development of ACS in patients experiencing tibial diaphysis fractures. Furthermore, by establishing the cut-off values for LDH and WBC, we have facilitated a more personalized assessment of ACS risk, enabling clinical doctors to implement targeted early interventions and optimize patient outcomes.
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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
| | - Limei Wu
- Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, 050000, China
| | - Leilei Ma
- Department of Burns and Plastic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Hui Qi
- 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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Sassoè-Pognetto M, Cavalcante R, Paonessa M. Acute compartment syndrome and fasciotomy after a viper bite in Italy: a case report. Ital J Pediatr 2024; 50:70. [PMID: 38627836 PMCID: PMC11020867 DOI: 10.1186/s13052-024-01638-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Bites caused by European vipers are rare medical emergencies but can occasionally cause life-threatening complications. Viper venom causes local symptoms, which can be accompanied by systemic manifestations in severe cases. The local effects of snakebites include edema and, more rarely, necrosis and compartment syndrome. The consequences of envenomation are often more pronounced in children due to their smaller body size. CASE PRESENTATION We present the case of a 6-year-old girl who experienced multiple viper bites in the lower limb in northwest Italy. The girl received supportive care but progressed to develop compartment syndrome that required emergency fasciotomy. The patient's condition improved promptly after surgical decompression and administration of antivenom, but full recovery required prolonged hospitalization and rehabilitation. CONCLUSIONS This case highlights the importance of obtaining a timely assessment of the severity of viper envenomation without delaying the administration of antivenom in most serious cases. The presence of multiple bite marks on the patient is one factor that may help to predict the clinical severity of snakebites and anticipate symptom progression.
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Affiliation(s)
- Marco Sassoè-Pognetto
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, C.so Massimo d'Azeglio, 52, 10126, Torino, Italy.
| | - Riccardo Cavalcante
- Centro Emys Piemonte, ELEADE Società Cooperativa a.r.l, Chiaverano, TO, Italy
| | - Matteo Paonessa
- Pediatric Orthopedic Surgery Department, "Regina Margherita" Children's Hospital, Torino, Italy
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Ochi T, Katsuno H, Kato H, Takagi S, Kikuchi K, Nakamura K, Endo T, Matsuo K, Yasuoka H, Nishimura A, Horiguchi A, Morise Z. Preliminary comparative study of lower extremity pressure measurements under the conditions using former models and new lithotomy stirrups in rectal cancer surgery. World J Surg Oncol 2024; 22:85. [PMID: 38566192 PMCID: PMC10988980 DOI: 10.1186/s12957-024-03352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/24/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND This study aimed to investigate the effect of the use of new lithotomy stirrups-2 on the pressure dispersal on lower limbs, which may lead to the prevention of well-leg compartment syndrome (WLCS) and deep venous thrombosis (DVT), which are the most commonly associated adverse events with laparoscopic and robot-assisted rectal surgery. METHODS A total of 30 healthy participants were included in this study. The pressure (mmHg) applied on various lower limb muscles when using conventional lithotomy stirrups-1 and new type stirrups-2 was recorded in various lithotomy positions; 1) neutral position, 2) Trendelenburg position (15°) with a 0° right inferior tilt, and 3) Trendelenburg position (15°) with a 10° right inferior tilt. Using a special sensor pad named Palm Q®, and the average values were compared between two types of stirrups. RESULTS The use of new lithotomy stirrups-2 significantly reduced the pressure applied on the lower limb muscles in various lithotomy positions compared with the use of lithotomy stirrups-1. The most pressured lower limb muscle when using both lithotomy stirrups was the central soleus muscle, which is the most common site for the development of WLCS and DVT. In addition, when using the conventional lithotomy stirrups-1, the pressure was predominantly applied to the proximal soleus muscle; however, when using lithotomy stirrups-2, the pressure was shifted to the more distal soleus muscle. CONCLUSION These results suggest that the new lithotomy stirrups-2 is useful in reducing the pressure load on leg muscles, especially on the proximal to central soleus, and may reduce the incidence of WLCS and DVT after rectal surgery performed in the lithotomy position. Further clinical studies are needed to determine whether the use of lithotomy stirrups-2 prevents these complications in various clinical settings.
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Affiliation(s)
- Takayuki Ochi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya, Japan
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan.
| | - Hiroyuki Kato
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya, Japan
| | - Shinya Takagi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Kenji Kikuchi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Kenichi Nakamura
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Kazuhiro Matsuo
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Hironobu Yasuoka
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya, Japan
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Akihiro Nishimura
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya, Japan
| | - Zenichi Morise
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
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Sauliunaite V, Vecsernyés N, Coronado M. Acute lumbar paraspinal compartment syndrome after radical cystectomy. BMJ Case Rep 2024; 17:e255983. [PMID: 38569733 PMCID: PMC10989141 DOI: 10.1136/bcr-2023-255983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
Lumbar paraspinal compartment syndrome (LPCS) is a rare diagnosis, seen in patients chronically after repeated lumbar trauma or acutely in a postoperative setting. Only a dozen cases are documented worldwide, and to date no clinical guidelines exist for the diagnosis nor the treatment.We describe the case of a 44-year-old man with excruciating lower back pain following a radical cystectomy. The postoperative laboratory values were compatible with acute rhabdomyolysis. The lumbar spine MRI showed necrosis of lumbosacral paraspinal muscles, making the diagnosis of acute LPCS. After seeking advice from different specialists, the conservative approach was chosen with combined pain treatment and physiotherapy. The patient is currently still disabled for some tasks and needs chronic pain medication.
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Affiliation(s)
- Vilte Sauliunaite
- Emergency Department, Riviera-Chablais Hospital, 1847 Rennaz, Switzerland
| | - Noémie Vecsernyés
- Department of Acute Medicine, Division of Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Marcos Coronado
- Department of Critical Care, Riviera-Chablais Hospital, 1847 Rennaz, Switzerland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Manini N, Unno H. Delayed onset of neonatal compartment syndrome associated with compound fetal presentation. BMC Pediatr 2024; 24:224. [PMID: 38561722 PMCID: PMC10983639 DOI: 10.1186/s12887-023-04505-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/21/2023] [Indexed: 04/04/2024] Open
Abstract
Neonatal compartment syndrome, although rare, has a classic presentation with sentinel skin findings and development of swelling, erythema, and tenderness of the affected extremity. Neonatal compartment syndrome requires prompt surgical intervention to preserve the affected limb and ensure its normal growth and development. Our patient was born at term via vaginal delivery complicated by a compound presentation involving the left upper extremity. No physical exam abnormalities were noted at birth, but she developed signs of neonatal compartment syndrome by 15 h of life. She was surgically treated at 22 h of life and recovered well. At one year of age, she has normal growth and function of the affected extremity. Our case adds to the growing literature associating neonatal compartment syndrome with a compound fetal presentation.
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Affiliation(s)
- Nicholas Manini
- Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
- Thomas Jefferson University Hospital, 111 S 11th St, Philadelphia, PA 19107, USA.
| | - Hayato Unno
- Thomas Jefferson University Hospital, 111 S 11th St, Philadelphia, PA 19107, USA
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Vicentin DM, Juárez CP, Luna C, Luna JD. Orbital compartment syndrome due to periorbital angioedema. Orbit 2024; 43:265-269. [PMID: 36185008 DOI: 10.1080/01676830.2022.2119263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/25/2022] [Indexed: 10/10/2022]
Abstract
A 68-year-old female presented with an episode of unilateral orbital compartment syndrome due to periorbital angioedema. The patient made a consultation at the general Emergency Room with sudden left periorbital edema and serious diminished ipsilateral visual acuity, with examination detecting orbital compartment syndrome secondary to a probable allergic angioedema after ingestion of ibuprofen. She received treatment with intravenous and oral corticosteroids, achieving a rapid improvement in the condition and clinical follow-up was carried out, with evaluation of the peripapillary retinal nerve fiber layer thickness and computed perimetry. Periorbital angioedema due to ibuprofen can be a cause of orbital compartment syndrome whose diagnosis and treatment must be carried out urgently to prevent permanent visual impairment.
