1
|
Ahmed N, Kuo YH. Factors associated with compartment syndrome after a tibial fracture in children. Trauma Surg Acute Care Open 2023; 8:e001158. [PMID: 37936901 PMCID: PMC10626752 DOI: 10.1136/tsaco-2023-001158] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023] Open
Abstract
Objectives Compartment syndrome (CS) after a tibial fracture in children is one of the orthopedic emergencies. Identifying high-risk patients in a timely fashion minimizes morbidities. This study aimed to find the risk factors of CS after a tibial fracture. Methods The study data was retrieved from the Trauma Quality Improvement Program database of the calendar year 2017-2019. All patients aged <18 years old who were admitted to the hospital with tibial fractures were included in the study. Patients' characteristics, including demography, injury, injury severity, and associated crushed and vascular injuries were analyzed between the groups who developed CS versus those who did not develop CS after a tibial fracture. Multiple logistic regression analyses were performed to find the association of CS. All p values are two-sided and a p value<0.05 is considered statistically significant. Results Of 4492 patients who qualified for the study, 49 (1.1%) patients developed CS. The patients who developed CS sustained more crush injuries and were associated with a higher rate of vascular injury (2% vs 0.1%, p=0.043% & 10.2% vs 2.2%, p=0.005). Multivariable analysis showed that for every increase in 1 year of age, the odds of occurrence of CS increased by 15.7% (adjusted OR (AOR)=1.157, 95% CI: 1.032 to 1.297, p=0.013). Non-African American race was associated with more than double the risk of developing CS when compared with the African American race, AOR was 2.238, (95% CI: (1.08 to 4.638)). The associated crush injury had an approximately 19-fold higher risk of CS when compared with patients presented with no crush injury, AOR was 18.812, (95% CI: (1.513 to 233.931)). Associated vascular injury was found to have significantly higher AOR, 3.509, 95% CI: (1.287 to 9.563) of CS. Conclusion Increased age, non-African American race, vascular injury, and crushed injury were associated with a risk of developing CS after a tibial fracture. Level of evidence IV Study type: Observational cohort study.
Collapse
Affiliation(s)
- Nasim Ahmed
- Department of Surgery, Division of Trauma and Surgical Critical Care, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey, USA
- Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Yen-Hong Kuo
- Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
- Office of Research Administration, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| |
Collapse
|
2
|
Kim GJ, Lim KH, Oh TH, Lee HJ, Hwang D, Jung H. Lethal abdominal compartment syndrome after extracorporeal cardiopulmonary resuscitation in a patient with out-of-hospital cardiac arrest: a case report. Int J Emerg Med 2023; 16:61. [PMID: 37752435 PMCID: PMC10521514 DOI: 10.1186/s12245-023-00543-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Clinical attempts of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) have increased in recent years; however, it also has life-threatening complications. Massive fluid and transfusion resuscitation, shock status, or low cardiac output status during ECPR may lead to ascites and interstitial edema, resulting in secondary abdominal compartment syndrome (ACS). CASE PRESENTATION A 43-year-old male patient was admitted to the emergency department due to cardiac arrest. Due to refractory ventricular fibrillation, ECPR was initiated. Approximately, 3 h after extracorporeal membrane oxygenation support, abdominal distension and rigidity developed. Therefore, ACS was suspected. Decompression laparotomy was required to relieve elevated intra-abdominal pressure. CONCLUSIONS We report a case of a patient with OHCA who developed lethal ACS after ECPR. Despite this, the patient was able to recover from several major crises. Regardless of how lethal the patient is, if compartment syndrome develops in any part of the body, we should aggressively consider surgical decompression.
