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Vernec A, Healy D. Prevalence of therapeutic use exemptions at the Olympic Games and association with medals: an analysis of data from 2010 to 2018. Br J Sports Med 2020; 54:920-924. [PMID: 32376674 PMCID: PMC7392493 DOI: 10.1136/bjsports-2020-102028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 01/13/2023]
Abstract
Objectives The percentage of athletes with Therapeutic Use Exemptions (TUEs) competing in elite sport and the association with winning medals has been a matter of speculation in the absence of validated competitor numbers. We used International Olympic Committee (IOC) and World Anti-Doping Agency (WADA) data to identify athletes competing with TUEs at five Olympic Games (Games) and a possible association between having a TUE and winning an Olympic medal. Methods We used the IOC’s competition results and WADA’s TUE database to identify the number of TUEs for athlete competitions (ACs, defined as one athlete competing in one event) and any associations with medals among athletes competing in individual competitions. We calculated risk ratios (RR) for the probability of winning a medal among athletes with a TUE compared with that of athletes without a TUE. We also reported adjusted RR (RRadj) controlling for country resources, which is a potential confounder. Results During the Games from 2010 to 2018, there were 20 139 ACs and 2062 medals awarded. Athletes competed with a TUE in 0.9% (181/20 139) of ACs. There were 21/2062 medals won by athletes with a TUE. The RR for winning a medal with a TUE was 1.13 (95% CI: 0.73 to 1.65; p=0.54), and the RRadj was 1.07 (95% CI: 0.69 to 1.56; p=0.73). Conclusion The number of athletes competing with valid TUEs at Games is <1%. Our results suggested that there is no meaningful association between being granted a TUE and the likelihood of winning a medal.
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Affiliation(s)
- Alan Vernec
- Science and Medicine, World Anti-Doping Agency, Montreal, Quebec, Canada
| | - David Healy
- Science and Medicine, World Anti-Doping Agency, Montreal, Quebec, Canada
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2
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Vernec A, Slack A, Harcourt PR, Budgett R, Duclos M, Kinahan A, Mjøsund K, Strasburger CJ. Glucocorticoids in elite sport: current status, controversies and innovative management strategies-a narrative review. Br J Sports Med 2019; 54:8-12. [PMID: 31326919 PMCID: PMC6923944 DOI: 10.1136/bjsports-2018-100196] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 01/08/2023]
Abstract
The use of systemic glucocorticoids (GCs), as well as local injections, continues to be a controversial issue in the sport/anti-doping community. There is widespread and legitimate use of GCs for numerous health conditions, yet there are concerns about side effects and the possibility of enhanced athletic performance in limited settings. This is compounded by the uncertainty regarding the prevalence of GC use, mechanisms underlying physiological effects and complex pharmacokinetics of different formulations. While WADA continues to promote research in this complex area, some international sporting federations, major event organisers and professional sports leagues have introduced innovative rules such as needle policies, mandatory rest periods and precompetition guidelines to promote judicious use of GCs, focusing on athlete health and supervision of medical personnel. These complementary sport-specific rules are helping to ensure the appropriate use of GCs in athletes where overuse is a particular concern. Where systemic GCs are medically necessary, Therapeutic Use Exemptions (TUEs) may be granted after careful evaluation by TUE Committees based on specific and strict criteria. Continued vigilance and cooperation between physicians, scientists and anti-doping organisations is essential to ensure that GC use in sport respects not only principles of fairness and adherence to the rules but also promotes athlete health and well-being. The purpose of this narrative review is to summarise the use and management of GCs in sport illustrating several innovative programmes by sport leagues and federations.
