Síndrome compartimental agudo en la baja de combate: una revisión narrativa / Acute compartment syndrome in combat casualties: a narrative review

Introducción: El síndrome compartimental agudo (SCA) es una complicación frecuente y potencialmente devastadora en las heridas de guerra que afectan a las extremidades, debido principalmente a las lesiones vasculares, óseas y de tejidos blandos frecuentemente asociadas, y a la dificultad para reevaluar a la baja durante su evacuación. El objetivo de esta revisión es analizar la evidencia científica disponible y actualizada sobre el manejo diagnóstico-terapéutico del SCA en la baja de combate.Material y métodos:Para la elaboración de este trabajo se ha realizado una búsqueda bibliográfica exhaustiva en las bases de datos: PubMed, Google Scholar, Scopus, ScienceDirect, Scielo y Latindex. Para la selección de artículos, se han establecido como criterios de inclusión que fueran realizados en entornos militares o sobre poblaciones de bajas de combate, escritos en castellano o inglés, y publicados durante los últimos quince años.Resultados y conclusiones:En el entorno operativo, el diagnóstico del SCA será fundamentalmente clínico y el tratamiento consistirá en una fasciotomía precoz y completa de todos los compartimentos del miembro afectado, ya que la fasciotomía tardía o incompleta se ha asociado con peores resultados y a un aumento de la morbimortalidad. La formación continuada en cirugía de guerra ha disminuido las tasas de fasciotomías de revisión. (AU)

Introduction: Acute compartment syndrome (ACS) is a frequent and potentially devastating complication of extremity war wounds, mainly due to the frequently associated vascular, bone and soft tissue injuries, and the limit close monitoring during casualty evacuation. The objective of this review is to analyze the available and updated scientific evidence on the diagnostic-therapeutic management of ACS in combat casualty.Material and Methods:For the preparation of this work, an exhaustive bibliographic search was carried out in the databases: PubMed, Google Scholar, Scopus, ScienceDirect, Scielo and Latindex. For the selection of articles, inclusion criteria have been established: carried out in military environments or on combat casualties populations, written in Spanish or English, and published during the last fifteen years.Results and Conclusions:In the combat zone, the diagnosis is even more heavily weighted toward clinical evaluation and the treatment will consist of a prompt and complete fasciotomy of all compartments of the affected limb, inasmuch as delayed or incomplete fasciotomy has been associated with worse outcomes and increased morbidity and mortality. Pre-deployment training of surgeons has decreased the rate of revision fasciotomies. (AU)

Periprosthetic infection in elderly patients treated with hemiarthroplasty of the hip following intracapsular fracture. Should we use antibiotic-loaded bone cement? / Infección periprótesica en pacientes ancianos tratados mediante hemiartroplastia de cadera tras fractura intracapsular. ¿Debemos usar cementación con antibiótico?

INTRODUCTION: Prosthetic infections are a potentially devastating complication, especially in elderly patients. Antibiotic-loaded bone cement has been used both as a treatment and prophylaxis in prosthetic infection, and its use is not well documented in the prophylaxis of infection in patients who have suffered a hip fracture. MATERIAL: A retrospective descriptive was performed. The data were obtained from all the patients who underwent hip hemiarthroplasty due to a subcapital fracture between 2011 and 2017 (N=241). An epidemiological study of the patients studied was carried out. We analysed the incidence of periprosthetic infection in the groups treated with cement without antibiotic and antibiotic-loaded bone cement, as well as the protective effect of the antibiotic-loaded bone cement. At the same time, a pilot cost analysis study was carried out. RESULTS: In the group that received antibiotic-loaded bone cement (n=94) there were 8 infections (8%), while in the group with cement without antibiotic (n=147) there were 28 infections (19%). The odds ratio (OR) was calculated, showing a 55.3% reduction in the risk of developing late infection in the group that received cement with antibiotic (95% CI: 6.2-78.7%, P=.0025). The use of antibiotic-loaded bone cement led to significant cost savings per patient. CONCLUSIONS: The use of antibiotic-loaded bone cement is a protective factor in the development of late infection after hip hemiarthroplasty surgery in elderly patients with hip fracture.