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1.
J Orthop Traumatol ; 25(1): 5, 2024 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-38282098

RESUMO

BACKGROUND: Intramedullary tibial nailing (IMN) is the gold standard for stabilizing tibial shaft fractures. IMN can be performed through an infra- or suprapatellar approach. PURPOSE: The aim of this study is to compare the rate of fasciotomies for acute compartment syndrome between infra- and suprapatellar approaches. METHODS: A total of 614 consecutive patients who were treated with IMN for tibial fracture between October 2007 and February 2020 were included in the study. The approach used for IMN was determined by the operating surgeon. Infrapatellar IMN was performed with the knee in deep flexion position, with or without calcaneal traction. Suprapatellar IMN was performed in straight or semiflexed position. The diagnosis of compartment syndrome was based on clinical analysis, but for some patients, a continuous compartment pressure measurement was used. The primary outcome was the rate of peri- and postoperative compartment syndrome treated with fasciotomies. RESULTS: The study sample included 513 patients treated with infrapatellar IMN and 101 patients treated with suprapatellar IMN technique. The mean age of the patients was 44.7 years (infrapatellar technique) and 48.4 years (suprapatellar technique). High energy trauma was seen in 138 (27%) patients treated with infrapatellar technique and in 39 (39%) patients treated with suprapatellar technique. In the suprapatellar group (n = 101), there were no cases of peri- or postoperative compartment syndrome treated with fasciotomies. In the infrapatellar group (n = 513), the need for fasciotomies was stated in 67 patients, 31 patients (6.0%) perioperatively and in 36 patients (7.0%) postoperatively. The rate of fasciotomies (0/101 versus 67/513 cases) differed significantly (p < 0.001). There were no significant differences in the fracture morphology or patient demographics between the study groups. CONCLUSIONS: The suprapatellar technique is recommended over the infrapatellar approach in the treatment of tibial shaft fractures. The rate of peri- and postoperative compartment syndrome and the need for fasciotomies was significantly lower with the suprapatellar technique. The major cause of increased rate of peri- or postoperative acute compartment syndrome with infrapatellar IMN technique is presumably associated with the positioning of the patient during the operation.


Assuntos
Fixação Intramedular de Fraturas , Fraturas da Tíbia , Humanos , Adulto , Fixação Intramedular de Fraturas/métodos , Fasciotomia , Pinos Ortopédicos , Fraturas da Tíbia/cirurgia , Tíbia/cirurgia , Resultado do Tratamento , Estudos Retrospectivos
2.
Scand J Trauma Resusc Emerg Med ; 32(1): 10, 2024 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-38291453

RESUMO

BACKGROUND: The purpose of this retrospective, single-institutional study was to report the clinical features and outcomes of orthopaedic injuries after the Kahramanmaras earthquake. METHODS: An institutional database review was conducted to evaluate the results of patients who applied to our hospital's emergency department after the Kahramanmaras earthquake. Trauma patients referred to orthopaedics and traumatology were identified. Patient records were checked for injury type, fracture site, treatment type (conservative or surgical), surgical technique, and outcome. Diagnosis with crush syndrome and the need for haemodialysis were also noted. Bedside fasciotomy was undertaken based on the urgency of the patient's condition, number of patients and the availability of the operating theatre. A team consisting of a trauma surgeon, a plastic surgeon, a board-certified physician in infectious disease, a reanimation specialist, a general surgeon and a nephrologist followed up with the patients. RESULTS: Within the first 7 days following the earthquake, 265 patients were admitted to the emergency department, and 112 (42.2%) of them were referred to orthopaedics and traumatology. There were 32 (28.5%) patients diagnosed with acute compartment syndrome. Fasciotomy was performed on 43 extremities of 32 patients. Of these extremities, 5 (11.6%) were upper and 38 (88.4%) were lower extremities.The surgeries of 16 (50%) of the patients who underwent fasciotomy were performed in the emergency department. There was no significant difference in terms of complications and outcomes between performing the fasciotomy at the bedside or in the operating theatre (p = 0.456). CONCLUSIONS: Fasciotomy appears to be a crucial surgical procedure for the care of earthquake causalities. Fasciotomy can be safely performed as a bedside procedure based on the urgency of the patient's condition as well as the availability of the operating theatre.