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Affiliation(s)
- Alan Vernec
- Department of Science and Medicine, WADA, Montreal, Quebec, Canada
| | - Andrew Slack
- Medical Affairs, Exactis Innovation, Montreal, Quebec, Canada
| | - Peter Rex Harcourt
- Department of Integrity, Australian Rules Football League (AFL), Melbourne, Victoria, Australia
| | | | - Martine Duclos
- Department of Sport Medicine and Functional Explorations, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, France
| | | | | | - Christian J Strasburger
- Endocrinology, Diabetes and Nutritional Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
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3
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Hainline B, Derman W, Vernec A, Budgett R, Deie M, Dvorak J, Harle CA, Herring S, McNamee M, Meeuwisse W, Moseley GL, Omololu B, Orchard J, Pipe A, Pluim BM, Raeder J, Siebert D, Stewart M, Stuart MC, Turner J, Ware M, Zideman D, Engebretsen L. Infographic. International Olympic Committee consensus statement on pain management in athletes: non-pharmacological strategies. Br J Sports Med 2019; 53:785-786. [PMID: 30952826 DOI: 10.1136/bjsports-2019-100853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Brian Hainline
- National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
| | - Wayne Derman
- Instiute of Sport and Exercise Medicine, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa.,International Olympic Committee Research Centre, Cape Town, South Africa
| | | | | | - Masataka Deie
- Orthopedic Surgery, Aichi Ika Daigaku, Aichi-gun, Aichi, Japan
| | - Jiri Dvorak
- Swiss Concussion Center, Zurich, Switzerland.,Spine Unit, Schulthess Clinic, Zurich, Switzerland
| | - Christopher A Harle
- Health Policy and Management, Indiana University, Indianapolis, Indiana, USA
| | - Stanley Herring
- Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | | | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Bade Omololu
- Orthopaedic Surgery, University of Ibadan College of Medicine, Ibadan, Western Nigeria, Nigeria
| | - John Orchard
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Pipe
- Sports Medicine, Royal Netherlands Lawn Tennis Association, Amersfoort, The Netherlands
| | - Babette M Pluim
- Sports Medicine, Royal Netherlands Lawn Tennis Association, Amersfoort, The Netherlands.,Home, Ede, The Netherlands
| | | | - David Siebert
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Mike Stewart
- Physical Therapy, East Kent Hospitals University, Canterbury, UK
| | | | - Judith Turner
- Psychology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mark Ware
- Pain Management, McGill University Health Centre, Montreal, Quebec, Canada
| | - David Zideman
- International Olympic Committee Medical and Scientific Games Group, Lausanne, Switzerland
| | - Lars Engebretsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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4
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Maughan RJ, Burke LM, Dvorak J, Larson-Meyer DE, Peeling P, Phillips SM, Rawson ES, Walsh NP, Garthe I, Geyer H, Meeusen R, van Loon LJC, Shirreffs SM, Spriet LL, Stuart M, Vernec A, Currell K, Ali VM, Budgett RG, Ljungqvist A, Mountjoy M, Pitsiladis YP, Soligard T, Erdener U, Engebretsen L. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med 2018; 52:439-455. [PMID: 29540367 PMCID: PMC5867441 DOI: 10.1136/bjsports-2018-099027] [Citation(s) in RCA: 325] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2018] [Indexed: 12/24/2022]
Abstract
Nutrition usually makes a small but potentially valuable contribution to successful performance in elite athletes, and dietary supplements can make a minor contribution to this nutrition programme. Nonetheless, supplement use is widespread at all levels of sport. Products described as supplements target different issues, including (1) the management of micronutrient deficiencies, (2) supply of convenient forms of energy and macronutrients, and (3) provision of direct benefits to performance or (4) indirect benefits such as supporting intense training regimens. The appropriate use of some supplements can benefit the athlete, but others may harm the athlete's health, performance, and/or livelihood and reputation (if an antidoping rule violation results). A complete nutritional assessment should be undertaken before decisions regarding supplement use are made. Supplements claiming to directly or indirectly enhance performance are typically the largest group of products marketed to athletes, but only a few (including caffeine, creatine, specific buffering agents and nitrate) have good evidence of benefits. However, responses are affected by the scenario of use and may vary widely between individuals because of factors that include genetics, the microbiome and habitual diet. Supplements intended to enhance performance should be thoroughly trialled in training or simulated competition before being used in competition. Inadvertent ingestion of substances prohibited under the antidoping codes that govern elite sport is a known risk of taking some supplements. Protection of the athlete's health and awareness of the potential for harm must be paramount; expert professional opinion and assistance is strongly advised before an athlete embarks on supplement use.