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Affiliation(s)
| | - Claudio P Juárez
- Centro Privado de Ojos Romagosa-Fundación VER, Córdoba, Argentina
| | - Catalina Luna
- Centro Privado de Ojos Romagosa-Fundación VER, Córdoba, Argentina
| | - Jose D Luna
- Centro Privado de Ojos Romagosa-Fundación VER, Córdoba, Argentina
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Shahrestani J, Smart EL, Mesa L, Martin C. Compartment Syndrome in the Pediatric Patient. Pediatr Rev 2024; 45:247-249. [PMID: 38556506 DOI: 10.1542/pir.2022-005562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Jasmin Shahrestani
- Department of Pediatrics and †Department of Orthopedic Surgery, University of South Florida, Tampa, FL
| | - Eric Landon Smart
- Department of Pediatrics and †Department of Orthopedic Surgery, University of South Florida, Tampa, FL
| | - Lazaro Mesa
- Department of Pediatrics and †Department of Orthopedic Surgery, University of South Florida, Tampa, FL
| | - Christa Martin
- Department of Emergency Medicine, Tampa General Hospital, Tampa, FL
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Bridges CS, Taylor TN, Bini T, Ontaneda AM, Coleman RD, Hill JF, Montgomery NI, Shenava VR, Gerow FT. Acute Compartment Syndrome in Pediatric Patients on Extracorporeal Membrane Oxygenation Support. J Pediatr Orthop 2024; 44:e285-e291. [PMID: 38084004 DOI: 10.1097/bpo.0000000000002592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND When acute compartment syndrome (ACS) occurs in pediatric patients requiring venoarterial extracorporeal membrane oxygen (VA ECMO) support, there is little data to guide surgeons on appropriate management. The purpose of this study is to characterize the presentation, diagnosis, timeline, and outcomes of patients who developed this complication. METHODS This is a single-center retrospective case series of children below 19 years old on VA ECMO support who subsequently developed extremity ACS between January 2016 and December 2022. Outcomes included fasciotomy findings, amputation, mortality, and documented function at the last follow-up. RESULTS Of 343 patients on VA ECMO support, 18 (5.2%) were diagnosed with ACS a median 29 hours after starting ECMO. Initial cannulation sites included 8 femoral, 6 neck, and 4 central. Femoral artery cannulation was associated with an increased risk of ACS [odds ratio=6.0 (CI: 2.2 to 15), P <0.0001]. In the hospital, the mortality rate was 56% (10/18). Fourteen (78%) patients received fasciotomies a median of 1.2 hours after ACS diagnosis. Only 4 (29%) patients had all healthy muscles at initial fasciotomy, while 9 (64%) had poor muscular findings in at least 1 compartment. Patients with worse findings at fasciotomy had a significantly longer duration between ischemia onset and ACS diagnosis. Patients required a median of 1.5 additional procedures after fasciotomy, and only 1 (7%) developed a surgical site infection. Of the 7 surviving fasciotomy patients, 2 required amputations, 3 developed an equinus contracture, 1 developed foot drop, and 3 had no ACS-related deficits. Four patients did not receive fasciotomies: 3 were deemed too ill and later died, and 1 was diagnosed too late to benefit. The only surviving nonfasciotomy patient required bilateral amputations. CONCLUSIONS Pediatric ECMO-associated ACS is not exclusive to patients with femoral artery cannulation. The majority of fasciotomy patients were diagnosed with ACS after muscle necrosis had already started. We were unable to definitively conclude whether fasciotomies provide better outcomes. There is a need for increased awareness and earlier recognition of this rare yet potentially devastating complication. LEVEL OF EVIDENCE Level IV-retrospective case series.
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Affiliation(s)
| | | | | | - Andrea M Ontaneda
- Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine
| | - Ryan D Coleman
- Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine
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13
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Frane N, Doxey SA, Huyke-Hernández FA, Cunningham BP, McKee MD. Use of a Continuous Intracompartmental Pressure Monitoring Device During Fasciotomy. Orthopedics 2024; 47:e98-e101. [PMID: 37921525 DOI: 10.3928/01477447-20231027-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
A 52-year-old man presented with a bicondylar tibial plateau fracture and acute compartment syndrome. Continuous compartment pressure monitoring was used while the patient was treated with fasciotomies and application of an external fixator. The intraoperative pressure reading in the anterior compartment decreased from 105 mm Hg to 50 mm Hg after skin and subcutaneous tissue incision. Pressure continued to decrease to 10 mm Hg after all 4 compartments were released. The patient underwent staged open reduction and internal fixation and healed both fracture and fasciotomy incisions without complication. To our knowledge, this is the first report of continuous pressure changes during the different stages of a compartment release. Future studies could expand on use of this technology to gain information on compartment pressures during release and how single release affects pressures in other compartments. [Orthopedics. 2024;47(2):e98-e101.].
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14
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Sert G, Menku Ozdemir FD, Uzun O, Üstün GG. The effect of time from injury to fasciotomy in patients with acute upper extremity compartment syndrome. ULUS TRAVMA ACIL CER 2024; 30:203-209. [PMID: 38506391 DOI: 10.14744/tjtes.2024.95519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Acute compartment syndrome of the upper extremity is a surgical emergency, and timely diagnosis with immediate fasciotomies is essential for the preservation of function. This retrospective study aimed to compare the complication rates of patients who underwent fasciotomy before and after 6 hours following the initial trauma. METHODS The medical records of the patients who underwent fasciotomy for surgical treatment of ACS of the upper extremity between 2016 and 2022 were retrospectively analyzed for age, gender, dominant hand, mechanism of injury, injury level, affected compartments, associated injuries, time elapsed till fasciotomy, and complications. The patients were divided into two groups according to the timing of fasciotomy. RESULTS A total of 32 patients underwent fasciotomies for upper extremity ACS. The mean age of patients who underwent fasciotomy ≤ 6 hours (group 1; 10 males, 7 females) and patients who underwent fasciotomy > 6 hours (group 2; 13 males, 2 females) was 31.1 and 34.8, respectively. The most common etiology was crushing injury. There was a significant difference in complication rates between group 1 (1/17) and group 2 (10/15) (p<0.001). The length of hospitalization stay in group 2 was statistically higher than in group 1 (p=0.005). CONCLUSION Fasciotomies for ACS of the upper extremity should be performed in less than 6 hours following the initial trauma to prevent complications.
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Affiliation(s)
- Gökhan Sert
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University, Faculty of Medicine, Ankara-Türkiye
| | | | - Oznur Uzun
- Department of Physical Therapy and Rehabilitation, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Galip Gencay Üstün
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University, Faculty of Medicine, Ankara-Türkiye
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15
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Altun A, VAN Beeck A, Michielsen J. Acute compartment syndrome of the thigh complicated with a pseudoaneurysm of the arteria profunda femoris. Acta Orthop Belg 2024; 90:131-134. [PMID: 38669662 DOI: 10.52628/90.1.11958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Compartment syndrome of the thigh and a pseudoaneurysm of the arteria profunda femoris are rare entities that usually occur independently. Untreated, both can lead to life-threatening complications making prompt diagnosis and management mandatory. The diagnosis of an acute compartment syndrome can be suspected clinically, and subsequently needs to be confirmed by intra-compartmental pressure measurement. Treatment should be done by urgent fasciotomy within 6 hours. A pseudoaneurysm can also be suspected clinically. Various imaging modalities exist to confirm the diagnosis, with duplex ultrasound being the diagnostic test of choice. Treatment is depending on the importance of clinical symptoms and on the size of the pseudoaneurysm. We present the first case in which an acute compartment syndrome of the thigh was complicated by a pseudoaneurysm of the arteria profunda femoris. The pseudoaneurysm was subsequently complicated by hemorrhage and infection.
