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1.
J Orthop Surg Res ; 19(1): 622, 2024 Oct 04.
Artículo en Inglés | MEDLINE | ID: mdl-39367457

RESUMEN

BACKGROUND: Most existing animal models of acute compartment syndrome (ACS) rely on exogenous manipulation of intra-compartmental pressures to model ACS. The purpose of the current study was to evaluate the endogenous effect of a blast injury on porcine lower leg intra-compartmental pressures (ICP). METHODS: The hindlimb of juvenile Landrace pigs was fractured at the diaphyseal tibia and subjected to blasts of compressed air to mimic a blast injury. Injured and control legs underwent pre-operative continuous ICP monitoring. At 4.5 h post injury, the fracture was stabilized followed by closure of the anterior compartment fascia (continued compartment pressure model, CCPM) or four compartment fasciotomy. Pressure measurements were made after operative fixation. Select pigs in CCPM were harvested between 48 and 72 h post-injury to evaluate the duration of ICP elevation. RESULTS: Post-injury, the model created significantly elevated ICP compared to control limbs (54.5 ± 18.2 vs. 18.2 ± 4.9 mmHg; p < 0.001). Operative fixation and anterior compartment fascial closure further increased the ICP (Mean: 87.4 ± 42.5 mmHg) relative to the pre-operative state (p = 0.037). Fasciotomy returned baseline compartment pressures (Mean: 13.7 ± 10.2 mmHg) which were equivalent to control limbs (p = 0.117). Pressure measurements at the time of delayed harvest (48-72 h) demonstrated that elevated ICP persisted following injury (69.7 ± 55.12 mmHg). CONCLUSION: The current study demonstrates that a pilot porcine blast model elevates ICP comparable to existing animal models of compartment syndrome without exogenous ICP manipulation. ICP remained elevated at 48-72 h in the absence of fasciotomy.


Asunto(s)
Traumatismos por Explosión , Síndromes Compartimentales , Modelos Animales de Enfermedad , Animales , Traumatismos por Explosión/fisiopatología , Porcinos , Síndromes Compartimentales/etiología , Síndromes Compartimentales/fisiopatología , Presión , Factores de Tiempo , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/fisiopatología , Fasciotomía/métodos , Miembro Posterior
3.
Mil Med ; 189(Suppl 3): 644-651, 2024 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-39160890

RESUMEN

INTRODUCTION: Acute Compartment Syndrome (ACS) is a severe trauma caused by elevated intra-muscle-compartment pressure (ICP). The current standard method for diagnosis is to insert a needle into the muscle sterilely under anesthesia. However, to secure the environment is sometimes not easy and leads to delays in diagnosis. Recently, we have focused on shear wave ultrasound elastography (SWE) as an alternative, which can be done concisely in unclean environment and without anesthesia. We would like to report the usefulness of SWE for ACS diagnosis using 2-pedal walking turkey model recently developed in our lab. MATERIALS AND METHODS: A total of 32 1-year-old Bourbon turkeys were used. 5% solution of chicken albumin was infused continuously into the tibialis cranialis (TC) muscle using IV pump. The ICP was increased stepwise from 0 to 50 mmHg. During the rising of ICP, the correlation between values of SWE (kPa) and ICP (mmHg) was measured. After the ICP reached 50 mmHg, half of the turkeys were maintained at this pressure for 2 hours and the rest for 6 hours. After infusion, a fasciotomy was performed on the half turkey. Half of the turkeys were euthanized after 2 weeks and the rest after 6 weeks. SWE of TC muscle and walking gait data on turkeys using a portable walkway system were measured weekly until euthanasia. At euthanasia, isometric tetanic muscle force (ITF) tests to TC muscle and histological evaluations were performed. RESULTS: SWE value (kPa) was highly significantly correlated to the actual ICP (mmHg) (R2 = 0.91). Stance of ACS side leg were significantly extended, and swing of the control side shortened from the second to the third week after ACS in the 6 hours infusion-no-fasciotomy group (P < 0.05*). ITF was significantly reduced mainly in the 6 hours infusion group (P < 0.05*). Histological evaluation revealed that in the 6 hours infusion and 6 weeks survival group, both the muscle fiber and intercellular distances were significantly expanded (P < 0.05). CONCLUSION: SWE seems to be a substitute measure of ICP in diagnosing ACS. With regard to our in vivo ACS model using turkey, survival at 50 mmHg ICP for 6 hours and 6 weeks post ACS would be an appropriate situation.