Assuntos
Síndromes Compartimentais , Síndrome de Esmagamento , Terremotos , Ortopedia , Humanos , Estudos Retrospectivos , Síndrome de Esmagamento/cirurgia , Síndrome de Esmagamento/complicações , Fasciotomia/efeitos adversos , Hospitais , Síndromes Compartimentais/complicações , Síndromes Compartimentais/cirurgia
3.
Ultrasound Med Biol ; 50(4): 571-579, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38281889

RESUMO

OBJECTIVE: The aim of the work described here was to evaluate the objectivity and reproducibility of non-invasive intra-compartment pressure (ICP) measurement using ultrasound shear wave elastography (SWE) in a turkey model in vivo and to determine the biological and histologic changes in acute compartment syndrome (ACS). METHODS: Twenty-four turkeys were randomly divided into four groups based on the duration and fasciotomy of ACS created by infusion of up to 50 mm Hg in the tibialis muscle: group 1, ACS 2 h; group 2, ACS 4 h; group 3, ACS 2 h + fasciotomy 2 h; group 4, ACS 4 h + fasciotomy 2 h. For each turkey, the contralateral limb was considered the control. Time-synchronized measures of SWE and ICP from each leg were collected. Then turkeys were euthanized for histology and quantitative reverse transcription polymerase chain reaction (qRT-PCR) examination. RESULTS: All models created reproducible increases in ICP and SWE, which had a strong linear relationship (r = 0.802, p < 0.0001) during phase 1. SWE remained stable (50.86 ± 9.64 kPa) when ICP remained at 50.28 ± 2.17 mm Hg in phase 2. After fasciotomy, SWE declined stepwise and then normalized (r = 0.737, p < 0.0001). Histologically, the myofiber diameter of group 2 (82.31 ± 22.92 µm) and group 4 (90.90 ± 20.48 µm) decreased significantly (p < 0.01) compared with that of the control group (103.1 ± 20.39 µm); the interstitial space of all groups increased significantly (p < 0.01). Multifocal muscle damage revealed neutrophilic infiltration, degeneration, hemorrhage and necrosis, especially in group 4. Quantitative RT-PCR verified that interleukin-6 and heparin-binding EGF-like growth factor were significantly increased in group 4. CONCLUSION: SWE provided sensitive measurements correlating to ICP in a clinically relevant ACS animal model. Once ACS time was exceeded, progression to irreversible necrosis continued spontaneously, even after fasciotomy. SWE may help surgeons in the early detection, monitoring, prognosis and decision making on fasciotomy for ACS.


Assuntos
Síndromes Compartimentais , Técnicas de Imagem por Elasticidade , Animais , Reprodutibilidade dos Testes , Síndromes Compartimentais/diagnóstico por imagem , Síndromes Compartimentais/cirurgia , Fasciotomia , Necrose
6.
J Am Acad Orthop Surg ; 32(4): e166-e174, 2024 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-38109720

RESUMO

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.


Assuntos
Síndromes Compartimentais , Síndrome de Esmagamento , Rabdomiólise , Humanos , Síndrome de Esmagamento/complicações , Rabdomiólise/complicações , Rabdomiólise/terapia , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Extremidades , Fasciotomia/efeitos adversos
7.
Bone Joint J ; 105-B(12): 1252-1258, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-38035608