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Al Tannir AH, Biesboer EA, Pokrzywa C, Golestani S, Kukushliev V, Jean X, Harding E, de Moya MA, Morris R, Kugler N, Schellenberg M, Murphy PB. Open versus endovascular repair of penetrating non-aortic arterial injuries: A systematic review and meta analysis. Injury 2024; 55:111368. [PMID: 38309083 DOI: 10.1016/j.injury.2024.111368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Non-aortic arterial injuries are common and are associated with high morbidity and mortality. Historically, open surgical repair (OSR) was the conventional method of repair. With recent advancements in minimally invasive techniques, endovascular repair (ER) has gained popularity. We sought to compare outcomes in patients undergoing endovascular and open repairs of traumatic non-aortic penetrating arterial injuries. METHODS A systematic review and meta-analysis was conducted using MEDLINE (OVID), Web of Science, Cochrane Library, and Scopus Database from January 1st, 1990, to March 20th, 2023. Titles and abstracts were screened, followed by full text review. Articles assessing clinically important outcomes between OSR and ER in penetrating arterial injuries were included. Exclusion criteria included blunt injuries, aortic injuries, pediatric populations, review articles, and non-English articles. Odds ratios (OR) and Cohen's d ratios were used to quantify differences in morbidity and mortality. RESULTS A total of 3770 articles were identified, of which 8 met inclusion criteria and were included in the review. The articles comprised a total of 8369 patients of whom 90 % were male with a median age of 28 years. 85 % of patients were treated with OSR while 15 % underwent ER. With regards to injury characteristics, those who underwent ER were less likely to present with concurrent venous injuries (OR: 0.41; 95 %CI: 0.18, 0.94; p = 0.03). Regarding hospital outcomes, patients who underwent ER had a lower likelihood of in-hospital or 30-day mortality (OR: 0.72; 95 %CI: 0.55, 0.95; p = 0.02) and compartment syndrome (OR: 0.29, 95 %CI: 0.12, 0.71; p = 0.007). The overall risk of bias was moderate. CONCLUSION Endovascular repair of non-aortic penetrating arterial injuries is increasingly common, however open repair remains the most common approach. Compared to ER, OSR was associated with higher odds of compartment syndrome and mortality. Further prospective research is warranted to determine the patient populations and injury patterns that most significantly benefit from an endovascular approach. LEVEL OF EVIDENCE Level III, Systematic Reviews & Meta-Analyses.
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Affiliation(s)
- Abdul Hafiz Al Tannir
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elise A Biesboer
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Courtney Pokrzywa
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Simin Golestani
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Vasil Kukushliev
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Xavier Jean
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Eric Harding
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marc A de Moya
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Morris
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nathan Kugler
- Department of Surgery, Division of Vascular & Endovascular Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Morgan Schellenberg
- Department of Surgery, Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA
| | - Patrick B Murphy
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
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Solasz S, Ganta A, Robitsek RJ, Egol KA, Konda S. Thigh compartment syndrome: Outcomes in an urban level 1 trauma center. Injury 2024; 55:111331. [PMID: 38244251 DOI: 10.1016/j.injury.2024.111331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Thigh compartment syndrome (TCS) is a rare surgical emergency associated with a high risk of morbidity with mortality rates as high as 47 %. There is sparse literature discussing the management as well as outcomes of these injuries. The purpose of this study is to review a consecutive series of patients presenting to a single urban Level 1 trauma center with TCS to identify injury characteristics, clinical presentation, and outcomes associated with this injury. METHODS A trauma database was queried for all patients with a diagnosis of TCS at a single level 1 urban trauma center between January 1, 2011 and December 31, 2021. Demographic and injury variables collected included age, sex, BMI, mechanism of injury, and creatine phosphokinase levels (CPK). Hospital quality measures including time from admission to surgery, length of both hospital and ICU stay, complications, and cost of care were collected. Descriptive statistics are reported as median [interquartile range] or N (percent). RESULTS There were 14 patients identified with a diagnosis of TCS. All were men with an average age 33.5 [23.5 - 38] years and an average BMI of 26 [22.9-28.1]. The most common cause of injury was blunt trauma (71.4 %), and the remaining 28.6 % were gunshot wound injuries. Within the cohort, 6 (42.9 %) patients sustained a femoral shaft fracture, and 4 (28.6 %) patients sustained a vascular injury. The median initial CPK of patients within this cohort was 3405 [1232-5339] and reached a peak of 5271 [3013-13,266]. The median time from admission to diagnosis was 6.8 [0-236.9] hours. The median time from admission to the operating room was 8.2 [0.6-236.9] hours, and the median number of operating room visits was 3 [2 - 6]. Five patients (35.7 %) wounds were closed with split thickness skin grafting. There were 12 (85.7 %) patients who required ICU care. The median ICU length of stay was 7.5 days [4-15]. The median hospital length of stay was 16.5 days [13.25-38.0]. The median total charges for a patient with thigh compartment syndrome was $129,159.00 [$24,768.00 - $587,152.00]. The median direct variable cost for these patients was $86,106.00 For comparison, the median direct variable cost for patients with femur fractures without TCS at this institution was $8,497.28 [$1,903.52-$21,893.13]. No patients required readmission within 60 days. There were no mortalities. CONCLUSION TCS is a rare and life-threatening injury associated with significant morbidity. Despite rapid diagnosis and fasciotomy, the majority of the patients have prolonged hospital courses, ICU lengths of stay, and significant costs of treatment. Providers can reference the outcomes reported in this study when caring for TCS patients.
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Affiliation(s)
- Sara Solasz
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US
| | - Abhishek Ganta
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US; Jamaica Hospital Medical Center, Department of Orthopaedic Surgery, 8900 Van Wyck Expressway, Richmond Hill, NY 11418, Canada
| | - R Jonathan Robitsek
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US
| | - Kenneth A Egol
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US; Jamaica Hospital Medical Center, Department of Orthopaedic Surgery, 8900 Van Wyck Expressway, Richmond Hill, NY 11418, Canada
| | - Sanjit Konda
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US; Jamaica Hospital Medical Center, Department of Orthopaedic Surgery, 8900 Van Wyck Expressway, Richmond Hill, NY 11418, Canada.
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Schuster M, Kappenschneider T, Meyer M, Holzapfel DE. Acute compartment syndrome of the thigh after total knee arthroplasty: a case report. J Med Case Rep 2024; 18:65. [PMID: 38374059 PMCID: PMC10877870 DOI: 10.1186/s13256-024-04378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION Acute compartment syndrome of the thigh after total knee arthroplasty is a rarely described complication. After the assessment of the diagnosis, immediate surgical intervention is necessary to prevent further tissue damage. Since only a few cases have been described and because of the high complication rate, early detection is essential for ensuring patient outcomes. CASE PRESENTATION After total knee arthroplasty in a high-volume university hospital, a 57-year-old Caucasian female patient experienced strong, disproportional pain in the ventromedial thigh of the affected leg, which did not respond to an adequate adjustment in pain medication. Imaging revealed a distinct swelling of the vastus intermedius muscle. This resulted in acute compartment syndrome of the thigh, which was immediately surgically treated. Apart from receiving surgery distal from the affected compartment and continuous intake of acetylsalicylic acid, the patient had no risk factors for developing compartment syndrome. The patient's recovery was uneventful, with timely wound closure and discharge to outpatient care without significant functional limitations. CONCLUSION Acute compartment syndrome of the thigh represents a rare, but severe complication that can occur after orthopedic surgery. In our case, no triggering factors for the development of acute compartment syndrome, such as the use of a tourniquet, were detected. Even in unusual locations, compartment syndrome should be considered as a differential diagnosis. With sufficient evidence, immediate fasciotomy should be indicated.
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Affiliation(s)
- Marie Schuster
- Department of Orthopaedic Surgery, University of Regensburg, Asklepios Klinikum, Bad Abbach, Germany.
| | - Tobias Kappenschneider
- Department of Orthopaedic Surgery, University of Regensburg, Asklepios Klinikum, Bad Abbach, Germany
| | - Matthias Meyer
- Department of Orthopaedic Surgery, University of Regensburg, Asklepios Klinikum, Bad Abbach, Germany
| | - Dominik Emanuel Holzapfel
- Department of Orthopaedic Surgery, University of Regensburg, Asklepios Klinikum, Bad Abbach, Germany
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Fernandez JJ, Smith SR. Traumatic Rhabdomyolysis: Crush Syndrome, Compartment Syndrome, and the 'Found Down' Patient. J Am Acad Orthop Surg 2024; 32:e166-e174. [PMID: 38109720 DOI: 10.5435/jaaos-d-23-00734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
Traumatic rhabdomyolysis is a systemic manifestation of muscle injury and can occur from various traumatic etiologies, including crush syndrome (CrshS) and compartment syndrome (CS). Although historically described in natural disaster survivors trapped under collapsed structures, the frequency of CrshS has increased in the setting of 'found down' patients from opioid overdoses. Signs and symptoms of the injured limb in CrshS may range from pressure-induced skin changes to neurologic deficits and paralysis. Although its pathophysiology differs from CS, severe injuries may lead to an associated CS. Identifying CS in a patient with CrshS can be difficult but is important to distinguish because it affects treatment. The degree of muscle damage, viability of the remaining muscular compartment, and presence of elevated compartment pressures dictate the need for surgical intervention in the form of fasciotomy. Surgical outcomes from CrshS and delayed CS result in similar high morbidity and surgical complications. This review defines and classifies the types of traumatic rhabdomyolysis and summarizes the outcomes to facilitate timely diagnosis and appropriate management for this population to reduce morbidity associated with these conditions.