Collapse
Affiliation(s)
- Gun Jik Kim
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, 41944, Republic of Korea
| | - Kyoung Hoon Lim
- Department of Surgery, Trauma Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, 41944, Republic of Korea
| | - Tak-Hyuk Oh
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, 41404, Republic of Korea
| | - Hyun-Joo Lee
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, 41944, Republic of Korea
| | - Deokbi Hwang
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, 41944, Republic of Korea
| | - Hanna Jung
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, 41944, Republic of Korea.
| |
Collapse
|
3
|
Meléndez-Lugo JJ, Caicedo Y, Guzmán-Rodríguez M, Serna JJ, Ordoñez J, Angamarca E, García A, Pino LF, Quintero L, Parra MW, Ordoñez CA. Prehospital Damage Control: The Management of Volume, Temperature… and Bleeding! Colomb Med (Cali) 2020; 51:e4024486. [PMID: 33795898 PMCID: PMC7968431 DOI: 10.25100/cm.v51i4.4486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Damage control resuscitation should be initiated as soon as possible after a trauma event to avoid metabolic decompensation and high mortality rates. The aim of this article is to assess the position of the Trauma and Emergency Surgery Group (CTE) from Cali, Colombia regarding prehospital care, and to present our experience in the implementation of the “Stop the Bleed” initiative within Latin America. Prehospital care is phase 0 of damage control resuscitation. Prehospital damage control must follow the guidelines proposed by the “Stop the Bleed” initiative. We identified that prehospital personnel have a better perception of hemostatic techniques such as tourniquet use than the hospital providers. The use of tourniquets is recommended as a measure to control bleeding. Fluid management should be initiated using low volume crystalloids, ideally 250 cc boluses, maintaining the principle of permissive hypotension with a systolic blood pressure range between 80- and 90-mm Hg. Hypothermia must be management using warmed blankets or the administration of intravenous fluids warmed prior to infusion. However, these prehospital measures should not delay the transfer time of a patient from the scene to the hospital. To conclude, prehospital damage control measures are the first steps in the control of bleeding and the initiation of hemostatic resuscitation in the traumatically injured patient. Early interventions without increasing the transfer time to a hospital are the keys to increase survival rate of severe trauma patients.
Collapse
Affiliation(s)
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Mónica Guzmán-Rodríguez
- Universidad de Chile, Instituto de Ciencias Biomédicas, Facultad de Medicina, Santiago de Chile, Chile
| | - José Julián Serna
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Sección de Cirugía de Trauma y Emergencias, Cali Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Sección de Cirugía de Trauma y Emergencias, Cali, Colombia
| | - Juliana Ordoñez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Sección de Cirugía de Trauma y Emergencias, Cali Colombia
| | | | - Alberto García
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Sección de Cirugía de Trauma y Emergencias, Cali Colombia.,Universidad Icesi, Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Sección de Cirugía de Trauma y Emergencias, Cali Colombia.,Hospital Universitario del Valle, Sección de Cirugía de Trauma y Emergencias, Cali, Colombia
| | - Laureano Quintero
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Sección de Cirugía de Trauma y Emergencias, Cali Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL, USA
| | - Carlos A Ordoñez
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Sección de Cirugía de Trauma y Emergencias, Cali Colombia.,Universidad Icesi, Cali, Colombia
| |
Collapse
|
4
|
Abstract
Snake bites are an important public health problem worldwide. Snake venom causes both systemic and local complications, which can prove fatal if not treated on time. The local effects of snake bite include tissue necrosis, edema, and compartment syndrome. Patients may also be left with permanent physical deformities due to residual sequelae of the snake bite. Compartment syndrome after a snake bite is an uncommon occurrence. The effects are more pronounced in children possibly due to the the reduced total dilution volume in children. The administration of anti-snake venom is the only specific therapy. Compartment syndrome occurs due to a vicious cycle of edema causing hypoxia and acidosis, which further increases capillary permeability and fluid extravasation. This results in a volume increase in the closed fascial compartment, which ultimately compromises circulation and causes irreversible muscle and nerve damage. Our report describes a case of upper limb compartment syndrome following a snake bite on the right wrist of a five-year-old girl who presented eight-hours after the snake bite to the emergency department of Nizwa Regional Referral Hospital. The patient received early and appropriate care but progressed to develop compartment syndrome for which she had to be taken to the operating theatre for emergency fasciotomy. All clinicians should be able to recognize the early symptoms and signs of an evolving compartment syndrome in absence of intracompartmental measuring equipment. The timely fasciotomy in our patient helped the patient achieve excellent functional results.