RESUMO

Aims: Lateral femoral cutaneous nerve (LFCN) injury is a potential complication after the direct anterior approach for total hip arthroplasty (DAA-THA). The aim of this study was to determine how the location of the fasciotomy in DAA-THA affects LFCN injury. Methods: In this trial, 134 patients were randomized into a lateral fasciotomy (n = 67) or a conventional fasciotomy (n = 67) group. This study was a dual-centre, double-blind, prospective randomized controlled two-arm trial with parallel group design and a 1:1 allocation ratio. The primary endpoint was the presence of LFCN injury, which was determined by the presence of numbness, decreased sensation, tingling, jolt-like sensation, or pain over the lateral aspect of the thigh, excluding the surgical scar, using a patient-based questionnaire. The secondary endpoints were patient-reported outcome measures (PROMs) using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS-12). Assessments were obtained three months after surgery. Results: The incidence of LFCN injury tended to be lower in the lateral fasciotomy group (p = 0.089). In the lateral fasciotomy group, there were no significant differences in the mean PROM scores between patients with and without LFCN injury (FJS-12: 54.42 (SD 15.77) vs 65.06 (SD 26.14); p = 0.074; JHEQ: 55.21 (SD 12.10) vs 59.72 (SD 16.50); p = 0.288; WOMAC: 82.45 (SD 6.84) vs 84.40 (SD 17.91); p = 0.728). In the conventional fasciotomy group, there were significant differences in FJS-12 and JHEQ between patients with and without LFCN injury (FJS-12: 43.21 (SD 23.08) vs 67.28 (SD 20.47); p < 0.001; JHEQ: 49.52 (SD 13.97) vs 59.59 (SD 15.18); p = 0.012); however, there was no significant difference in WOMAC (76.63 (SD 16.81) vs 84.16 (SD 15.94); p = 0.107). Conclusion: The incidence of LFCN injury at three months after THA was comparable between the lateral and conventional fasciotomy groups. Further studies are needed to assess the long-term effects of these approaches.


Assuntos
Artroplastia de Quadril , Coxa da Perna , Humanos , Coxa da Perna/inervação , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Estudos Prospectivos , Antivirais , Fasciotomia , Nervo Femoral/lesões , Resultado do Tratamento
8.
Medicine (Baltimore) ; 102(42): e35660, 2023 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-37861509

RESUMO

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.


Assuntos
Traumatismos do Tornozelo , Síndromes Compartimentais , Doenças do Pé , Masculino , Humanos , Adulto , Pé/cirurgia , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Doenças do Pé/etiologia , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/cirurgia , Dor/complicações , Fasciotomia
9.
Foot Ankle Int ; 44(11): 1097-1104, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37724857

RESUMO

BACKGROUND: Chronic exertional compartment syndrome involving the lower leg lateral compartment (lat-CECS) seldom occurs isolated but is usually combined with CECS of the anterior (ant-CECS) or deep posterior compartment (dp-CECS). Patient characteristics in lat-CECS and outcome after surgery are largely unknown. The aim of this prospective case series was to describe patient characteristics and symptoms and to report on outcome following a fasciotomy. METHODS: All patients diagnosed with lat-CECS based on exertional lateral lower leg symptoms and elevated intracompartmental pressure (ICP) measurements according to the Pedowitz criteria (ICP ≥ 15 mm Hg at rest, and/or ≥30 mm Hg after 1 minute, and/or ≥20 mm Hg 5 minutes after exercise) were eligible for this study. A standard intake questionnaire scoring symptom patterns was completed by all patients. Patients who were operated for lat-CECS were asked to complete a 3-month and 12-month postoperative questionnaire scoring symptoms and surgical outcome. Patients with a history of CECS surgery, recent lower leg trauma, or peripheral neurovascular disease were excluded. RESULTS: A total of 881 patients with possible lower leg CECS completed an intake questionnaire and 88 (10%) were diagnosed with lat-CECS according to the Pedowitz criteria (isolated lat-CECS n = 10; lat/ant CECS n = 54, lat/ant/dp CECS n = 19, lat/dp CECS n = 5). Severe pain during exercise and moderate tightness during rest were frequently reported. A group of 28 patients (49 legs; isolated lat-CECS n = 2; lat/ant CECS n = 22, lat/ant/dp CECS n = 3, lat/dp CECS n = 1) was analyzed after fasciotomy. Complications were minor (wound infection requiring antibiotics, n = 3; temporary complex regional pain syndrome with spontaneous recovery, n = 1). Superficial peroneal nerve damage was not observed. One year after surgery, 64% rated outcome as excellent or good, whereas 71% had resumed sports activities. CONCLUSION: One in 10 patients with anterolateral exertional lower leg pain evaluated in a tertiary referral center met diagnostic criteria for lat-CECS. Pain and tightness were present during exertion and were often reported occurring during rest and at night. In this series, we found fasciotomy-either an isolated (lateral) or a multiple (combined with anterior and/or deep posterior) compartment fasciotomy-is safe and beneficial in most patients. LEVEL OF EVIDENCE: Level IV, case series.