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20
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Ghanem D, Rogers DL, Benes G, Siler B, Lobaton G, Shafiq B. Gluteal compartment syndrome: who is most at risk? Eur J Orthop Surg Traumatol 2024; 34:773-779. [PMID: 37695367 DOI: 10.1007/s00590-023-03704-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE Gluteal compartment syndrome (GCS) is a rare but devastating condition with a paucity of literature to help guide diagnosis and management. This study aims to identify and describe the risk factors and patient characteristics associated with GCS to facilitate early diagnosis. METHODS This is a retrospective case series of patients undergoing gluteal compartment release between 2015 and 2022 at an academic Level I trauma center. Chart reviews were performed to extract data on patient demographics, presenting symptoms, risk factors, operative findings, and postoperative outcomes. RESULTS 14 cases of GCS were identified. 12 (85.7%) were male, with a mean age of 39.4 ± 13 years and a mean BMI of 25.1 ± 4.1 kg/m2. 12 (85.7%) patients did not present as traumas and only 3 had ≥ 1 fracture. 9 patients reported drug use. Hemoglobin (Hgb) (11.7 ± 4 g/dL) was generally low (5 had Hgb < 10 g/dL). Creatine kinase (49,617 ± 60,068 units/L) was consistently elevated in all cases, and lactate (2.8 ± 1.6 mmol/L) was elevated in 9. 13 had non-viable muscle requiring debridement. Postoperatively, the mean ICU length of stay was 12 ± 23 days. 2 patients died during admission and all remaining patients required discharge to rehabilitation facilities. CONCLUSION GCS is more likely to present in a young to middle-aged, otherwise healthy, male using drugs who is either found down or experienced an iatrogenic injury. Recognizing that GCS is different from that of the leg, in terms of etiology, may help avoid delays in diagnosis and treatment.
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Affiliation(s)
- Diane Ghanem
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA.
| | - Davis L Rogers
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Gregory Benes
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Brad Siler
- School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Gilberto Lobaton
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Babar Shafiq
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
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Epanomeritakis IE, Li L, Treharne L, Grant I. Congenital brachial artery occlusion causing neonatal forearm compartment syndrome. J Hand Surg Eur Vol 2024; 49:275-277. [PMID: 37728888 DOI: 10.1177/17531934231200530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Congenital brachial artery occlusion is rare. We report four patients who presented at birth with absent wrist pulses. We propose management recommendations that include anti-coagulation, duplex ultrasound assessment and fasciotomy surgery as early as is safe and possible.
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Affiliation(s)
| | - Lily Li
- Department of Plastic Surgery, Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK
| | - Linda Treharne
- Department of Plastic Surgery, Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK
| | - Ian Grant
- Department of Plastic Surgery, Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bilichtin E, Choufani C, Derkenne C, Vioujard C, Pacull R. First Case of Surgically Treated Chronic Exertional Compartment Syndrome of the Arm. Mil Med 2024; 189:e454-e456. [PMID: 37651584 DOI: 10.1093/milmed/usad349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/26/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023] Open
Abstract
This paper reports the first case of chronic exertional compartment syndrome in the arm treated surgically. The diagnosis was made in a patient who is under 30 years old, military, and very athletic, with recurrent exertional pain in the anterior compartment of the arms associated with rhabdomyolysis. The high-pressure measurements in the arms' anterior compartment after exertional exercise confirmed the diagnosis. Given the patient's functional demands, a surgical treatment of fasciotomy of the anterior compartment by miniapproach was performed and allowed the resolution of symptomatology with a return to sport at the same level after 3 months.
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Affiliation(s)
- Emilie Bilichtin
- Orthopedic Surgery Department, Saint-Anne Army Instruction Hospital, Toulon 83000, France
- Toulon Mediterranean Orthopedic and Sport Trauma (TMOST) association, Toulon 83000, France
| | - Camille Choufani
- Orthopedic Surgery Department, Saint-Anne Army Instruction Hospital, Toulon 83000, France
- Toulon Mediterranean Orthopedic and Sport Trauma (TMOST) association, Toulon 83000, France
| | - Clément Derkenne
- Battalion of the Paris Fire Brigade, 3rd Group, Caserne Champerret, Paris 75017, France
| | - Clotilde Vioujard
- Medical imaging department, Saint-Anne Army Instruction Hospital, Toulon 83000, France
| | - Romain Pacull
- Orthopedic Surgery Department, Saint-Anne Army Instruction Hospital, Toulon 83000, France
- Toulon Mediterranean Orthopedic and Sport Trauma (TMOST) association, Toulon 83000, France
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24
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Taniguchi M, Inata Y, Shimizu Y, Tamura D, Takeuchi M. Compartment syndrome due to group A streptococcal infection associated with intramuscular venous malformation. Pediatr Int 2024; 66:e15756. [PMID: 38641929 DOI: 10.1111/ped.15756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/05/2024] [Accepted: 02/05/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Masashi Taniguchi
- Department of Pediatrics, Hirakata City Hospital, Hirakata, Osaka, Japan
| | - Yu Inata
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Yoshiyuki Shimizu
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Daisuke Tamura
- Department of Orthopedics Surgery, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Muneyuki Takeuchi
- Department of Intensive Care Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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25
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Udall D, Zimmerman R, Bastrom T, Schlechter J. The Pressure Is on: Dorsal Versus Volar Univalves for Long-arm Casts. J Pediatr Orthop 2024; 44:e15-e19. [PMID: 37728108 DOI: 10.1097/bpo.0000000000002521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Fiberglass casts are routinely used to treat fractures of the upper extremity. When posttraumatic edema is anticipated, the cast is often valved to hopefully prevent potential complications, especially compartment syndrome. Due to volar forearm compartments being most involved with upper extremity compartment syndrome, volar skin surface pressures (SSP) are paramount. Despite past literature showing that a univalved cast will retain a 3-point mold better than a bivalved cast, there is a paucity of information analyzing the effects of univalving on the volar SSP. We hypothesized that a volar univalve technique would have a greater decrease in the volar skin surface pressures compared to a dorsal univalve in long-arm casts. METHODS A 100-mL saline bag attached to an arterial line pressure transducer was placed between a long-arm cast and the skin along the volar forearm of a single adult volunteer. Fourteen casts were applied by a single certified orthopaedic technologist with 30 years of experience and assigned randomly to receive either a volar or dorsal univalve. We calculated the change in volar forearm SSP on each cast in 4 stages: isolated univalve, with a 3-mm cast spacer, with a 6-mm spacer, and with bivalve. Statistical analysis of the data was performed using a Mann-Whitney U test. RESULTS When comparing volar versus dorsal univalve, volar SSP significantly dropped by a mean of 32.00 versus 20.43 mm Hg ( P value=0.001) in stage I, 45.14 versus 38.00 mm Hg in stage II ( P value=0.026), and 56.53 versus 49 mm Hg in stage III ( P value=0.001). There was no significant difference between the 2 groups after a bivalve was performed at stage IV ( P value=0.318). CONCLUSION Our findings support that a volar univalve with a 6-mm spacer will provide the greatest reduction of skin surface pressure while theoretically maintaining the cast's structural integrity and biomechanical properties when compared to a bivalved cast. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Dallyn Udall
- Department of Orthopaedic Surgery, Riverside University Health System-Medical Center, Moreno Valley
| | | | | | - John Schlechter
- Department of Orthopaedic Surgery, Riverside University Health System-Medical Center, Moreno Valley
- CHOC Children's Hospital
- Pediatric Orthopedic Specialists of Orange County, Orange
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26
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The Incidence and Risk Factors Associated With the Need for Fasciotomy in Tibia and Forearm Fractures: An Analysis of the National Trauma Data Bank: Erratum. J Orthop Trauma 2024; 38:e41. [PMID: 38093440 DOI: 10.1097/BOT.0000000000002715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
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27
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Oishi H, Numasawa T, Nohmi S, Nitobe Y, Ono H, Nagaoki T, Izawa T, Nodagashira T, Konn A. Exercise-induced acute rhabdomyolysis with bilateral gluteal, thigh, and leg compartment syndrome: A case report. J Orthop Sci 2024; 29:361-365. [PMID: 35272916 DOI: 10.1016/j.jos.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/27/2021] [Accepted: 01/27/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Hirotaka Oishi
- Department of Orthopaedic Surgery, Hachinohe City Hospital, Hachinohe, Japan.