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Affiliation(s)
| | - Louise M Burke
- Sports Nutrition, Australian Institute of Sport, Canberra, Australia
- Mary MacKillop Institute for Health Research, Melbourne, Australia
| | - Jiri Dvorak
- Department of Neurology, Schulthess Clinic, Zurich, Switzerland
| | - D Enette Larson-Meyer
- Department of Family & Consumer Sciences (Human Nutrition), University of Wyoming, Laramie, Wyoming, USA
| | - Peter Peeling
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Western Australia, Australia
- Western Australian Institute of Sport, Mount Claremont, Australia
| | | | - Eric S Rawson
- Department of Health, Nutrition, and Exercise Science, Messiah College, Mechanicsburg, Pennsylvania, USA
| | - Neil P Walsh
- College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Ina Garthe
- The Norwegian Olympic and Paralympic Committee and Confederation of Sport, Oslo, Norway
| | - Hans Geyer
- Institute of Biochemistry, Center for Preventive Doping Research, German Sport University, Cologne, Germany
| | - Romain Meeusen
- Human Physiology Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lucas J C van Loon
- Mary MacKillop Institute for Health Research, Melbourne, Australia
- Department of Human Biology and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Lawrence L Spriet
- Human Health & Nutritional Sciences, University of Guelph, Ontario, Canada
| | | | - Alan Vernec
- Department of Science and Medicine, World Anti-Doping Agency (WADA), Montreal, Canada
| | | | - Vidya M Ali
- Medical and Scientific Commission, International Olympic Committee, Lausanne, Switzerland
| | - Richard Gm Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | | | - Margo Mountjoy
- Human Health and Nutritional Sciences, Health and Performance, Centre University of Guelph, Guelph, Ontario, Canada
- Medical and Scientific Commission Games Group, International Olympic Committee, Lausanne, Switzerland
| | - Yannis P Pitsiladis
- Medical and Scientific Commission, International Olympic Committee, Lausanne, Switzerland
| | - Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Uğur Erdener
- Medical and Scientific Commission, International Olympic Committee, Lausanne, Switzerland
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
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5
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Hainline B, Derman W, Vernec A, Budgett R, Deie M, Dvořák J, Harle C, Herring SA, McNamee M, Meeuwisse W, Lorimer Moseley G, Omololu B, Orchard J, Pipe A, Pluim BM, Ræder J, Siebert C, Stewart M, Stuart M, Turner JA, Ware M, Zideman D, Engebretsen L. International Olympic Committee consensus statement on pain management in elite athletes. Br J Sports Med 2017; 51:1245-1258. [DOI: 10.1136/bjsports-2017-097884] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/10/2017] [Accepted: 06/26/2017] [Indexed: 12/18/2022]
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Vernec A, Pipe A, Slack A. A painful dilemma? Analgesic use in sport and the role of anti-doping. Br J Sports Med 2017; 51:1243-1244. [DOI: 10.1136/bjsports-2017-097867] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 11/03/2022]
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Vaillancourt C, Shrier I, Vandal A, Falk M, Rossignol M, Vernec A, Somogyi D. Acute compartment syndrome: How long before muscle necrosis occurs? CAN J EMERG MED 2015; 6:147-54. [PMID: 17433166 DOI: 10.1017/s1481803500006837] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACTObjectives:Acute compartment syndrome (ACS) is a limb-threatening condition often first diagnosed by emergency physicians. Little is known about the rapidity with which permanent damage may occur. Our objective was to estimate the time to muscle necrosis in patients with ACS.Methods:This historical cohort analysis of all patients who had a fasciotomy for ACS was conducted in 4 large teaching hospitals. Diagnosis was confirmed clinically or by needle measurement of compartment pressure. Muscle necrosis was determined using pathology reports and surgeons’ operative protocols. We used descriptive statistics and estimated tissue survival probability using the Vertex exchange method for interval-censored data.Results:Between 1989 and 1997 there were 76 cases of ACS. Most cases occurred in young men (median age 32) as a result of a traumatic incident (82%). Forty-nine percent (37/76) of all patients suffered some level of muscle necrosis, and 30% (11/37) of those with necrosis lost more than 25% of the muscle belly. Necrosis occurred in 2 of 4 cases in which the patient had been operated on within 3 hours of the injury, and our exploratory survival analysis estimates that 37% (95% confidence interval, 13%-51%) of all cases of ACS may develop muscle necrosis within 3 hours of the injury.Conclusions:This is the largest cohort of ACS and the first clinical estimation of time to muscle necrosis ever published. Ischemia from ACS can cause muscle necrosis before the 3-hour period post-trauma that is traditionally considered safe. Further research to identify risk factors associated with the development of early necrosis is necessary.