Asunto(s)
Síndromes Compartimentales , Diagnóstico por Imagen de Elasticidad , Pavos , Animales , Diagnóstico por Imagen de Elasticidad/métodos , Diagnóstico por Imagen de Elasticidad/estadística & datos numéricos , Diagnóstico por Imagen de Elasticidad/normas , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/fisiopatología , Modelos Animales de Enfermedad , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/fisiopatología
4.
Ophthalmic Plast Reconstr Surg ; 40(4): 408-410, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38967565

RESUMEN

PURPOSE: To assess the utility of a marginal full thickness blepharotomy (MFTB) for the treatment of orbital compartment syndrome. METHODS: An experimental study design employing a cadaver model for orbital compartment syndrome was used to assess the efficacy of an MFTB. Elevated orbital compartment pressures were created in 12 orbits of 6 fresh cadaver heads. Intraocular pressure, as an analog of orbital pressure, was measured before and after inferior and superior MFTBs were performed. Statistical analysis was performed on the collected data to assess the efficacy of the procedure. RESULTS: Both procedures were found to significantly lower the orbital compartment pressure. MFTB of the inferior lateral eyelid decreased orbital compartment pressure by an average of 62.2 mm Hg (95% CI, 56.9-67.5). MFTB of the superior lateral eyelid following MFTB of the inferior lateral eyelid decreased the orbital compartment pressure by an additional average of 10.3 mm Hg (total average reduction of 72.5 mm Hg; 95% CI, 68.1-76.9). CONCLUSIONS: Orbital compartment syndrome is a time-sensitive vision-threatening emergency that requires prompt diagnosis and intervention to prevent irreversible vision loss. The authors describe the MTFB, a simple one-step procedure that when performed correctly results in a significant decrease in orbital compartment pressure, making it a viable option when canthotomy and cantholysis fails or is unable to be performed.


Asunto(s)
Cadáver , Síndromes Compartimentales , Párpados , Presión Intraocular , Enfermedades Orbitales , Humanos , Síndromes Compartimentales/cirugía , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/fisiopatología , Síndromes Compartimentales/etiología , Párpados/cirugía , Presión Intraocular/fisiología , Enfermedades Orbitales/cirugía , Enfermedades Orbitales/diagnóstico , Órbita/cirugía , Procedimientos Quirúrgicos Oftalmológicos/métodos
5.
Adv Biol (Weinh) ; 8(10): e2400037, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39031943

RESUMEN

Skeletal muscle trauma such as fracture or crush injury can result in a life-threatening condition called acute compartment syndrome (ACS), which involves elevated compartmental pressure within a closed osteo-fascial compartment, leading to collapse of the microvasculature and resulting in necrosis of the tissue due to ischemia. Diagnosis of ACS is complex and controversial due to the lack of standardized objective methods, which results in high rates of misdiagnosis/late diagnosis, leading to permanent neuro-muscular damage. ACS pathophysiology is poorly understood at a cellular level due to the lack of physiologically relevant models. In this context, microfluidics organ-on-chip systems (OOCs) provide an exciting opportunity to investigate the cellular mechanisms of microvascular dysfunction that leads to ACS. In this article, the state-of-the-art OOCs designs and strategies used to investigate microvasculature dysfunction mechanisms is reviewed. The differential effects of hemodynamic shear stress on endothelial cell characteristics such as morphology, permeability, and inflammation, all of which are altered during microvascular dysfunction is highlighted. The article then critically reviews the importance of microfluidics to investigate closely related microvascular pathologies that cause ACS. The article concludes by discussing potential biomarkers of ACS with a special emphasis on glycocalyx and providing a future perspective.


