RESUMO
OBJECTIVES: To determine the impact of acute compartment syndrome (ACS) and identify cost drivers of 1-year total treatment costs for operative tibial plateau fractures. DESIGN: Retrospective review. SETTING: Level 1 trauma center. PATIENTS: 337 patients with tibial plateau fractures, 24 of which were complicated by ACS. OUTCOMES: The primary outcome was total treatment cost over the first year for operatively treated tibial plateau fractures. The secondary objective was to use regression analysis to identify significant cost drivers. RESULTS: The diagnosis of ACS was associated with 2.85 times higher total treatment cost ( P < 0.001). ACS demonstrated increased total treatment cost when controlling for polytrauma ( P < 0.001) and postoperative infection ( P < 0.001). Regression analysis identified 5 variables significantly associated with total cost of care: body mass index, injury severity score, ACS, staged external fixation, and locking fixation ( P < 0.001; R 2 = 0.57). The diagnosis of ACS had the largest impact on total cost with a 3.5× greater impact on cost compared with the next highest variable, staged external fixation. CONCLUSIONS: Tibial plateau fractures complicated by ACS are associated with 2.85 times higher treatment costs over a 1-year period. There were 5 significant variables identified by regression analysis with ACS having the highest impact on total treatment. Together, these 5 factors account for 57% of treatment cost variability. LEVEL OF EVIDENCE: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Síndromes Compartimentais , Fraturas da Tíbia , Fraturas do Planalto Tibial , Humanos , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Fixação Interna de Fraturas/efeitos adversos , Fraturas da Tíbia/complicações , Fraturas da Tíbia/cirurgia , Resultado do TratamentoRESUMO
SUMMARY: Acute limb compartment syndrome can occur with cytotoxic snake envenomation. Ultrasound (US) assessment of the affected limb has been suggested as an adjunct to the administration of snakebite polyvalent antivenom to ameliorate the systemic and local effects. US may also aid in the diagnosis of compartment syndrome and the need for fasciotomy to prevent limb loss. This report presents an adult male who had severe soft tissue swelling from a puff adder bite to the wrist and highlights the use of US in assessing and monitoring the degree of swelling in subcutaneous and fascial compartments of the arm. This US monitoring in conjunction with frequent physical examination avoided the need for a fasciotomy and its attendant morbidity, resulting in complete resolution of the swelling and full recovery of limb function.
Assuntos
Síndromes Compartimentais , Mordeduras de Serpentes , Masculino , Humanos , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/terapia , Fasciotomia , Sistemas Automatizados de Assistência Junto ao Leito , Antivenenos/uso terapêutico , Síndromes Compartimentais/diagnóstico por imagem , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgiaRESUMO
BACKGROUND AND PURPOSE: Proximal tibial fractures are infrequent injuries in children, and the literature on epidemiology, associated injuries, and management is limited. We calculated a population-based incidence and described the characteristics of proximal tibial fractures in children in terms of complications and management. PATIENTS AND METHODS: This is a retrospective study over a 6-year-period during including 241 children with proximal tibial fractures who presented to our university hospital. Demographic and fracture-related data was collected from the Kids' Fracture Tool. The number of children during the study period was collected from statistical yearbooks of the City of Helsinki to estimate annual incidence. RESULTS: Extra-articular fractures (129/241) peaked at the age of 3 and tibial tubercle (42/241) and intra-articular fractures (70/241) peaked at the age of 15. Annual incidences were estimated to be 3.4/100,000 children and 22/100,000 children in the age group of 13-16 years for ACL avulsions, and 3.8/100,000 children and 21/100,000 children in the age group of 13-16 years for tibial tubercle fractures. The incidence of vascular compromise (0%) and compartment syndrome was low (0.4 %, 1/241). CONCLUSION: Proximal tibial fractures present with a bimodal distribution, with extra-articular fractures peaking at the age of 3 years and fractures of the tibial tuberosity and intra-articular fractures peaking at the age of 15 years. Additionally, associated compartment syndrome and vascular compromise was not as common as previously reported.