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Affiliation(s)
- Christian Vaillancourt
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa Health Research Institute, University of Ottawa, Ottawa, Canada
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8
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9
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Dvorak J, Baume N, Botré F, Broséus J, Budgett R, Frey WO, Geyer H, Harcourt PR, Ho D, Howman D, Isola V, Lundby C, Marclay F, Peytavin A, Pipe A, Pitsiladis YP, Reichel C, Robinson N, Rodchenkov G, Saugy M, Sayegh S, Segura J, Thevis M, Vernec A, Viret M, Vouillamoz M, Zorzoli M. Time for change: a roadmap to guide the implementation of the World Anti-Doping Code 2015. Br J Sports Med 2014; 48:801-6. [PMID: 24764550 PMCID: PMC4033186 DOI: 10.1136/bjsports-2014-093561] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A medical and scientific multidisciplinary consensus meeting was held from 29 to 30 November 2013 on Anti-Doping in Sport at the Home of FIFA in Zurich, Switzerland, to create a roadmap for the implementation of the 2015 World Anti-Doping Code. The consensus statement and accompanying papers set out the priorities for the antidoping community in research, science and medicine. The participants achieved consensus on a strategy for the implementation of the 2015 World Anti-Doping Code. Key components of this strategy include: (1) sport-specific risk assessment, (2) prevalence measurement, (3) sport-specific test distribution plans, (4) storage and reanalysis, (5) analytical challenges, (6) forensic intelligence, (7) psychological approach to optimise the most deterrent effect, (8) the Athlete Biological Passport (ABP) and confounding factors, (9) data management system (Anti-Doping Administration & Management System (ADAMS), (10) education, (11) research needs and necessary advances, (12) inadvertent doping and (13) management and ethics: biological data. True implementation of the 2015 World Anti-Doping Code will depend largely on the ability to align thinking around these core concepts and strategies. FIFA, jointly with all other engaged International Federations of sports (Ifs), the International Olympic Committee (IOC) and World Anti-Doping Agency (WADA), are ideally placed to lead transformational change with the unwavering support of the wider antidoping community. The outcome of the consensus meeting was the creation of the ad hoc Working Group charged with the responsibility of moving this agenda forward.