| | - Takuya Numasawa
- Department of Orthopaedic Surgery, Hachinohe City Hospital, Hachinohe, Japan
| | - Shuya Nohmi
- Department of Orthopaedic Surgery, Hachinohe City Hospital, Hachinohe, Japan
| | - Yohshiro Nitobe
- Department of Orthopaedic Surgery, Hachinohe City Hospital, Hachinohe, Japan
| | - Hiroya Ono
- Department of Orthopaedic Surgery, Hachinohe City Hospital, Hachinohe, Japan
| | - Toshihide Nagaoki
- Department of Orthopaedic Surgery, Hachinohe City Hospital, Hachinohe, Japan
| | - Tomomi Izawa
- Department of Critical Care and Emergency Medicine, Hachinohe City Hospital, Hachinohe, Japan
| | - Tatsuya Nodagashira
- Department of Critical Care and Emergency Medicine, Hachinohe City Hospital, Hachinohe, Japan
| | - Akihide Konn
- Department of Critical Care and Emergency Medicine, Hachinohe City Hospital, Hachinohe, Japan
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28
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Mungmunpuntipantip R, Wiwanitkit V. Letter re: Lower Extremity Compartment Syndrome, COVID-19 Myositis and Vaccination: Correspondence. Am Surg 2024; 90:165. [PMID: 35802883 PMCID: PMC9272039 DOI: 10.1177/00031348221114026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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29
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Ratnayake AS, Worlton TJ, Bowyer M. Letter re: Do We Overdo Prophylactic Fasciotomy? In Response to Two Urgency Categories, Same Outcome: No Difference after "Therapeutic" vs. Prophylactic" Fasciotomy. Am Surg 2023; 89:6440. [PMID: 34854738 DOI: 10.1177/00031348211058624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Amila S Ratnayake
- Department of Surgery, Military Hospital Narahenpita, Colombo, Sri Lanka
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Tamara J Worlton
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Mark Bowyer
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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30
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Azenkot T, Aronowitz PB. Isolated Finger Compartment Syndrome Following Crush Injury. J Gen Intern Med 2023; 38:3636-3637. [PMID: 37723367 PMCID: PMC10713936 DOI: 10.1007/s11606-023-08396-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/24/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Tali Azenkot
- Davis Department of Internal Medicine, University of California, Sacramento, CA, USA.
| | - Paul B Aronowitz
- Davis Department of Internal Medicine, University of California, Sacramento, CA, USA
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31
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Chao YP, Chen YH, Chien KH. Disseminated amoebic infection with orbital compartment syndrome. QJM 2023; 116:938-939. [PMID: 37449897 DOI: 10.1093/qjmed/hcad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Yuan-Ping Chao
- Department of Ophthalmology, Kaohsiung Armed Forces General Hospital, Kaohsiung, 802, Taiwan (R.O.C.)
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan (R.O.C.)
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan (R.O.C.)
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan (R.O.C.)
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32
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Bui T, Anies LE, Super E, Jahja E, Janze A. Perineural Injection Therapy for Chronic Exertional Compartment Syndrome Refractory to Initial Compartment Release: A Case Report. Mil Med 2023; 188:e3726-e3729. [PMID: 37646777 DOI: 10.1093/milmed/usad344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/07/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023] Open
Abstract
This is a case of a 26-year-old active duty male with a 1-year history of distal anterolateral leg pain and numbness which would persist following activity cessation. He was referred to physical therapy and eventually orthopedic surgery for bilateral anterior exertional compartment syndrome and underwent bilateral anterolateral fasciotomies. One year after surgery, he continued to have pain along the posterior aspect of his lower legs with residual numbness over his left dorsomedial foot. He was referred to sports medicine for further evaluation and Botox injections without significant symptomatic changes. He subsequently underwent diagnostic ultrasound of his lower legs which showed multiple entrapment points of the left superficial peroneal nerve along the fasciotomy scar. An additional electrodiagnostic study showed left superficial peroneal sensory mononeuropathy. Eighteen months following surgery, he received his first perineural injection therapy (PIT) treatment. A mixture of lidocaine and D5W was prepared to achieve 1 mg/cc which was then injected along his tibial, saphenous, and sural nerves. Following four PIT sessions, the patient's overall lower extremity pain, weakness, and functionality had improved. This case demonstrates potential benefit with PIT in patients with refractory symptoms following surgery for chronic exertional compartment syndrome. These symptoms may be due to chronic irritation of cutaneous nerves and they may benefit from treatment with PIT. Our case may represent a possible paradigm shift in the conservative treatment of chronic exertional compartment syndrome, especially when refractory to surgical compartment release.
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Affiliation(s)
- Tam Bui
- Physical Medicine & Rehabilitation Residency Program, Walter Reed National Military Medical Center/National Capital Consortium, Bethesda, MD 20814, USA
| | - Lt Ervin Anies
- Physical Medicine & Rehabilitation Residency Program, Walter Reed National Military Medical Center/National Capital Consortium, Bethesda, MD 20814, USA
| | - Eric Super
- Physical Medicine & Rehabilitation Residency Program, Walter Reed National Military Medical Center/National Capital Consortium, Bethesda, MD 20814, USA
| | - Erol Jahja
- Physical Medicine & Rehabilitation Residency Program, Sinai Hospital of Baltimore PM&R, Baltimore, MD 21215, USA
| | - Aeneas Janze
- Physical Medicine & Rehabilitation Residency Program, Walter Reed National Military Medical Center/National Capital Consortium, Bethesda, MD 20814, USA
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33
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Kantor AH, Clapp I, O'Neill DC, Daryoush JR, Myhre LA, Marchand L, Haller JM. Tibial Plateau Fractures Complicated by Compartment Syndrome Are Associated With a 3 Times Higher Cost of Care. J Orthop Trauma 2023; 37:568-573. [PMID: 37459502 DOI: 10.1097/bot.0000000000002674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES To determine the impact of acute compartment syndrome (ACS) and identify cost drivers of 1-year total treatment costs for operative tibial plateau fractures. DESIGN Retrospective review. SETTING Level 1 trauma center. PATIENTS 337 patients with tibial plateau fractures, 24 of which were complicated by ACS. OUTCOMES The primary outcome was total treatment cost over the first year for operatively treated tibial plateau fractures. The secondary objective was to use regression analysis to identify significant cost drivers. RESULTS The diagnosis of ACS was associated with 2.85 times higher total treatment cost ( P < 0.001). ACS demonstrated increased total treatment cost when controlling for polytrauma ( P < 0.001) and postoperative infection ( P < 0.001). Regression analysis identified 5 variables significantly associated with total cost of care: body mass index, injury severity score, ACS, staged external fixation, and locking fixation ( P < 0.001; R 2 = 0.57). The diagnosis of ACS had the largest impact on total cost with a 3.5× greater impact on cost compared with the next highest variable, staged external fixation. CONCLUSIONS Tibial plateau fractures complicated by ACS are associated with 2.85 times higher treatment costs over a 1-year period. There were 5 significant variables identified by regression analysis with ACS having the highest impact on total treatment. Together, these 5 factors account for 57% of treatment cost variability. LEVEL OF EVIDENCE Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Adam H Kantor
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
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34
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Famili DT, Fernandez-Garcia MA, Vanegas M, Goldberg MF, Voermans N, Quinlivan R, Jungbluth H. Recurrent atraumatic compartment syndrome as a manifestation of genetic neuromuscular disease. Neuromuscul Disord 2023; 33:866-872. [PMID: 37919205 DOI: 10.1016/j.nmd.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023]
Abstract
Compartment syndrome (CS) is a medical emergency that occurs secondary to excessively high pressures within a confined fibro-osseous space, resulting in reduced perfusion and subsequent tissue injury. CS can be divided into acute forms, most commonly due to trauma and considered an orthopaedic emergency, and chronic forms, most commonly presenting in athletes with recurrent exercise-induced pain. Downstream pathophysiological mechanisms are complex but do share commonalities with mechanisms implicated in genetic neuromuscular disorders. Here we present 3 patients with recurrent CS in the context of a RYR1-related disorder (n = 1) and PYGM-related McArdle disease (n = 2), two of whom presented many years before the diagnosis of an underlying neuromuscular disorder was suspected. We also summarize the literature on previously published cases with CS in the context of a genetically confirmed neuromuscular disorder and outline how the calcium signalling alterations in RYR1-related disorders and the metabolic abnormalities in McArdle disease may feed into CS-causative mechanisms. These findings expand the phenotypical spectrum of RYR1-related disorders and McArdle disease; whilst most forms of recurrent CS will be sporadic, above and other genetic backgrounds ought to be considered in particular in patients where other suggestive clinical features are present.