Asunto(s)
Microfluídica , Microvasos , Humanos , Microvasos/fisiopatología , Microvasos/patología , Microfluídica/métodos , Microfluídica/instrumentación , Animales , Dispositivos Laboratorio en un Chip , Síndromes Compartimentales/fisiopatología , Síndromes Compartimentales/diagnóstico , Heridas y Lesiones/fisiopatología
6.
Eur J Orthop Surg Traumatol ; 34(6): 3067-3071, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38916802

RESUMEN

PURPOSE: Supracondylar humerus (SCH) fractures account for approximately 30% of injuries for those younger than 7 years of age (Cheng et al. in J Pediatr Orthop 19:344-350, 1999). Recent studies examining the association of patient age and SCH fracture outcomes have provided conflicting findings. The purpose of this study is to investigate SCH fracture outcomes in children at different ages of skeletal development. METHODS: Retrospective review of a Level I pediatric trauma center between 2010 and 2014 was conducted. 190 patients with SCH fractures, age < 14 years, fracture type Gartland III or IV (AO/OTA 13-M 3.1 III and IV) were included. Patients were sorted into age groups: < 2 years, 4-6 years, and > 8 years. Patients were treated with either a closed or open reduction with percutaneous fixation. Clinical outcomes including postoperative elbow range of motion, nerve palsy, compartment syndrome, infection, and cubitus varus were assessed. RESULTS: Patients in younger age groups were more likely to obtain postoperative full elbow flexion (< 2 years = 77%; 4-6 years = 66%; > 8 years = 43%) and full elbow extension (< 2 years = 96%; 4-6 years = 88%; > 8 years = 64%). Age was a significant predictor of nerve palsy on admission, mean operative time (< 2 years = 21.8 min; 4-6 years = 43.0 min; > 8 years = 80.7 min), and mean fluoroscopy time (< 2 years = 22.9 s; 4-6 years = 59.5 s; > 8 years = 171.9 s). There were no differences in rates of open reduction, compartment syndrome, pin tract infection, cubitus varus, or reoperation among groups. CONCLUSION: Increasing age is associated with increased elbow stiffness after percutaneous fixation of Gartland Type III and Type IV SCH fractures. Older patients with SCH fractures may benefit from formal rehabilitation. LEVEL OF EVIDENCE: III.


Asunto(s)
Articulación del Codo , Fracturas del Húmero , Rango del Movimiento Articular , Humanos , Fracturas del Húmero/cirugía , Fracturas del Húmero/fisiopatología , Fracturas del Húmero/complicaciones , Niño , Estudios Retrospectivos , Masculino , Preescolar , Femenino , Factores de Edad , Articulación del Codo/fisiopatología , Articulación del Codo/cirugía , Rango del Movimiento Articular/fisiología , Adolescente , Resultado del Tratamiento , Reducción Abierta/métodos , Complicaciones Posoperatorias/etiología , Síndromes Compartimentales/etiología , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/fisiopatología , Lactante , Reducción Cerrada/métodos
7.
Eur J Orthop Surg Traumatol ; 34(6): 2997-3004, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38847913

RESUMEN

PURPOSE: Compartment syndrome remains difficult to diagnose early in its clinical course. Pressure transducer catheters have been used to directly measure intracompartmental pressure (ICP), but this method is unreliable, with a false positive rate of 35%. We have previously used intramuscular near infrared spectroscopy to detect changes in tissue oxygen saturation (StO2) in response to increasing ICP using a novel implantable probe. However, measuring StO2 may not be sufficient to identify CS in the clinical setting. The pathophysiology of CS consists of increased ICP, leading to decreased tissue perfusion, and resulting in reduced tissue oxygenation. More clinically useful information may come from the integration of multiple data streams to aid in the diagnosis of CS. In this study, we present a novel, intramuscular probe capable of simultaneous measurement of ICP, StO2, and microvascular blood flow in a porcine model of ACS. METHODS: Proof of concept for this device is demonstrated in a porcine lower extremity balloon compression model of ACS. Pressure was maintained for 20 min (short-term) or 3 h (long-term) before the balloon volume was removed. RESULTS: In both short- and long-term experiments, as ICP increased with increasing balloon volume, the novel multimodal sensor simultaneously and reliably detected pressure elevation and corresponding reversible reductions in microvascular flow rate and tissue oxygenation. CONCLUSION: This novel trimodal device simultaneously measured the elevated ICP, decreased perfusion, and tissue ischemia of evolving ACS, substantiating our basic understanding of CS pathophysiology.