Assuntos
Síndromes Compartimentais , Fraturas Intra-Articulares , Fraturas da Tíbia , Humanos , Adolescente , Criança , Pré-Escolar , Fraturas da Tíbia/epidemiologia , Fraturas da Tíbia/cirurgia , Fraturas Intra-Articulares/etiologia , Tíbia , Fixação Interna de Fraturas/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Síndromes Compartimentais/etiologiaRESUMO
BACKGROUND: In an effort to increase health care value, there has been a recent focus on the transition of traditionally inpatient procedures to an outpatient setting. We hypothesized that in the treatment of Gartland extension type II supracondylar humerus fractures (SCHF), outpatient surgery can be performed safely and with similar clinical and radiographic outcomes compared with urgent inpatient treatment with an overall reduction in cost. METHODS: We compared a prospective cohort of Gartland type II SCHF treated primarily as outpatients (postprotocol) to a retrospective cohort treated primarily as urgent inpatients (preprotocol), excluding patients with preoperative neurovascular injury, open fracture, additional ipsilateral upper extremity fracture, and prior ipsilateral SCHF. Inpatient versus outpatient treatment was also compared. Outcomes including perioperative factors, complications, readmission, reoperation, postoperative radiographic measurements, and direct hospital costs underwent univariate and multivariate analyses. RESULTS: A total of 220 patients in the postprotocol cohort (88 inpatients and 132 outpatients) and 129 in the preprotocol cohort (97 inpatients and 32 outpatients) were analyzed. There were no differences in operative times, number of pins, conversion to open reductions, readmissions, or reoperations between cohorts or groups, and no cases developed postoperative neurovascular injuries or compartment syndromes. Total complications did not differ between the preprotocol and postprotocol cohorts; however, were higher in the inpatient group (3.8% vs. 0%; P=0.016) in the univariate, but not multivariate analysis. There were no differences in Baumann angle or humerocondylar angle. Significantly more inpatients' anterior humeral line fell outside of the middle third of the capitellum in the univariate, but not multivariate analysis. There were significant reductions in total cost per patient between the preprotocol and postprotocol cohorts (marginal effect, -$215; P<0.0001) and between the inpatient and outpatient groups (marginal effect, -$444; P<0.0001). CONCLUSIONS: Delayed treatment of Gartland type II SCHF in the outpatient setting can be performed safely and with similar clinical and radiographic outcomes to those treated urgently as inpatients with a significant cost reduction. LEVEL OF EVIDENCE: Therapeutic level III-retrospective comparative study.
Assuntos
Assistência Ambulatorial/economia , Procedimentos Cirúrgicos Ambulatórios/economia , Hospitalização/economia , Fraturas do Úmero/economia , Fraturas do Úmero/cirurgia , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Pinos Ortopédicos , Criança , Pré-Escolar , Síndromes Compartimentais/etiologia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Fraturas do Úmero/diagnóstico por imagem , Masculino , Redução Aberta/efeitos adversos , Estudos Prospectivos , Reoperação , Estudos Retrospectivos , Tempo para o Tratamento , Resultado do TratamentoRESUMO
BACKGROUND: Because acute compartment syndrome is one of the few limb-threatening and life-threatening orthopaedic conditions and is difficult to diagnose, it is a frequent source of litigation. Understanding the factors that lead to plaintiff verdicts and higher indemnity payments may improve patient care by identifying common pitfalls. METHODS: The VerdictSearch legal claims database was queried for the term "compartment syndrome." After 46 cases were excluded for missing information or irrelevancy, 139 cases were reviewed. The effects of plaintiff demographics, mechanism of injury, and complications were assessed. RESULTS: Of 139 cases, 37 (27%) were settled, 69 (50%) resulted in a defendant ruling, and 33 (24%) resulted in a plaintiff ruling. Juries were more likely to rule in favor of juvenile plaintiffs than adult patients (P = 0.002) and female plaintiffs than male plaintiffs (P = 0.008), but indemnity payments were not affected by the age or sex of the plaintiff. Plaintiffs who experienced acute compartment syndrome as a complication of surgery were more likely to win their suit and receive higher awards (P < 0.05), compared with those in whom the condition developed as a result of trauma. Amputation or delay in diagnosis or treatment did not affect plaintiff verdicts or awards. CONCLUSION: Defendants were more likely to lose a lawsuit concerning the management of acute compartment syndrome if the patient was a woman or child or if acute compartment syndrome developed as a complication of a surgical procedure.