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Affiliation(s)
- Dennis T Famili
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Miguel A Fernandez-Garcia
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Maria Vanegas
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Nicol Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom; Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College London, London, United Kingdom.
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35
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Lechtig A, Hanna P, Nagy JA, Wixted J, Nazarian A, Rutkove SB. Electrical impedance myography for the early detection of muscle ischemia secondary to compartment syndrome: a study in a rat model. Sci Rep 2023; 13:18252. [PMID: 37880267 PMCID: PMC10600169 DOI: 10.1038/s41598-023-45209-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023] Open
Abstract
Acute Compartment Syndrome (ACS) is one of the most devastating orthopedic conditions, affecting any of the body's many compartments, which, if sufficiently severe, may result in disability and amputation. Currently, intra-compartmental pressure measurements serve as the gold standard for diagnosing ACS. Diagnosing limbs at risk for ACS before irreversible damage to muscle and nerve is critical. Standard approaches for diagnosing impending compartment syndrome include clinical evaluation of the limb, such as assessment for "tightness" of the overlying skin, reduced pulses distally, and degree of pain, none of which are specific or sensitive. We have proposed a novel method to detect ACS via electrical impedance myography (EIM), where a weak, high-frequency alternating current is passed between one pair of electrodes through a region of tissue, and the resulting surface voltages are measured via a second pair. We evaluated the ability of EIM to detect early muscle ischemia in an established murine model of compression-induced muscle injury, where we collected resistance, reactance, and their dimensionless product, defined as Relative Injury Index (RII) during the study. Our model generated reproducible hypoxia, confirmed by Hypoxyprobe™ staining of endothelial regions within the muscle. Under conditions of ischemia, we demonstrated a reproducible, stable, and significant escalation in resistance, reactance, and RII values, compared to uninjured control limbs. These data make a reasonable argument for additional investigations into using EIM for the early recognition of muscle hypoperfusion and ischemia. However, these findings must be considered preliminary steps, requiring further pre-clinical and clinical validation.
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Affiliation(s)
- Aron Lechtig
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Philip Hanna
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Janice A Nagy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - John Wixted
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
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36
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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37
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Wang X, Guo W, Ding D, Wang H. Bilateral Orbital Compartment Syndrome Following a Craniotomy With Coronal Incision. J Craniofac Surg 2023; 34:e690-e692. [PMID: 37590015 DOI: 10.1097/scs.0000000000009608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Orbital compartment syndrome is a rare ophthalmic emergency characterized by increased intraorbital pressure and hypoperfusion of critical neural structures, most of which were caused by trauma, and can also be caused by periorbital surgery, local injections, other preexisting medical conditions and so on. It requires rapid identification and immediate treatment for the preservation of vision. CLINICAL PRESENTATION A 61-year-old female with left frontal lobe-parafalcine meningioma underwent a craniotomy with a bicoronal incision. Postoperatively, the patient presented absence of pupillary reaction in both eyes, and complained loss of vision after recovery from anesthesia. Bilateral orbital compartment syndrome was considered 18 hours postoperatively since the marked bilateral proptosis with eyelid edema and conjunctival chemosis. The patient was treated with methylprednisolone, mannitol, hyperbric oxygenation, and neurotrophic agents as recommended by the ophthalmologist. There was no improvement in visual acuity at discharge or at 3-month follow-up postoperatively. DISCUSSION AND CONCLUSION This is a rare case of bilateral irreversible blindness caused by orbital compartment syndrome after a craniotomy with coronal incision. Neurosurgeons need to improve the awareness of this complication for adequate prevention, such as direct ocular pressure from skin flaps, congestion from head positioning, and adequate intraoperative eye protection, and also earlier recognition and management.
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Affiliation(s)
- Xingdong Wang
- Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu
| | - Wenqiang Guo
- Department of Neurosurgery, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong
| | - Dacheng Ding
- Department of Neurosurgery, Tianjin Huanhu Hospital
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
| | - Hu Wang
- Department of Neurosurgery, Tianjin Huanhu Hospital
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
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38
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Jones J, Lee K, Jones M, Gadsden J. Lower Extremity Peripheral Nerve Blocks for Patients at Risk for Acute Compartment Syndrome. Orthop Clin North Am 2023; 54:417-425. [PMID: 37718081 DOI: 10.1016/j.ocl.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
A delayed acute compartment syndrome (ACS) diagnosis often results in devastating complications; however, the sensitivity of the classic signs and symptoms is very low. All analgesic modalities have been implicated in delaying the diagnosis, but there is very little evidence linking peripheral nerve blocks (PNBs) with delays in diagnosis. In fact, there is evidence that PNBs may facilitate an early diagnosis; this may be in part due to differences in how ischemic and inflammatory pain is transmitted through unique nociceptive pathways. Collaboration is required to optimize care for patients at risk for ACS.
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Affiliation(s)
- Jerry Jones
- East Memphis Anesthesia Services, Department of Anesthesiology, University of Tennessee Health Science Center, Memphis, USA.
| | - Kevin Lee
- College of Medicine, The University of Tennessee Health Science Center, Memphis, USA
| | - Madeline Jones
- College of Arts and Sciences, The University of Tennessee, Knoxville, USA
| | - Jeff Gadsden
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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Susanne J, Åsa H. Preventing well leg compartment syndrome among patients in the lithotomy position-Operating room nurses' perspectives: A qualitative study. Nurs Open 2023; 10:7092-7101. [PMID: 37571958 PMCID: PMC10495710 DOI: 10.1002/nop2.1971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
AIM To describe operating room nurses' experiences of well leg compartment syndrome and how they work perioperative to prevent it during the lithotomy position. DESIGN The study had a qualitative design. METHODS Focus group interviews were performed with 10 operating room (OR) nurses. The interviews were semi-structured and analysed by qualitative content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS The main theme showed that the OR nurses shoulder duty and responsibility, independently and in the team, but they need more structural support and knowledge. The themes showed that they follow routines whenever possible and take responsibility for positioning; however, they have to balance between flexibility and strict routines. Although they also develop and participate in teamwork, they still need further knowledge. CONCLUSION The severe complication of well leg compartment syndrome (WLCS) can occur when the patient is in the lithotomy position. Maintaining the same routines and paying attention to the WHO's surgical safety checklist were described as actions that could prevent well leg compartment syndrome. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. We have interviewed nurses but without financial support since the study was performed and supervised within a master programme.
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Abstract
BACKGROUND We aimed to describe the demographic, injury-related, and treatment-related characteristics of patients who undergo fasciotomies for acute hand compartment syndrome. METHODS A cohort of 53 adult patients with acute hand compartment syndrome treated with fasciotomy at 2 tertiary care referral centers over a 10-year time period from January 1, 2006, to June 30, 2015, were retrospectively identified. We reviewed the electronic medical record for patient-related variables (eg, age, sex, smoking status, diabetes mellitus), injury-related variables (eg, mechanism of injury, presence of fractures), and treatment-related variables (eg, compartments released, number of operations, use of split-thickness skin grafts, and time from injury to surgery). RESULTS The mean age of our cohort was 45 years, and 33 patients (62%) were men. The mechanism of injury varied widely, but the most common causative mechanisms were crush injury (25%), prolonged decubitus (17%), and infection (11%). Associated hand fractures were present in 15 (28%) patients. The surgically released compartments varied; the dorsal interosseous compartments (83%), thenar compartment (75%), and hypothenar compartment (74%) were most frequently released, while the adductor pollicis compartment (43%) and Guyon canal (28%) were least frequently released. CONCLUSIONS The demographics of acute hand compartment syndrome have evolved in the last 25 years compared with the prior literature, partly as a result of the opioid epidemic leading to a rise in "found down" compartment syndrome. Treating providers should recognize crush injury, prolonged decubitus, and infection as the most common causes of acute hand compartment syndrome.