Asunto(s)
Síndromes Compartimentales , Modelos Animales de Enfermedad , Extremidad Inferior , Músculo Esquelético , Animales , Porcinos , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/fisiopatología , Músculo Esquelético/fisiopatología , Músculo Esquelético/irrigación sanguínea , Músculo Esquelético/metabolismo , Extremidad Inferior/fisiopatología , Extremidad Inferior/irrigación sanguínea , Espectroscopía Infrarroja Corta/instrumentación , Espectroscopía Infrarroja Corta/métodos , Presión , Oxígeno/metabolismo , Oxígeno/sangre , Tecnología Inalámbrica/instrumentación , Flujo Sanguíneo Regional/fisiología , Microcirculación/fisiología , Prueba de Estudio Conceptual , Saturación de Oxígeno/fisiología
9.
Chirurgie (Heidelb) ; 95(7): 529-538, 2024 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-38806712

RESUMEN

Acute compartment syndrome (ACS) is defined by a disorder of the microcirculation due to a persistent pathological pressure increase within a muscle compartment. The ischemia of the tissue leads to an initially reversible functional impairment and finally irreversible damage of the musculature, nerves and other structures. Based on the understanding of the pathophysiology, the current diagnostic concepts and treatment using the so-called dermatofasciotomy of the affected muscle compartments can be derived. In addition to the suspicion of a possible ACS based on the medical history of the patient, the findings of the clinical examination are decisive. This review article gives a summary of all the essential aspects of the diagnostics. In clinically uncertain cases and for monitoring, an objectification of the findings using instrument-based techniques is increasingly required. Nowadays, invasive needle pressure measurement is available; however, due to limited reliability, specificity and sensitivity, these measurements only represent an aid to decision guidance supporting or advising against the indications for dermatofasciotomy. The increasing demands on making a certain diagnosis and justification of a surgical intervention from a legal point of view, substantiate the numerous scientific efforts to develop noninvasive instrument-based diagnostics. These methods are based either on detection of increasing intracompartmental pressure or decreasing perfusion pressure and microcirculation. The various measurement principles are summarized in a lucid form.


Asunto(s)
Síndromes Compartimentales , Humanos , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/fisiopatología , Enfermedad Aguda , Microcirculación/fisiología , Fasciotomía/métodos
10.
Chirurgie (Heidelb) ; 95(7): 526-528, 2024 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-38777912

RESUMEN

The positioning-related compartment syndrome is a well-known rare but absolutely avoidable event and is therefore often the subject of legal disputes. That is why medical personnel need to have detailed knowledge of the causes, pathophysiology, treatment and above all prevention.


Asunto(s)
Síndromes Compartimentales , Posicionamiento del Paciente , Humanos , Síndromes Compartimentales/etiología , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/cirugía , Síndromes Compartimentales/fisiopatología , Posicionamiento del Paciente/efectos adversos
11.
Chirurgie (Heidelb) ; 95(7): 513-519, 2024 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-38634918

RESUMEN

Even after the endovascular revolution, acute compartment syndrome (CS) remains an important and frequently present differential diagnosis after many operations. Based on a qualitative review this article gives an overview of the most frequent forms of CS as well as some less frequent entities that require attention in the routine clinical practice. Additionally, the pathophysiology, diagnostics and treatment as well as current research topics for CS, especially concerning the lower leg, are dealt with in detail. In summary, nothing has essentially changed ever since the first description of CS in that the clinical estimation remains the gold standard. The detection and the adequate treatment especially of abdominal CS and CS of the lower leg remain a key competence of vascular surgeons.


Asunto(s)
Síndromes Compartimentales , Isquemia , Procedimientos Quirúrgicos Vasculares , Humanos , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/etiología , Síndromes Compartimentales/fisiopatología , Síndromes Compartimentales/cirugía , Procedimientos Quirúrgicos Vasculares/efectos adversos , Isquemia/etiología , Isquemia/diagnóstico , Isquemia/cirugía , Pierna/irrigación sanguínea , Pierna/cirugía , Complicaciones Posoperatorias/etiología , Diagnóstico Diferencial
12.
Sci Rep ; 11(1): 21891, 2021 11 08.
Artículo en Inglés | MEDLINE | ID: mdl-34750470

RESUMEN

Compartment syndrome (CS) is a pathological event caused by elevated intracompartmental pressure (ICP); however, changes from the onset of inducing atraumatic CS remained unclear. The study aimed to investigate the physiological changes in a newly developed in vivo porcine acute atraumatic CS model. CS was induced by ischemia-reperfusion injury in the left hind leg of fourteen pigs divided into an echogenicity group (EG) and a shear wave elastography group (SEG). Echogenicity was measured in EG, and shear elastic modulus (SEM) was measured in SEG seven times before, at the onset of inducing CS, and every 30 min after the onset over eight hours. Simultaneously, ICP, blood pressure, and muscle perfusion pressure (MPP) were also measured in both groups. Our results indicate that SEM of the experimental leg in SEG significantly increased as CS developed compared to the control leg (p = 0.027), but no statistical difference in the echogenicity in EG was found between the experimental leg and control leg. There were also significant correlations between SEM and ICP (p < 0.001) and ICP and MPP (p < 0.001). Our method and findings can be a basis to develop a non-invasive diagnostic tool using a shear wave elastography for atraumatic CS.