Assuntos
Síndromes Compartimentais , Perna (Membro) , Humanos , Perna (Membro)/cirurgia , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/cirurgia , Síndrome Compartimental Crônica do Esforço/cirurgia , Síndrome Compartimental Crônica do Esforço/complicações , Fasciotomia/efeitos adversos , Doença Crônica , Dor/etiologia , Resultado do Tratamento
10.
J Hand Surg Am ; 48(12): 1200-1209, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37725027

RESUMO

PURPOSE: The objective of this systematic review and meta-analysis was to synthesize the available randomized controlled trial data comparing needle fasciotomy and collagenase treatment for single-digit Dupuytren contractures with a minimum of 3-year follow-up and determine whether one treatment is superior regarding contracture correction and functional outcomes. METHODS: A systematic review and meta-analysis was conducted by searching four databases for randomized controlled trials investigating the single-digit treatment outcomes for Dupuytren contracture comparing collagenase treatment and needle fasciotomy with a minimum of 3-year follow-up. The risk of bias of included studies was assessed using the Cochrane risk-of-bias tool. A meta-analysis was performed using a random effects model in anticipation of unobserved heterogeneity. The primary outcome measure was contracture recurrence. Secondary outcome measures included final fixed flexion contracture (FFC), Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) scores, and Unité Rhumatologique des Affections de la Main (URAM) scores. RESULTS: After screening 264 articles, 4 randomized clinical trials were eligible for final inclusion. One trial had a high risk of bias, and two trials had some concern for bias. The final meta-analysis included 347 patients, 169 who underwent collagenase treatment and 178 who underwent needle fasciotomy. No significant differences were noted between the groups in contracture recurrence, FFC, and URAM scores. The pooled data showed a higher QuickDASH score in the collagenase treatment group compared with the needle fasciotomy group, but the observed difference was less than what would be expected to be clinically relevant. CONCLUSIONS: Needle fasciotomy and collagenase treatment have similar outcomes with regards to contracture recurrence, final FFC, QuickDASH scores, and URAM scores for the single-digit treatment for Dupuytren contracture at a minimum of 3-year follow-up. Relevant factors that may be considered during the shared decision-making process for treatment selection include surgeon and patient preferences, costs of treatment, and the disparate complication profiles of these two treatments. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.


Assuntos
Contratura de Dupuytren , Luxações Articulares , Humanos , Contratura de Dupuytren/tratamento farmacológico , Contratura de Dupuytren/cirurgia , Fasciotomia , Ensaios Clínicos Controlados Aleatórios como Assunto , Colagenases/uso terapêutico , Resultado do Tratamento , Colagenase Microbiana/uso terapêutico
11.
Medicina (Kaunas) ; 59(9)2023 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-37763712

RESUMO

Background and Objectives: The current study aims to determine the impact of fasciotomy on mortality and morbidity in children and adults with crush-related AKI following the 2023 Kahramanmaras earthquakes. Materials and Methods: The study included individuals who had suffered crush injuries after the 2023 Kahramanmaras earthquakes and were identified as having an acute kidney injury (AKI). Patients with an AKI were divided into two groups based on age: those under 18 years and those over 18 years. A comparative analysis was conducted between the mortality and morbidity rates of patients who underwent fasciotomy and those who did not. Disseminated intravascular coagulopathy (DIC), sepsis, and adult respiratory distress syndrome (ARDS) have all been identified as contributors to morbidity. Results: The study was conducted with a total of 40 patients (21 males and 19 females) aged between 4 and 83 years. A total of 21 patients underwent fasciotomy, and the patients underwent varying numbers of fasciotomy, ranging from 0 to 11. The mortality rate was 12.5%, corresponding to five adult patients. No instances of mortality were reported in the paediatric cohort. The application of fasciotomy in instances of crush-induced AKI did not result in elevated levels of mortality in either the paediatric or adult demographic. Within the adult population, a substantial difference in the duration of dialysis was observed between individuals who underwent fasciotomy and those who did not. A statistically significant increase in the number of fasciotomy incisions was observed in patients diagnosed with sepsis compared with those without sepsis. The study found a significant positive correlation between the number of fasciotomy incisions and dialysis days. Conclusions: Neither adult nor paediatric patients with crush-induced AKI showed an increased risk of death after fasciotomy. The number of fasciotomy incisions significantly correlated with the development of sepsis. Despite experiencing delays in hospital admission for paediatric patients, the incidence of both crush syndrome and mortality rates among children remained relatively low.