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Affiliation(s)
- Jiri Dvorak
- FIFA/F-MARC FIFA-Strasse, , Zurich, Switzerland
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10
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Vernec A, Stear SJ, Burke LM, Castell LM. A–Z of nutritional supplements: dietary supplements, sports nutrition foods and ergogenic aids for health and performance: Part 48. Br J Sports Med 2013. [DOI: 10.1136/bjsports-2013-092941] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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11
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Vaillancourt C, Shrier I, Falk M, Rossignol M, Vernec A, Somogyi D. Quantifying delays in the recognition and management of acute compartment syndrome. CAN J EMERG MED 2012; 3:26-30. [PMID: 17612437 DOI: 10.1017/s148180350000511x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify where most efforts should be made to decrease ischemia time and necrosis in acute compartment syndrome (ACS) and to determine the causes for late interventions. METHODS This was a multicentre, historical cohort study of patients who underwent fasciotomy for ACS within the McGill Teaching Hospitals between 1989 and 1997. Patients studied had a clinical diagnosis of ACS or compartment pressures greater than 30 mm Hg. In all cases, ACS was confirmed at the time of fasciotomy. Patients were stratified into traumatic and non-traumatic groups, and a step-by-step analysis was performed for each part of the process between injury and operation. RESULTS Among the 62 traumatic ACS cases, the longest delays occurred between initial assessment and diagnosis (median time 2h56, range from 0 to 99h20) and between diagnosis and operation (median 2h13, range 0h15-29h45). Among the 14 non-traumatic ACS cases, delays primarily occurred between inciting event and hospital presentation (median 9h19, range 0h04-289h29) and between initial assessment and diagnosis (median 8h18, range 0-104h15). CONCLUSIONS ACS is a limb-threatening condition for which early intervention is critical. Substantial delays occur after the time of patient presentation. For traumatic and non-traumatic ACS, increased physician awareness and faster operating room access may reduce treatment delays and prevent disability.
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Affiliation(s)
- C Vaillancourt
- Department of Emergency Medicine, Sir Mortimer B. Davis-Jewish General Hospital and Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
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12
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Affiliation(s)
- Neil Robinson
- Swiss Laboratory for Doping Analyses, University Centre of Legal Medicine, Epalinges, Switzerland
| | - Martial Saugy
- Swiss Laboratory for Doping Analyses, University Centre of Legal Medicine, Epalinges, Switzerland
| | - Alan Vernec
- Medical Department, World Anti-Doping Agency, Montreal, Quebec, Canada
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Abstract
The authors describe their experience in setting up a sports medicine teaching unit within a family practice center of a teaching hospital. The unit's patient population more closely resembles that of a typical family practice than that of a traditional musculoskeletal teaching clinic (e.g., orthopedics, emergency room). The teaching program includes direct observation of residents performing history taking and physical examinations through one-way mirrors, close supervision for each case, and a sports therapist who educates patients and residents about home exercise programs when physiotherapy within private clinics is not necessary or affordable. At the end of each session 20-30 minutes are devoted to teaching specific physical examination skills. The authors describe how their clinic interacts with other services within the hospital and how certain obstacles they encountered when setting up the clinic might be avoided by others. They feel that this type of unit complements other existing programs in the family medicine department and provides an excellent learning experience for family medicine residents, who are likely to see a high proportion of patients with muskuloskeletal injuries in their practices.
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Affiliation(s)
- A Vernec
- Sports Medicine Clinic, the Herzl Family Practice Center, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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14
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Abstract
Acute Atraumatic Compartment Syndrome (AACS) can be a potentially life and limb threatening complication of either drug abuse or medication injection. Prompt recognition followed by emergency fasciotomy is required to avoid permanent disability. A better understanding of the different clinical presentations may lead to improved outcomes through more expedient diagnosis and treatment. We describe five new cases of AACS caused by illicit drug abuse within the McGill University Hospitals, with a review of all 102 similar patients previously documented in the literature between January 1970 and May 1997. The average age for all cases was 29 years, with 74% being male. The presence of edema, pain, tension, and skin changes were the most frequent symptoms and signs reported. There appear to be two distinct mechanisms of poisoning-induced AACS: (1) direct vasotoxicity and (2) limb compression caused by prolonged comatose state. Direct vasotoxicity is more likely to lead to eventual amputation, whereas prolonged limb compression is more likely to progress to systemic complications such as azotemia, hypotension, cardiac arrhythmia, and renal failure (Crush Syndrome). Long-term sequelae of motor loss, sensory disruption, and development of contracture were common in AACS of both causes. Because Compartment Syndrome is a surgical emergency, primary care and emergency physicians must have a high index of suspicion to promptly recognize and treat this problem.
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Affiliation(s)
- J M Franc-Law
- Division of Emergency Medicine, University of Alberta, Edmonton, Canada
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