Asunto(s)
Síndromes Compartimentales/diagnóstico por imagen , Diagnóstico por Imagen de Elasticidad/métodos , Animales , Síndromes Compartimentales/etiología , Síndromes Compartimentales/fisiopatología , Modelos Animales de Enfermedad , Módulo de Elasticidad/fisiología , Extremidades/diagnóstico por imagen , Humanos , Masculino , Sus scrofa
14.
Am J Emerg Med ; 49: 273-275, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34174777

RESUMEN

Hematological malignancies rarely present with spontaneous haematomas (Lakhotia et al., 2015 [1]). Although cutaneous and mucous membrane bleeds do occur in chronic myeloid leukemia (CML) due to quantitative or qualitative platelet abnormalities, deep soft tissue bleeds are rare (Lakhotia et al., 2015 [1]). We report the case of a 49 year old man presenting with an acute hematoma of the left biceps brachii causing compartment syndrome of his left upper limb leading to flaccid paralysis. He underwent surgical evacuation of the hematoma and investigations revealed that he had CML with leukemic infiltration in the biceps brachii.


Asunto(s)
Leucemia Mielógena Crónica BCR-ABL Positiva/complicaciones , Extremidad Superior/fisiopatología , Síndromes Compartimentales/complicaciones , Síndromes Compartimentales/fisiopatología , Diagnóstico Diferencial , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/fisiopatología , Masculino , Persona de Mediana Edad , Extremidad Superior/inervación
15.
J Med Case Rep ; 15(1): 100, 2021 Mar 03.
Artículo en Inglés | MEDLINE | ID: mdl-33653379

RESUMEN

BACKGROUND: Acutely painful lower limb is a common presentation to the emergency department, and acute compartment syndrome is an important differential diagnosis to consider given the correct predisposing history and clinical presentation. However, idiopathic spontaneous compartment syndrome is an uncommon occurrence. CASE PRESENTATION: A 54-year-old Caucasian man with no previous comorbidities presented with acute right-sided lower limb pain with classical symptoms showing gradual evolution. He had no other history of medical relevance and no preceding injury. Examination showed a marginally enlarged right lower limb with stretched skin and tenderness. Routine blood tests were normal including D-dimer levels. However, in the absence of any underlying risk factors, acute compartment syndrome was suspected on clinical merit and confirmed with magnetic resonance imaging. He underwent successful surgical intervention with fasciotomy and achieved good recovery. DISCUSSION: Acute compartment syndrome, though commonly attributed to trauma, can occur due to varied causes. Spontaneous acute compartment syndrome is attributed to diabetes mellitus. Idiopathic acute spontaneous compartment syndrome occurs in the absence of either intrinsic or extrinsic risk factors and is rarely documented in the literature. This case highlights the importance of appreciating classical clinical signs and having the clinical acumen to consider an obvious diagnosis even in its rarer form of presentation.


Asunto(s)
Síndromes Compartimentales/diagnóstico por imagen , Hipoestesia/fisiopatología , Dolor/fisiopatología , Síndromes Compartimentales/fisiopatología , Síndromes Compartimentales/cirugía , Fasciotomía , Humanos , Pierna , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad
16.
Clin Toxicol (Phila) ; 59(9): 794-800, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33605805

