Compartment Syndrome following Intramedullary Nail Fixation in Closed Tibial Shaft Fractures.

Introduction: Compartment syndrome complicating intramedullary nailing of closed tibia fractures has been described as early as the 1980s, but currently remains less described in literature compared to compartment syndrome directly following trauma. This study aims to review this potentially disabling complication and highlight the importance of timely diagnosis and management of compartment syndrome following fracture fixation, not just after fracture itself, via a review of three cases. Material and methods: A retrospective study of a series of three cases was conducted. The type of fracture, wait time to fixation, surgery duration, reaming, size of nail implant used, tourniquet time, and surgical technique were recorded. Time to diagnosis of compartment syndrome, compartment pressure if available, extent of muscle necrosis, reconstructive procedures performed, and post-operative complications were analysed. Results: The three cases following high-energy trauma from road traffic accidents presented from January to May 2010. Compartment syndrome was diagnosed clinically for all cases, between one to six days post-operatively and supported by elevated compartment pressure measurements in two of the three cases. Conclusion: This study advocates thorough clinical monitoring and maintaining strong clinical suspicion of compartment syndrome in patients even after intramedullary nail fixation of tibial shaft fractures to achieve timely limb-salvaging intervention. While intercompartmental pressure can be used to aid in diagnosis, we do not advise using it in isolation to diagnose compartment syndrome. Tendon transfer improves functional mobility and provides a good result in patients with severe muscle damage, while skin grafting sufficient in patients with minimal muscle damage.

Gradient radial basis function networks for nonlinear and nonstationary time series prediction.

We present a method of modifying the structure of radial basis function (RBF) network to work with nonstationary series that exhibit homogeneous nonstationary behavior. In the original RBF network, the hidden node's function is to sense the trajectory of the time series and to respond when there is a strong correlation between the input pattern and the hidden node's center. This type of response, however, is highly sensitive to changes in the level and trend of the time series. To counter these effects, the hidden node's function is modified to one which detects and reacts to the gradient of the series. We call this new network the gradient RBF (GRBF) model. Single and multistep predictive performance for the Mackey-Glass chaotic time series were evaluated using the classical RBF and GRBF models. The simulation results for the series without and with a tine-varying mean confirm the superior performance of the GRBF predictor over the RBF predictor.

Oculomotor nerve palsy after functional endoscopic sinus surgery.

We report an unusual case of partial oculomotor nerve palsy occurring after functional endoscopic sinus surgery, without anatomical disruption of the extra-ocular muscles. The clinical course and possible pathogenic mechanisms are also presented.