Assuntos
Injúria Renal Aguda , Terremotos , Sepse , Feminino , Masculino , Adulto , Humanos , Criança , Adolescente , Pré-Escolar , Adulto Jovem , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fasciotomia , Diálise Renal , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia
12.
BMC Musculoskelet Disord ; 24(1): 704, 2023 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-37667241

RESUMO

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.


Assuntos
Anestesia , Síndromes Compartimentais , Humanos , Fasciotomia , Estudos Retrospectivos , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Extremidades/cirurgia
13.
Artigo em Inglês | MEDLINE | ID: mdl-37713415

RESUMO

Plantar fasciitis is a common cause of heel pain. The aim of this study was to review the current literature and attempt to clarify whether endoscopic plantar fasciotomy (EPF) is an effective and reliable treatment for plantar fasciitis in comparison with other invasive or noninvasive treatments. We performed an electronic search of the medical literature in PubMed database using combinations of the following keywords: plantar fasciitis, endoscopic treatment, and plantar aponeurosis. Overall, we had shown that patients had better scores following EPF/endoscopic plantar fascia release. The clinical scores were improved postoperatively and most of the patients were satisfied. Furthermore, the clinical trials showed that time to return to work or to previous activities was shorter compared with other treatments. These studies suggest that EPF/endoscopic plantar fascia release is probably an effective treatment of chronic plantar fasciitis. EPF is an efficient, safe treatment with good early postoperative results in patients with recalcitrant plantar fasciitis. There is evidence that other methods are equivalently effective for EPF, and some authors support that they should be considered as a second-line treatment because of their minimal invasive character and very low risk of complications; thus, more research is required.


Assuntos
Fasciíte Plantar , Humanos , Fasciíte Plantar/cirurgia , Fasciotomia/métodos , Resultado do Tratamento , Endoscopia/métodos ,
14.
Mil Med ; 188(11-12): e3726-e3729, 2023 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-37646777

RESUMO

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.


Assuntos
Síndrome do Compartimento Anterior , Síndromes Compartimentais , Humanos , Masculino , Adulto , Síndrome Compartimental Crônica do Esforço , Hipestesia , Doença Crônica , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Síndrome do Compartimento Anterior/etiologia , Síndrome do Compartimento Anterior/cirurgia , Síndrome do Compartimento Anterior/diagnóstico , Perna (Membro) , Fasciotomia/métodos , Dor
15.
J Orthop Surg Res ; 18(1): 537, 2023 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-37501149

RESUMO

BACKGROUND: The decision of fasciotomy or amputation in crush syndrome is controversial and challenging for surgeons. We aimed to share our experiences after the Kahramanmaras earthquake, to predict the severity of crush syndrome and mortality, and to guide the surgical decision. METHODS: The clinical data of patients during their first week of hospitalization were analyzed retrospectively. Totally, 233 crush syndrome patients were included. Demographic data, physical and laboratory findings, surgical treatments, and outcomes were recorded. RESULTS: The mean time under the rubble was 41.89 ± 29.75 h. Fasciotomy and amputation were performed in 41 (17.6%) and 72 (30.9%) patients. One hundred and two patients (56.7%) underwent hemodialysis. Fifteen patients (6.4%) died. Lower extremity injury, abdominal trauma, and thoracic trauma were associated with mortality. Mortality was significantly increased in patients with thigh injuries (p = 0.028). The mean peak CK concentration was 69.817.69 ± 134.812.04 U/L. Peak CK concentration increased substantially with amputation (p = 0.002), lower limb injury (p < 0.001), abdominal trauma (p = 0.011), and thoracic trauma (p = 0.048). CONCLUSIONS: Thigh injury is associated with the severity of crush syndrome and mortality. Late fasciotomy should not be preferred in crush syndrome. Amputation is life-saving, especially in desperate lower extremity injuries.