RESUMEN

BACKGROUND: The incidence of acute compartment syndrome (ACS) following snakebite envenomation may be seriously overestimated in Taiwan. Snakebite-induced ACS is difficult to determine solely by clinical examination. Snakebite patients previously underwent surgical intervention based on speculation and general clinical examinations suggesting ACS presentations instead of direct intracompartmental pressure (IP) measurement prior to fasciotomy. Point-of-care ultrasound (POCUS) is a relatively widely available noninvasive tool. This study aimed to evaluate snakebite-envenomated patients for the presence of subcutaneous edema and diastolic retrograde arterial flow (DRAF). MATERIALS AND METHODS: Snakebite patients were prospectively recruited between 2017 and 2019. All patients were examined with POCUS to locate edema and directly visualize and measure the arterial flow in the compressed artery. The presence of DRAF in the compressed artery is suggestive of ACS development because when compartment space restriction occurs, increased retrograde arterial flow is observed in the artery. RESULTS: Twenty-seven snakebite patients were analyzed. Seventeen patients (63%) were bitten by Crotalinae snakes, seven (26%) by Colubridae, one (4%) by Elapidae, and two (7%) had unidentified snakebites. All Crotalinae bit patients received antivenom, had subcutaneous edema and lacked DRAF in a POCUS examination series. DISCUSSION: POCUS facilitates clinical decisions for snakebite envenomation. We also highlighted that the anatomic site of the snakebite is an important factor affecting the prognosis of the wounds. There were limitations of this study, including a small number of patients and no comparison with the generally accepted invasive evaluation for ACS. CONCLUSIONS: We are unable to state that POCUS is a valid surrogate measurement of ACS from this study but see this as a starting point to develop further research in this area. Further study will be needed to better define the utility of POCUS in patients envenomated by snakes throughout the world.


Asunto(s)
Antivenenos/uso terapéutico , Síndromes Compartimentales/diagnóstico , Edema/diagnóstico , Pruebas en el Punto de Atención/normas , Guías de Práctica Clínica como Asunto , Mordeduras de Serpientes/diagnóstico , Mordeduras de Serpientes/tratamiento farmacológico , Ultrasonografía/normas , Animales , Toma de Decisiones Clínicas , Síndromes Compartimentales/fisiopatología , Edema/fisiopatología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Proyectos Piloto , Mordeduras de Serpientes/epidemiología , Mordeduras de Serpientes/fisiopatología , Taiwán/epidemiología
18.
Arch Orthop Trauma Surg ; 141(2): 253-259, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32474698

RESUMEN

INTRODUCTION: Established multiple compartments syndrome of the leg (EMCSL) is defined as permanent ischemic lesions of muscles and nerves of the compartment, leading to multiple muscle contractions, muscle weakness and wasting and reduced limb sensation. The leg is seriously affected and the patient is unable to return to prior activities. The objective of this research is to quantify long-term consequences, morbidity and socioeconomic impact of established multiple compartments syndrome of the leg MATERIALS AND METHODS: 28 patients suffering from complications from EMCSL were referred to our clinic for secondary management between January 2012 and April 2016 and were followed for mean 41.4 months. Reconstructive procedures to address multiple conditions following established tibia compartment syndrome were performed. The number of reconstructive procedures, days of hospitalization, relationship, educational and employment status per patient were recorded. Preop and postop SF-12 score at final follow-up was documented for the 21 patients who were operated on. RESULTS: A median of three reconstructive procedures was performed per patient for 21 patients. The hospitalization period ranged from 6 to 365 days, with a mean period of 47.5 days (SD 71.4). At the final follow-up, 19 patients had lost their occupation, 3 patients had returned to lighter manual labor, 5 patients had lost two school years, and 1 patient had abandoned school. At the time of injury, 24 patients were single. At final follow-up, 19 of these patients, with a mean age of 38.5 years, were still single. Preoperative and postoperative (at final follow-up) physical and mental components of the SF-12 score had a statistically significant difference (p < 0.001), but final values were not normal. CONCLUSIONS: Despite advancements in surgical reconstructive intervention, patients with established compartment tibia syndrome experience permanent grave residual disability with personal and social implications.


Asunto(s)
Síndromes Compartimentales , Pierna/fisiopatología , Adulto , Síndromes Compartimentales/complicaciones , Síndromes Compartimentales/fisiopatología , Síndromes Compartimentales/cirugía , Humanos , Procedimientos de Cirugía Plástica , Reinserción al Trabajo
19.
Chin J Traumatol ; 24(2): 109-112, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33288404