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Affiliation(s)
| | - George S. M. Dyer
- Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Department of Orthopedic Surgery, Boston, MA, USA
| | - Arvind von Keudell
- Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Department of Orthopedic Surgery, Boston, MA, USA
| | - Dafang Zhang
- Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Department of Orthopedic Surgery, Boston, MA, USA
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DeKeyser G, Bunzel E, O'Neill D, Nork S, Haller J, Barei D. Single-Incision Fasciotomy Decreases Infection Risk Compared with Dual-Incision Fasciotomy in Treatment of Tibial Plateau Fractures With Acute Compartment Syndrome. J Orthop Trauma 2023; 37:519-524. [PMID: 37296085 DOI: 10.1097/bot.0000000000002644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Comparison of surgical site infection (SSI) rates in tibial plateau fractures with acute compartment syndrome treated with single-incision (SI) versus dual-incision (DI) fasciotomies. DESIGN Retrospective cohort study. SETTING Two, Level-1, academic, trauma centers. PATIENTS Between January 2001 and December 2021, one-hundred ninety patients with a diagnosis of tibial plateau fracture and acute compartment syndrome met inclusion criteria (SI: n = 127, DI: n = 63) with a minimum of 3-month follow-up after definitive fixation. INTERVENTION Emergent 4-compartment fasciotomy, using either SI or DI technique, and eventual plate and screw fixation of the tibial plateau. OUTCOMES The primary outcome was SSI requiring surgical debridement. Secondary outcomes included nonunion, days to closure, method of skin closure, and time to SSI. RESULTS Both groups were similar in demographic variables and fracture characteristics (all P > 0.05). The overall infection rate was 25.8% (49 of 190), but the SI fasciotomy patients had significantly fewer SSIs compared with the DI fasciotomy patients [SI 18.1% vs. DI 41.3%; P < 0.001; OR 2.28, (confidence interval, 1.42-3.66)]. Patients with a dual (medial and lateral) surgical approach and DI fasciotomies developed an SSI in 60% (15 of 25) of cases compared with 21.3% (13 of 61) of cases in the SI group ( P < 0.001). The nonunion rate was similar between the 2 groups (SI 8.3% vs. DI 10.3%; P = 0.78). The SI fasciotomy group required fewer debridement's ( P = 0.04) until closure, but there was no difference in days until closure (SI 5.5 vs. DI 6.6; P = 0.09). There were zero cases of incomplete compartment release requiring return to the operating room. CONCLUSIONS Patients with DI fasciotomies were more than twice as likely to develop an SSI compared with SI patients despite similar fracture and demographic characteristics between the groups. Orthopaedic surgeons should consider prioritizing SI fasciotomies in this setting. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Graham DeKeyser
- Department of Orthopaedic Surgery, Oregon Health & Sciences University, Portland, OR
| | - Eli Bunzel
- Harborview Medical Center, University of Washington Department of Orthopaedic Surgery, Seattle, WA; and
| | - Dillon O'Neill
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Sean Nork
- Harborview Medical Center, University of Washington Department of Orthopaedic Surgery, Seattle, WA; and
| | - Justin Haller
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - David Barei
- Harborview Medical Center, University of Washington Department of Orthopaedic Surgery, Seattle, WA; and
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Conchin A, Kaux JF, Daenen B, Bruyère PJ, Radoux C, Courtois AC. [Acute deltoid compartment syndrome]. Rev Med Liege 2023; 78:535-539. [PMID: 37830316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
In this article, we present a rare type of acute compartment syndrome affecting the deltoid muscle, which occurred after a crush syndrome in a patient discovered at home in a stuporous state. Although compartment syndromes are not rare, certain circumstances cause unusual consequences and localizations, shoulder impotence in the present case. The importance of an early diagnosis is obvious to avoid the risk of irreversible lesions. We describe predisposing circumstances and provide a brief review of the pathophysiology of this syndrome.
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Affiliation(s)
- Antoine Conchin
- Service de Médecine physique et Réadaptation fonctionnelle, CHU Liège, Belgique
| | - Jean-François Kaux
- Service de Médecine physique et Réadaptation fonctionnelle, CHU Liège, Belgique
| | | | | | - Cécile Radoux
- Service de Médecine physique et Réadaptation fonctionnelle, CHR Huy, Belgique
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Onoe A, Muroya T, Nakamura Y, Nakamura F, Yagura T, Nakajima M, Kishimoto M, Sakuramoto K, Kajino K, Ikegawa H, Kuwagata Y. Efficacy of the shoelace technique for extremity fasciotomy wounds due to compartment syndrome. BMC Musculoskelet Disord 2023; 24:704. [PMID: 37667241 PMCID: PMC10476399 DOI: 10.1186/s12891-023-06849-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/31/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The shoelace technique for compartment syndrome allows application of sustained tightening tension to an entire wound and intermittent tightening of the shoelace without requiring its replacement or anesthesia. We retrospectively evaluated the usefulness of the shoelace technique in the management of extremity fasciotomy wounds before and after its introduction in our institution. METHODS We targeted 25 patients who were diagnosed as having compartment syndrome and underwent extremity fasciotomy at our hospital from April 2012 to December 2021. The N group, comprising 12 patients treated without the shoelace technique, and the S group, comprising 13 patients treated with the shoelace technique, were compared retrospectively for each outcome. RESULTS There were no significant differences between the two groups in patient background. Compared with the N group patients, all of the S group patients avoided skin grafting (S group: n = 0, 0%; N group: n = 6, 50.0%; p < 0.01). However, there was no significant difference in the number of days to final wound closure (S group: 39.5 [IQR 24.3-58.0] days; N group: 24.0 [IQR 18.5-31.0] days, p = 0.06). CONCLUSIONS We considered the shoelace technique to be a useful wound closure method for fasciotomy wounds caused by compartment syndrome because it can significantly reduce the need for skin grafting and tends to shorten the wound closure period.
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Affiliation(s)
- Atsunori Onoe
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010.
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Yoshihiro Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Takuma Yagura
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Mari Nakajima
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Masanobu Kishimoto
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Hitoshi Ikegawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
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Spyres MB, Maker G, Aldy K, Wolk BJ, Meadors KE, Christian M, Ruha AM. Compartment Syndrome after Crotalid Envenomation in the United States: A Review of the North American Snakebite Registry from 2013 to 2021 on Behalf of the ToxIC Snakebite Study Group. Wilderness Environ Med 2023; 34:322-327. [PMID: 37474357 DOI: 10.1016/j.wem.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/13/2023] [Accepted: 05/16/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Compartment syndrome (CS) is a rare but serious complication after crotalid envenomation in the United States. Few data are available regarding the epidemiology and management of these cases. Significant controversy and misunderstanding over best practices, including measurement of compartment pressures and use of fasciotomy, exist for this syndrome. This study aims to describe presentation and management of suspected CS cases after native snakebite reported to the North American Snakebite Registry (NASBR). METHODS This is an analysis of snakebite cases reported to the Toxicology Investigators Consortium NASBR between January 1, 2013 and December 31, 2021. Cases of native snakebite with documented concern for CS were included. RESULTS Over an 8-y period, 22 cases of suspected CS were identified, representing 1% of all cases reported to the NASBR. Fasciotomies were performed in 41% (n=9) of these cases, most commonly to the upper extremity (67%, n=6). In cases of suspected CS, intracompartmental pressures (ICPs) were rarely measured (23%, n=5) and fasciotomies were performed without measurement of ICPs frequently (56%, n=5). In 1 case, ICPs were measured and found to be low (8 mm Hg) and fasciotomy was avoided. CONCLUSIONS Measurement of compartment pressures in cases of suspected CS was uncommon in cases reported to the NASBR. Fasciotomy was commonly performed without measurement of compartment pressures.