Assuntos
Síndrome de Esmagamento , Terremotos , Traumatismos da Perna , Traumatismos Torácicos , Humanos , Síndrome de Esmagamento/cirurgia , Estudos Retrospectivos , Fasciotomia , Amputação Cirúrgica , Traumatismos Torácicos/complicações
16.
J Orthop Trauma ; 37(8S): S7-S8, 2023 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-37443436

RESUMO

SUMMARY: The video described by this article presents a safe and effective technique for single-incision, 4-compartment fasciotomy of the leg in a patient with a tibial plateau fracture and clinically diagnosed compartment syndrome. We also demonstrate a technique for the application of a negative pressure wound dressing when delayed closure or coverage is planned.


Assuntos
Síndromes Compartimentais , Tratamento de Ferimentos com Pressão Negativa , Humanos , Fasciotomia/métodos , Perna (Membro) , Resultado do Tratamento , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Bandagens
17.
Jt Dis Relat Surg ; 34(2): 497-502, 2023 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-37462658

RESUMO

OBJECTIVES: This study aims to evaluate the results of patients who underwent cruris fasciotomy for acute compartment syndrome (ACS) after the 2023 Kahramanmaras earthquake and used subcuticular polydioxanone (PDS) method or negative pressure wound therapy (NPWT) with vacuum-assisted closure (VAC) for fasciotomy follow-up and closure of the defect. PATIENTS AND METHODS: Between March 2023 and April 2023, a total of 52 patients (31 males, 21 females; mean age: 29±14.8 years; range, 5 to 74 years) were retrospectively analyzed. The patients were divided into two groups as the dermatotraction (PDS) group (Group 1, n=30), and the VAC group (Group 2, n=22). Data including demographic, clinical, and operative data such as fasciotomy closure time, graft need, and infection rate were recorded. RESULTS: More grafts were needed to close the fasciotomy in patients followed with VAC. The mean closure time of the fasciotomy was 25.9±3.8 days in the PDS group and 27.3±3.5 days in the VAC group, indicating no significant difference between the groups (p=0.738). There was no significant difference in the rate of wound infection between the two groups (p=0.482). CONCLUSION: Our study results suggest that more grafts are needed to close the fasciotomy in patients followed with VAC; however, it seems to increase the cost of the treatment.


Assuntos
Síndromes Compartimentais , Terremotos , Tratamento de Ferimentos com Pressão Negativa , Masculino , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Fasciotomia , Tratamento de Ferimentos com Pressão Negativa/métodos , Estudos Retrospectivos , Síndromes Compartimentais/cirurgia
18.
Jt Dis Relat Surg ; 34(2): 516-522, 2023 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-37462661

RESUMO

OBJECTIVES: This study aims to evaluate the effect of hyperbaric oxygen therapy (HBOT) on the amputation level in patients undergoing fasciotomy with a Mangled Extremity Severity Score (MESS) score of ≥7 after 2023 Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and March 10th, 2023, a total of 23 patients (14 males, 9 females; mean age: 36.8±13.2 years; range, 17 to 64 years) who needed amputation with a MESS score of ≥7 and refused amputation were included in the study. All fasciotomies were performed in an external center, and five of them was incomplete. First, incomplete fasciotomies were completed with debridement due to deep muscle necrosis. Daily two HBOT sessions were performed for the first three days. In the following days, daily one HBOT session was performed. The HBOT was terminated for the patients who were decided by the council that they did not benefit from HBOT treatment. RESULTS: Six (26.08%) of the patients had a bone fracture (n=2 forearm, n=1 femur, n=2 tibia, and n=1 ankle fracture). The mean number of HBOT session was 13.24±5.4 (range, 7 to 30) and the mean duration of HBOT was 26.5±10.8 (range, 14 to 60) h. The mean MESS score was 9.96±1.36 (range, 7 to 12). All of the patients were trapped under the rubble with a mean time of 12.3±5.4 (range, 6 to 23) h. All fasciotomies were performed within the first 30 h. Twenty-two of the patients were amputated at the level previously determined by the experienced trauma surgeons. The amputation level changed in only one patient. After 38 h of HBOT, transradial amputation was performed to the patient in whom transhumeral amputation level was determined previously. None of the patients had any adverse event related to HBOT. CONCLUSION: Our study results suggest that the MESS is a useful scoring system for amputation decision after a high-energy trauma, such as an earthquake, with a high accuracy rate. The outcomes of HBOT are not satisfactory for high-energy traumas, such as earthquakes, in those requiring fasciotomy having more muscle necrosis and a MESS score of ≥7.