Assuntos
Síndromes Compartimentais/etiologia , Imperícia/estatística & dados numéricos , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adolescente , Adulto , Fatores Etários , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/economia , Síndromes Compartimentais/terapia , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Masculino , Imperícia/economia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/terapia , Fatores SexuaisRESUMO
Electrical injuries and especially those of high voltage still remain a source of high morbidity. Over the past few years, a change in the epidemiologic profile of these lesions was noticed at the Vall d'Hebron University Hospital Burn Unit, corresponding to an increase in cases out of the legal framework. It is our aim to describe this particular subset, to determine the extent of their injuries and to understand the reason for their increased incidence. We think this was favoured by the rise in the unemployment rate, along with higher copper prices.
Assuntos
Acidentes Domésticos/estatística & dados numéricos , Queimaduras por Corrente Elétrica/epidemiologia , Recessão Econômica , Traumatismos Ocupacionais/epidemiologia , Roubo/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação Cirúrgica , Queimaduras por Corrente Elétrica/complicações , Queimaduras por Corrente Elétrica/cirurgia , Criança , Pré-Escolar , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Cobre , Desbridamento , Fasciotomia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Transplante de Pele , Espanha/epidemiologia , Desemprego/estatística & dados numéricos , Adulto JovemRESUMO
OBJECTIVES: To quantify the impact of compartment syndrome in the setting of tibial shaft fracture on hospital length of stay (LOS) and total hospital charges. DESIGN: Retrospective case-control study. SETTING: All New York State hospital admissions from 2001 to 2011, as recorded by the New York Statewide Planning and Research Cooperative System database. PATIENTS: Thirty three thousand six hundred twenty-nine inpatients with isolated open or closed fractures of the tibia and/or fibula (AO/OTA 41-43). Six hundred ninety-two patients developed a compartment syndrome in the setting of tibia fracture. All patients were filtered to ensure none had other complications or medical comorbidities that would increase LOS or total hospital charges. INTERVENTION: Fasciotomy and delayed closure in patients who developed a compartment syndrome. MAIN OUTCOME MEASURE: Hospital LOS (days) and total inflation-adjusted hospital charges. RESULTS: A total of 33,629 patients with tibial shaft fracture were included in the study. There were 32,937 patients who did not develop a compartment syndrome. For this group, the mean LOS was 6 days, and the mean inflation-adjusted hospital charges were $34,000. Patients who developed compartment syndrome remained in-house for an average of 14 days with average charges totaling $79,000. These differences were highly significant for both lengths of stay and hospital charges (P < 0.001). CONCLUSIONS: Besides the obvious physical detriment experienced by patients with compartment syndrome, there is also a significant economic impact to the healthcare system. Compartment syndrome after a tibial fracture more than doubles LOS and total hospital charges. These findings highlight the need for a standardized care algorithm aimed toward efficiently and adequately treating acute compartment syndrome. Such an algorithm would optimize cost of care and presumably decrease LOS. LEVEL OF EVIDENCE: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Síndromes Compartimentais/etiologia , Procedimentos Cirúrgicos Dermatológicos/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Tempo de Internação/economia , Procedimentos Ortopédicos/economia , Fraturas da Tíbia/complicações , Algoritmos , Estudos de Casos e Controles , Síndromes Compartimentais/cirurgia , Procedimentos Cirúrgicos Dermatológicos/métodos , Fasciotomia , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/métodos , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Fraturas da Tíbia/cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Acute compartment syndrome (ACS) is a clinical condition with potentially dramatic consequences, therefore, it is important to recognise and treat it early. Good management of ACS minimises or avoids the sequelae associated with a late diagnosis, and may also reduce the risk of malpractice claims. The aim of this article was to evaluate different errors ascribed to the surgeon and to identify how the damage was evaluated. MATERIALS AND METHODS: A total of 66 completed and closed ACS cases were selected. The following were analysed for each case: clinical management before and after diagnosis of ACS, imputed errors, professional fault, damage evaluation and quantification. Particular attention was paid to distinguishing between impairment because of primary injury and iatrogenic impairment. Statistical analyses were performed using Fisher's exact test and Pearson's correlation. RESULTS: The most common presenting symptom was pain. Delay in the diagnosis, and hence delay in decompression, was common in the study. A total of 48 out of 66 cases resolved with the verdict of iatrogenic damage, which varied from 12% to 75% of global capability of the person. A total of $394,780 out of $574,680 (average payment) derived from a medical error. CONCLUSIONS: ACS is a clinical emergency that requires continuous clinical surveillance from both medical and nursing staff. The related damage should be evaluated in two parts: damage deriving from the trauma, so that it is considered inevitable and independent from the surgeon's conduct, and damage deriving from a surgeon's error, which is eligible for an indemnity payment.