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Affiliation(s)
- Meghan B Spyres
- Department of Internal Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Department of Medical Toxicology, Banner-University Medical Center Phoenix, Phoenix, AZ.
| | - Greg Maker
- Department of Internal Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Department of Medical Toxicology, Banner-University Medical Center Phoenix, Phoenix, AZ
| | - Kim Aldy
- American College of Medical Toxicology, Phoenix, AZ; Department of Emergency Medicine, Baylor University Medical Center, Dallas, TX
| | - Brian J Wolk
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA
| | - Kevan E Meadors
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Christian
- Department of Emergency Medicine, University of Missouri‒Kansas City School of Medicine, Kansas City, MO
| | - Anne-Michelle Ruha
- Department of Internal Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Department of Medical Toxicology, Banner-University Medical Center Phoenix, Phoenix, AZ
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Petrochko JM, Ullrich LA. Lateral Compartment Syndrome From Inversion Injury. Am Surg 2023; 89:3857-3858. [PMID: 37142260 DOI: 10.1177/00031348231173950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A 17-year-old male presented for the evaluation of right calf pain after an inversion ankle sprain sustained while playing soccer 24 hours prior. On exam, he exhibited swelling and tenderness to palpation over his right calf, mild first web space numbness, and compartment pressures <30 mmHg. Magnetic resonance imaging was significant for findings of lateral compartment syndrome (CS). Upon admission, his exam worsened, prompting an anterior and lateral compartment fasciotomy. Intraoperative findings were significant for lateral CS, with findings of avulsed, nonviable muscle with associated hematoma. Postoperatively the patient had mild foot drop, which improved with physical therapy. Lateral CS rarely develops from an inversion ankle sprain. This presentation of CS is unique due to its mechanism, delayed clinical presentation, and limited signs of CS. Providers should maintain a high index of suspicion for CS in patients with this injury complex and continued pain beyond 24 hours without signs of ligamentous injury.
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Affiliation(s)
- Jameson M Petrochko
- Department of General Surgery Residency, St Luke's University Health Network, Bethlehem, PA, USA
| | - Lauryn A Ullrich
- Department of General Surgery Residency, St Luke's University Health Network, Bethlehem, PA, USA
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47
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Kaga T, Ezure M, Hasegawa Y, Yamada Y, Hoshino J, Okada S, Morishita H, Seki M, Konno N, Oi A, Tamura N, Atomura D, Yamatsu Y. [Compartment Syndrome After Stanford Type A Acute Aortic Dissection Surgery:Report of a Case]. Kyobu Geka 2023; 76:714-718. [PMID: 37735732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
A 53-year-old man presented to the emergency department with chest and back pain. Contrast-enhanced computed tomography( CT) revealed a Stanford type A acute aortic dissection with a pseudo-lumen occlusion. On the same day, the patient underwent emergent aortic arch replacement with frozen elephant trunk. When introducing cardiopulmonary bypass, arterial cannula was inserted into the right femoral artery. The day after surgery, swelling of the right lower leg appeared with CK and intramuscular compartment pressure elevation. Thus, the patient was diagnosed with compartment syndrome and decompressive fasciotomy was performed. Although there was no preoperative blood flow disturbance in the lower extremities on preoperative CT, lower limbs ischemia happened. Necrotic muscles in his right leg required debridement, but amputation was not needed. The patient was discharged unaided utilising orthotics on the day 120. In muscular, young male patients, care should be taken in the method of blood delivery.
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Affiliation(s)
- Tohru Kaga
- Department of Cardiovascular Surgery, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
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Kondo E, Kubo-Kaneda M, Mori K, Yoshida K, Nii M, Toriyabe K, Maki S, Magawa S, Okamoto K, Ikeda T. Efficacy of a portable interface pressure sensor for robotic surgery in preventing compartment syndrome. Asian J Surg 2023; 46:3575-3580. [PMID: 37142500 DOI: 10.1016/j.asjsur.2023.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND/OBJECTIVE This study determines whether the use of a portable interface pressure sensor (Palm Q) for robotic surgery could prevent compartment syndrome. METHODS In the present single center, non-trial observational study, patients diagnosed with gynecological diseases between April 2015 and August 2020 treated with laparoscopic or robotic surgery were enrolled. We assessed 256 cases involving surgery performed in the lithotomy position with an operative time >4 h. The Palm Q device was placed preoperatively on both sides of the patients' lower legs. The pressure was measured every 30 min preoperatively and intraoperatively and adjusted to ≤30 mmHg. If the pressure reached ≥30 mmHg, the operation was stopped, the patient was repositioned, the leg position was released, the pressure was reduced to ≤30 mmHg, and the procedure was resumed. We compared the maximum creatine kinase levels of the Palm Q and non-Palm Q groups. We also analyzed the correlation between the patients' symptoms postoperatively (shoulder and leg pain) and compartment syndrome. RESULTS Our data showed that immediate postoperative creatine kinase levels predict compartment syndrome. Propensity score matching of the 256 enrolled patients resulted in 92 cases (46 per group), balanced for age, body mass index, and lifestyle disease. Creatine kinase levels differed significantly between the Palm Q and non-Palm Q groups (p = 0.041). None of the patients in the Palm Q group experienced well-leg compartment syndrome complications. CONCLUSION Palm Q can potentially help to prevent perioperative compartment syndrome.
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Affiliation(s)
- Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan; 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan.
| | - Michiko Kubo-Kaneda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan; 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan
| | - Kotoko Mori
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan; 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan
| | - Kenta Yoshida
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan; 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan; 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan
| | - Kuniaki Toriyabe
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan; 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan
| | - Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan; 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan
| | - Shoichi Magawa
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan; 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan
| | - Kota Okamoto
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan; 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan; 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan
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Yang SS, Anidjar M, Azzam MA. 'A pain in the buttock': A case report of gluteal compartment syndrome after robotic partial nephrectomy. J Perioper Pract 2023; 33:263-268. [PMID: 35485632 DOI: 10.1177/17504589221092563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute compartment syndrome is a surgical emergency that, if unrecognised, leads to tissue and muscle ischaemia, necrosis, multi-organ failure and even death. Gluteal compartment syndrome is a rare type of compartment syndrome that typically occurs as a sequela of trauma, and its presentation may be difficult to recognise. We describe a case of a patient who developed gluteal compartment syndrome following a prolonged renal surgery in lateral decubitus position. Our case report aims to raise clinicians' awareness to consideration of this rare syndrome in patients presenting with lower extremity or back pain after prolonged surgery.
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Affiliation(s)
- Stephen Su Yang
- Department of Anesthesia, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
- Department of Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Maurice Anidjar
- Division of Critical Care, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Milène A Azzam
- Department of Anesthesia, Jewish General Hospital, McGill University, Montreal, QC, Canada
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50
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Wei D, Cheng J, Jiang Y, Huang N, Xiang J, Li J, Wang H, Su W, Zhao J. A practical nomogram for predicting amputation rates in acute compartment syndrome patients based on clinical factors and biochemical blood markers. BMC Musculoskelet Disord 2023; 24:640. [PMID: 37559005 PMCID: PMC10410859 DOI: 10.1186/s12891-023-06746-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/23/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Amputation is a serious complication of acute compartment syndrome (ACS), and predicting the risk factors associated with amputation remains a challenge for surgeons. The aim of this study was to analyze the risk factors for amputation in patients with ACS and develop a nomogram to predict amputation risk more accurately. METHODS The study population consisted of 143 patients (32 in the amputation group and 111 in the limb preservation group) diagnosed with ACS. LASSO and multivariate logistic regression were used to screen predictors and create a nomogram. The model's accuracy was assessed by receiver operating characteristic (ROC) curves, C-index, calibration curves, and decision curve analysis (DCA). RESULTS The predictors included cause of injury, vascular damage, shock, and fibrinogen in the nomogram. The C-index of the model was 0.872 (95% confidence interval: 0.854-0.962), and the C-index calculated by internal validation was 0.838. The nomogram's area under the curve (AUC) was 0.849, and the calibration curve demonstrated a high degree of agreement between the nomogram's predictions and actual observations. Additionally, the DCA indicated good clinical utility for the nomogram. CONCLUSION The risk of amputation in ACS patients is associated with the cause of injury, vascular damage, shock, and fibrinogen. Our nomogram integrating clinical factors and biochemical blood markers enables doctors to more conveniently predict the risk of amputation in patients with ACS.
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Affiliation(s)
- Donglei Wei
- Department of Traumatology and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, China
- Guangxi Key Laboratory of Regenerative Medicine, Orthopaedic Department, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, China
| | - Jianwen Cheng
- Department of Traumatology and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, China
- Guangxi Key Laboratory of Regenerative Medicine, Orthopaedic Department, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, China
| | - Yage Jiang
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, China
| | - Nanchang Huang
- Department of Traumatology and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, China
| | - Jianhui Xiang
- Department of Traumatology and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, China
| | - Junfeng Li
- Department of Traumatology and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, China
| | - Hui Wang
- Department of Traumatology and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, China
| | - Wei Su
- Department of Traumatology and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, China.
| | - Jinmin Zhao
- Department of Traumatology and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, China.
- Guangxi Key Laboratory of Regenerative Medicine, Orthopaedic Department, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, China.
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