Assuntos
Terremotos , Oxigenoterapia Hiperbárica , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Fasciotomia , Amputação Cirúrgica , Necrose
19.
Jt Dis Relat Surg ; 34(2): 523-529, 2023 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-37462662

RESUMO

OBJECTIVES: The aim of this study was to evaluate the treatment management and demographic data of earthquake victims admitted to Plastic Surgery Department of our center after the 2023 Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and February 15th, 2023, a total of 120 patients (65 males, 55 females; mean age: 36.3±17.3 years; range, 85 to 88 years) who were consulted to the Plastic Surgery Department of our center were included. Demographic data of the patients, time to admission to the emergency room, removal time under the rubble, type of injury, emergency operation requirement, fasciotomy requirement, hyperbaric oxygen therapy administration, and length of stay in the intensive care unit were evaluated. After the first intervention, patients with compartment syndrome underwent emergency fasciotomy immediately. Perioperative laboratory values of the patients were followed closely to prevent the development of crush syndrome. RESULTS: Due to stay under the rubble, upper extremity soft tissue injury was seen in 46.2% of the patients. The pelvic and abdominal region were the least affected soft tissues in 1.7% patients. Fasciotomy was performed in 75 patients who stayed under the rubble. Hyperbaric oxygen therapy was applied to 21 of 75 patients who underwent fasciotomy. Amputation was performed in four patients, three of which were in the upper extremity and one in the lower extremity, during follow-up after fasciotomy. A total of 10.83% of the patients were treated conservatively and 11.67% of them were reconstructed with free flaps. Totally 7.5% of the patients who stayed under the rubble were hospitalized in our clinic for maxillofacial injuries. A total of 66.6% of these patients were treated surgically, while 33.3% of them were further treated conservatively. CONCLUSION: Proper triage, proper fasciotomy, and appropriate surgical interventions reduce the amputation rate, yielding clinically satisfactory results.


Assuntos
Síndromes Compartimentais , Síndrome de Esmagamento , Terremotos , Cirurgia Plástica , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Síndrome de Esmagamento/cirurgia , Síndromes Compartimentais/prevenção & controle , Síndromes Compartimentais/cirurgia , Fasciotomia
20.
Handchir Mikrochir Plast Chir ; 55(5): 330-335, 2023 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-37429329

RESUMO

BACKGROUND: Dupuytren's disease often leads to an increasing limitation in finger extension in affected patients. As the incidence rises with age, the number of cases is expected to rise in the future due to the demographic change. Therefore, an easy and patient-oriented treatment is required. In the following study, we investigated the short and medium-term results after percutaneous needle fasciotomy (PNF). PATIENTS AND METHODS: Overall, 65 fingers of 40 patients were treated with PNF. We evaluated the total passive deficit of extension (TPED), the passive deficit of extension of the joints (PED), the Buck-Gramcko score, rate of recurrence, DASH score and patient satisfaction. The average age of the patients was 65,9 years. Most of the patients (82%) were male. RESULTS: Directly after the PNF, extension in the treated fingers improved significantly (TPED before PNF 74,6°±41,1 SD to 32,8°±29,0 SD after the procedure). By the time of the follow-up examination (30,2±13,9 SD months), TPED had increased again (52,7°±40,2 SD). The rate of recurrence was 29,7%, and a higher Tubiana stage before the procedure correlated significantly with a higher recurrence rate. Nevertheless, patients demonstrated a very high level of satisfaction with the procedure and almost all patients would choose to undergo PNF again. CONCLUSION: Although it is associated with a relatively high recurrence rate, PNF represents an effective and patient-oriented treatment of Dupuytren's contracture.


Assuntos
Contratura de Dupuytren , Humanos , Masculino , Feminino , Contratura de Dupuytren/cirurgia , Fasciotomia/métodos , Satisfação do Paciente , Dedos , Agulhas , Resultado do Tratamento
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