Assuntos
Síndromes Compartimentais/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Doença Iatrogênica/economia , Seguro de Responsabilidade Civil/estatística & dados numéricos , Erros Médicos/economia , Procedimentos Ortopédicos/estatística & dados numéricos , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Síndromes Compartimentais/epidemiologia , Síndromes Compartimentais/etiologia , Diagnóstico Tardio/economia , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes , Humanos , Doença Iatrogênica/epidemiologia , Revisão da Utilização de Seguros/estatística & dados numéricos , Seguro de Responsabilidade Civil/economia , Itália/epidemiologia , Masculino , Erros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de TempoRESUMO
BACKGROUND AND PURPOSE: Because of recent advances in minimally invasive surgical techniques, robot-assisted radical prostatectomy (RARP) has become the primary treatment option in prostate cancer. RARP, however, necessitates patients to be placed in a steep Trendelenberg position, which presents multiple opportunities for complications relating to the positioning of the patient. Our study aims to study the prevalence and demographic predictors of these positioning complications and assess their impacts on length of stay (LOS) and total cost. PATIENTS AND METHODS: We included patients who underwent RP from 2008 to 2009 using data extracted from the Nationwide Inpatient Sample database. Positioning complications (eye, nerve, compartment syndrome/rhabdomyolysis) were identified using patient-level diagnosis and procedural International Classification of Disease, 9th edition, Clinical Modification codes. Logistic regression models assessed relationships between demographic factors and occurrence of complications and the effects of them on prolonged LOS and total inpatient cost. RESULTS: Positioning complications occurred in 0.4% of cases with eye complications contributing the most to this frequency. Laparoscopic RP procedure (odds ratio [OR]=2.88, P<0.01) and comorbidities (OR=2.34, P<0.01) were highly associated with increased odds of positioning complication occurrence, whereas RARP procedures (OR=0.93, P>0.4) were not associated with positioning complications. Having positioning complications increased a patient's odds of having increased inpatient costs and extended LOS by almost 400% and 300%, respectively. CONCLUSION: The steep Trendelenberg position used in RARP was not shown to be associated with patient positioning-related complications in this sample. The occurrence of positioning-related complications, however, places huge burdens on total inpatient costs and LOS.
Assuntos
Decúbito Inclinado com Rebaixamento da Cabeça/efeitos adversos , Tempo de Internação/economia , Posicionamento do Paciente/efeitos adversos , Prostatectomia/métodos , Idoso , Síndromes Compartimentais/etiologia , Bases de Dados Factuais , Oftalmopatias/etiologia , Humanos , Laparoscopia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Posicionamento do Paciente/estatística & dados numéricos , Prostatectomia/economia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Rabdomiólise/etiologiaAssuntos
Fraturas Expostas/cirurgia , Traumatismos da Perna/cirurgia , Padrões de Prática Médica , Lesões do Sistema Vascular/cirurgia , Adulto , Idoso , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/cirurgia , Diagnóstico Tardio , Emergências , Fraturas do Colo Femoral/diagnóstico , Fraturas do Colo Femoral/cirurgia , Fraturas Expostas/complicações , Fraturas Expostas/diagnóstico , Humanos , Traumatismos da Perna/complicações , Traumatismos da Perna/diagnóstico , Responsabilidade Legal , Imperícia/legislação & jurisprudência , Pessoa de Meia-Idade , Ordens quanto à Conduta (Ética Médica) , Gestão de Riscos , Tálus/lesões , Tálus/cirurgia , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/etiologiaRESUMO
OMS National Insurance Company insures over 4700 oral and maxillofacial surgeons, 83% of the fellows and members of the American Association of Oral and Maxillofacial Surgeons. The company has over 10,000 closed malpractice claims involving oral and maxillofacial surgeons. Data and trends involving infections that developed following elective surgical procedures and trends involving patients with preexisting odontogenic infections with adverse outcomes are well known to the company. Seven percent of the 10,000+ closed claims involve infections. Recognition and diagnosis of the infection leads to appropriate and timely treatment of infections. Delayed recognition, consultation, and referral leads to delay in the institution of appropriate treatment and can lead to adverse outcomes.