Collapse
Affiliation(s)
- Dinesh Dhar
- Orthopedics Department, Nizwa Regional Referral Hospital, Nizwa, Oman
| |
Collapse
|
5
|
Hwang JH, Kim KS, Lee SY. A case of nonisland pedicled foot fillet flap for below-knee amputation stump wound: treatment option for compartment syndrome after fibular free flap surgery. J Korean Med Sci 2014; 29:305-8. [PMID: 24550664 PMCID: PMC3924016 DOI: 10.3346/jkms.2014.29.2.305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 01/03/2014] [Indexed: 11/20/2022] Open
Abstract
Despite the frequent use of the fibular free flap, there have been no reports of severe compartment syndrome of the donor leg that necessitated limb amputation. A 66-yr-old man had a fibular osseous free flap transfer from the left leg to the mandible that was complicated by postoperative compartment syndrome. An extensive chronic leg wound resulted, which was treated with multiple debridements and finally with below-knee amputation. Successful coverage of the below-knee amputation stump was accomplished with a nonisland pedicled foot fillet flap. Various foot fillet flaps may be used acutely as a free or an island pedicled flap, but dissection of the vascular pedicle may be difficult in a chronically inflamed wound because of inflammation and adhesions to surrounding tissue. The nonisland pedicled foot fillet flap may be considered as a useful option for treatment of a chronically inflamed stump wound after below-knee amputation.
Collapse
Affiliation(s)
- Jae Ha Hwang
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Kwang Seog Kim
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sam Yong Lee
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
6
|
Filho JS, Ramos LA, Sayum J, de Carvalho RT, Ejnisman B, Matsuda MM, Nicolini A, Cohen M. LEG'S COMPARTMENT SYNDROME AFTER RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT: CASE REPORT. Rev Bras Ortop 2011; 46:730-2. [PMID: 27047834 PMCID: PMC4799352 DOI: 10.1016/s2255-4971(15)30333-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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] [Received: 08/20/2010] [Accepted: 03/25/2011] [Indexed: 12/04/2022] Open
Abstract
The authors report a case of a patient that was submitted to a surgery of reconstruction of anterior cruciate ligament and collateral medial ligament repair of the left knee that complicated to a compartment syndrome.
Collapse
Affiliation(s)
- Jorge Sayum Filho
- Assistant Physician of the Sports Traumatology Center (CETE) of the Department of Orthopedics and Traumatology (DOT) of Universidade Federal de São Paulo (Unifesp) São Paulo, SP, Brazil
| | - Leonardo Adeo Ramos
- Assistant Physician of the Sports Traumatology Center (CETE) of the Department of Orthopedics and Traumatology (DOT) of Universidade Federal de São Paulo (Unifesp) São Paulo, SP, Brazil
| | - Jorge Sayum
- Head of the Department of Orthopedics and Traumatology of Hospital e Maternidade Assunção (HMA) - São Bernardo do Campo, SP, Brazil
| | - Rogério Teixeira de Carvalho
- Assistant Physician of the Sports Traumatology Center (CETE) of the Department of Orthopedics and Traumatology (DOT) of Universidade Federal de São Paulo (Unifesp) São Paulo, SP, Brazil
| | - Benno Ejnisman
- Assistant Physician of the Sports Traumatology Center (CETE) of the Department of Orthopedics and Traumatology (DOT) of Universidade Federal de São Paulo (Unifesp) São Paulo, SP, Brazil
| | - Marcelo Mitsuro Matsuda
- Assistant Physician of the Sports Traumatology Center (CETE) of the Department of Orthopedics and Traumatology (DOT) of Universidade Federal de São Paulo (Unifesp) São Paulo, SP, Brazil
| | - Alexandre Nicolini
- Assistant Physician of the Sports Traumatology Center (CETE) of the Department of Orthopedics and Traumatology (DOT) of Universidade Federal de São Paulo (Unifesp) São Paulo, SP, Brazil
| | - Moisés Cohen
- Lecturer of the Department of Orthopedics and Traumatology (DOT) of Universidade Federal de São Paulo (Unifesp) and Head of the Sports Traumatology Center (CETE) - São Paulo, SP, Brazil
| |
Collapse
|