RESUMEN

PURPOSE: Impending compartment syndrome is a common event following closed tibia fractures, which can progress to sinister compartment syndrome. Fasciotomy is the only definitive treatment available, though it has its own drawbacks and complications. Medical management at present consists of limb elevation and adequate hydration. This study aims at determining whether intravenous administration of Mannitol reduced the intracompartmental pressure in patients with closed tibial fractures. METHODS: This is a double blinded, randomized control trial done in a single tertiary care center in India. Forty-five patients were recruited between February 2012 and October 2012. Forty patients who presented to the emergency department with isolated, closed, high velocity, and proximal 2/3 tibia fractures were included in this study. Patients with contraindication to Mannitol were excluded. They were allocated into 2 groups by the investigator using computer generated randomization. The pressure in the anterior compartment of the leg was measured with a handheld Stryker pressure monitor. Then either 20% Mannitol or 0.9% normal saline as given intravenously in a blinded manner, based on the randomization. The intracompartmental pressure was measured at 0, 1 and 3 h after the infusion. The participant, investigator and statistician were masked to the group assessment. RESULTS: There was no difference in intracompartmental pressures at 1 or 3 h, between the groups. However, in patients with the baseline of compartmental pressures ≥30 mmHg, Mannitol showed a marked reduction in pressure of 8.5 mmHg at 1 h compared to almost no change in pressure in the saline group. There were no adverse events with the use of Mannitol. CONCLUSIONS: This preliminary study appears to show that Mannitol is useful in the management of the increased compartment pressure. The limitations of this study were that it only involved a small group of patients and the baseline pressures in both the groups were not comparable. More studies are required before the use of Mannitol as a standard of care in the management of compartment syndrome can be established.


Asunto(s)
Síndromes Compartimentales/tratamiento farmacológico , Síndromes Compartimentales/etiología , Fracturas Óseas/complicaciones , Fracturas Cerradas/complicaciones , Manitol/administración & dosificación , Presión , Tibia/lesiones , Administración Intravenosa , Adolescente , Adulto , Anciano , Síndromes Compartimentales/fisiopatología , Femenino , Fracturas Óseas/fisiopatología , Fracturas Cerradas/fisiopatología , Humanos , Pierna/fisiopatología , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven
20.
JAMA Ophthalmol ; 139(1): 109-112, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33211075

RESUMEN

Importance: Critically ill patients with coronavirus disease 2019 (COVID-19) who are unresponsive to maximum optimal ventilator settings may be in a prone position for at least 16 hours per day to improve oxygenation. This extended duration of prone positioning puts patients at risk of developing orbital compartment syndrome if direct pressure to the orbit and the globe occurs and concomitant protection of the eyes is not undertaken. Objective: To report 2 cases of orbital compartment syndrome, as well as optic disc edema and retinal hemorrhages, in the setting of prolonged prone positioning of patients in the intensive care unit during the COVID-19 pandemic. Design, Setting, and Participants: The cases took place from April 27, 2020, to May 4, 2020, at a COVID-19 intensive care unit of a tertiary care hospital. Four of 16 patients in the intensive care unit required prolonged prone-position ventilation. A bedside eye examination was performed on 4 selected patients due to the observed presence of substantial periorbital edema. Main Outcomes and Measures: Intraocular pressures and fundus findings of 4 patients with periorbital edema. Results: Two of 4 patients who were in the prone position for extended periods of time had bilateral fundoscopic findings of optic disc edema and retinal hemorrhages, possibly consistent with a papillophlebitis. Additionally, both patients had a substantial increase in intraocular pressure of 2- to 3-fold in the prone position compared with the supine position. Conclusions and Relevance: Prolonged prone positioning of patients with COVID-19 can be associated with elevated intraocular pressure from periorbital edema, direct compression on the eye, and increased orbital venous pressure. Orbital compartment syndrome can be avoided by the use of protective cushioning around the eyes and maintaining the patient's head position above heart level during prone positioning. Patients with COVID-19 may also develop papillophlebitis with optic disc edema and retinal hemorrhages, which may be associated with a hypercoagulable state caused by COVID-19. These observations suggest awareness for the possible presence of these ophthalmic findings while treating severely ill patients with COVID-19.


Asunto(s)
COVID-19/terapia , Síndromes Compartimentales/prevención & control , Dispositivos de Protección de los Ojos , Presión Intraocular , Enfermedades Orbitales/prevención & control , Posicionamiento del Paciente/efectos adversos , Posición Prona , Respiración Artificial , Adulto , COVID-19/diagnóstico , COVID-19/fisiopatología , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/etiología , Síndromes Compartimentales/fisiopatología , Enfermedad Crítica , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/etiología , Enfermedades Orbitales/fisiopatología , Factores de Tiempo , Resultado del Tratamiento
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