Assuntos
Imperícia/legislação & jurisprudência , Procedimentos Cirúrgicos Bucais/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Adolescente , Adulto , Causas de Morte , Síndromes Compartimentais/etiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Fasciite Necrosante/etiologia , Feminino , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Doenças Mandibulares/etiologia , Pessoa de Meia-Idade , Osteomielite/etiologia , Choque Séptico/etiologia , Infecções Estreptocócicas/etiologia , Streptococcus pyogenes/fisiologia , Extração Dentária/efeitos adversos , Estados Unidos , Adulto JovemRESUMO
Each year, British Columbia's Health Care Protection Program reviews up to 20 reported cases of compartment syndrome. This article summarizes some of the key learnings from a review of those reported incidents. Hospital staff who care for orthopedic trauma patients need to be vigilant to the signs and symptoms of compartment syndrome and they must document their findings and interventions. Early intervention can prevent further serious harm to patients who most often have already suffered trauma in a sports or motor vehicle accident.
Assuntos
Síndromes Compartimentais/enfermagem , Doenças Musculoesqueléticas/complicações , Gestão de Riscos , Ferimentos e Lesões/complicações , Plantão Médico , Síndromes Compartimentais/etiologia , Diagnóstico Precoce , Humanos , Avaliação em Enfermagem , Ortopedia , Relações Médico-EnfermeiroRESUMO
BACKGROUND: To survey surgeon opinion regarding the management of the open abdomen (OA) and abdominal compartment syndrome (ACS) to assess current practice and direct future prospective clinical studies. METHODS: Opinions of self-designated trauma, general, pediatric, and vascular surgeons belonging to the Trauma Association of Canada (TAC), were surveyed through a mixed-mode (mail and Web based) questionnaire. RESULTS: Among 102 eligible candidates, 86 (84%) responded; 83% did regular trauma call, 45% regular critical care call being a separate call 79% of the time; 79% worked in centers serving >500,000 people; the median year of practice entry was 1997. There was no standard definition of what constituted an "open abdomen", preferred time for re-operation, or preferred method for alternate fascial closure, although 90% reported having not closing the fascia after a trauma laparotomy. Being "physically unable" was reported as an indication twice as often as objective measures of airway or bladder pressures. The decision to proceed with OA was reported as rarely or never being made preoperatively by 78% of respondents. None reported an institutional policy regarding OA. Eighty-four percent reported (re)opening an abdomen for primary ACS, 46% for secondary ACS, 28% for tertiary ACS. Self-assessed familiarity for the ACS was 6/7 on a Likert scale. Physical examination was reported as a diagnostic criterion for ACS by 66%, and used to screen by 21% of respondents. CONCLUSIONS: There is no consensus regarding definition, functional indications, or management of an open abdomen in the perceptions of Canadian trauma providers despite a high self reported level of familiarity with the abdominal compartment syndrome. This is an area of practice with potential and requirements for further multi-center study.
Assuntos
Abdome/cirurgia , Atitude do Pessoal de Saúde , Síndromes Compartimentais , Laparotomia/métodos , Médicos/psicologia , Traumatologia/métodos , Canadá , Competência Clínica/normas , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/prevenção & controle , Tomada de Decisões , Fasciotomia , Previsões , Necessidades e Demandas de Serviços de Saúde , Humanos , Laparotomia/efeitos adversos , Laparotomia/educação , Laparotomia/estatística & dados numéricos , Programas de Rastreamento , Seleção de Pacientes , Exame Físico , Médicos/organização & administração , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Recidiva , Reoperação , Autoeficácia , Sociedades Médicas , Telas Cirúrgicas , Inquéritos e Questionários , Técnicas de Sutura , Fatores de Tempo , Traumatologia/educação , Traumatologia/estatística & dados numéricosRESUMO
We present a case of compartment syndrome after electromyographic study of the upper limbs. The cause was the unintentional punction and laceration of the ulnar artery while the electromyography was being performed.
Assuntos
Síndromes Compartimentais/etiologia , Eletromiografia/efeitos adversos , Adulto , Feminino , Antebraço , HumanosAssuntos
Síndromes Compartimentais/prevenção & controle , Traumatismos da Perna/complicações , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/terapia , Fraturas Ósseas/complicações , Hospitalização , Humanos , Programas de Assistência GerenciadaRESUMO
The purpose of this study was to objectively evaluate the risk of compartment syndrome as a complication during arthroscopy, particularly with the use of mechanical infusion systems. Little experimental data are available. This study shows that when elevated compartment pressures occur, extravasated fluid dissipates quickly, minimizing the risk of compartment syndrome and subsequent neuromuscular damage. Twelve live pig hind limbs (six swine) were used. Three additional limbs were used as shams. After anesthesia and portal placement for mechanical fluid infusion, two standardized capsulotomies were created to allow free extravasation of fluid. We dynamically monitored intraarticular pressure, and intracompartmental pressure in the anterior (leg), deep posterior (leg), and quadriceps (thigh) compartments. Nerve conduction studies were performed on the tibial and peroneal nerves. Data collection began at the onset of fluid infusion and continued after infusion ceased until elevated compartment pressures fell below 20 mm Hg. There were two study variables: intraarticular pressure (100, 150, or 200 mm Hg) and time of fluid ingress (30, 60, or 90 minutes). Following this, the swine were evaluated serially for 13 to 16 days. Repeat nerve conduction studies, muscle biopsies (in the three previously mentioned compartments), and electromyography were performed 13 to 16 days following the operation. Maximum compartment pressures during fluid infusion averaged 78.75 mm Hg. Significant variability existed when comparing the interrelationships of infusion time, maximum compartment pressures, time of resolution of elevated pressures, and intraarticular pressures. Most importantly, elevated compartment pressures resolved quickly (mean, 25.5 minutes; range, 0 to 100 minutes; n = 36 compartments) when stopping fluid infusion. Nerve conduction studies were normal on all postoperative studies. Electromyographic (EMG) analysis showed normal study results in the biceps, gracilis, abductor digiti quinti, and adductor digiti segundi. Although EMG analysis of the tibialis anterior and extensor digitorum brevis showed 1+ fibrillation (1+ to 4+ scale), this was seen in sham studies with tourniquet alone (no fluid infusion). Muscle biopsies were without evidence of myonecrosis. Finally, 5 of 6 swine ambulated without difficulty on the first postoperative day, whereas 1 swine limped for 2 days. All swine were normal by the 3rd postoperative day and also at the end of the study. These data show that in this model, the risk of developing sequela from compartment syndrome during arthroscopy is minimal, even when there exists significant fluid extravasation and elevated compartment pressures.
Assuntos
Artroscopia/efeitos adversos , Síndromes Compartimentais/etiologia , Articulação do Joelho/cirurgia , Medição de Risco , Animais , Biópsia , Síndromes Compartimentais/patologia , Síndromes Compartimentais/fisiopatologia , Eletromiografia , Feminino , Seguimentos , Articulação do Joelho/patologia , Articulação do Joelho/fisiopatologia , Condução Nervosa/fisiologia , Sistema Nervoso Periférico/fisiologia , Fatores de Risco , SuínosRESUMO
Pulse oximetry has been proposed as an aid to monitoring raised intracompartmental pressures (ICPs). ICP and percentage haemoglobin oxygen saturation in the affected limb were studied in 10 consecutive patients with raised ICP. Compartment pressures ranged from 28 to 64 mmHg (mean 40.9 mmHg). In two patients with absent pulses, pulse oximetry failed to detect pulsatile flow and recorded 0 per cent saturation. The remaining eight patients, including four with absent peripheral pulses, all had percentage haemoglobin saturations within 2 per cent of the opposite normal limb. Arterial haemoglobin desaturation was not associated with raised ICP. The presence of an oximeter signal and a normal reading does not necessarily imply adequacy of tissue perfusion. Pulse oximetry does not appear to be a reliable aid in the diagnosis or monitoring of impaired perfusion due to raised ICP.
Assuntos
Síndromes Compartimentais/diagnóstico , Oximetria , Fraturas da Tíbia/complicações , Adolescente , Adulto , Criança , Pré-Escolar , Síndromes Compartimentais/sangue , Síndromes Compartimentais/etiologia , Hemoglobinas/análise , Humanos , Lactente , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Mordeduras de Serpentes/sangue , Mordeduras de Serpentes/complicações , Fraturas da Tíbia/sangueRESUMO
Nine children with ischaemia of the forearm, associated with supracondylar fractures of the humerus, which failed to respond promptly to conservative measures, were managed by exploration of the antecubital fossa together with flexor compartment fasciotomies. The anatomic findings are described, operative procedures discussed, and clinical results reviewed. A plan of management is outlined which incorporates early surgical intervention. Results show that this is a safe and effective method of managing these injuries.