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1.
Bull Hosp Jt Dis (2013) ; 76(2): 123-132, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29799372

ABSTRACT

Faced with a patient who presents with unexplained disproportionate pain, a surgeon may be tempted to diagnose a low pain threshold, malingering, poor coping, anxiety, or other emotional condition. However, a variety of conditions must be ruled out before the orthopedist can prescribe watchful waiting. Computed tomography and magnetic resonance imaging can detect occult fractures, acute spinal conditions or vascular occlusions, but early on are inadequate to diagnose a compartment syndrome, necrotizing fasciitis, or reflex sympathetic dystrophy (RSD). These diagnoses underpin a pain-out-of-proportion situation whereby the patient presents with disproportionate pain following a sometimes minor trauma with normal imaging studies and otherwise nonspecific presentations. Though these conditions are well described in the literature, investigations of malpractice data reveal a non-negligible prevalence of missed diagnoses for each of these entities. Determining that a patient exhibits otherwise unexplained pain-out-of-proportion situation is the first step in making a timely diagnosis.


Subject(s)
Pain Measurement , Pain Perception , Pain Threshold , Pain/diagnosis , Compartment Syndromes/diagnosis , Compartment Syndromes/physiopathology , Compartment Syndromes/psychology , Early Diagnosis , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/physiopathology , Fasciitis, Necrotizing/psychology , Humans , Pain/physiopathology , Pain/prevention & control , Pain/psychology , Pain Management/methods , Predictive Value of Tests , Reflex Sympathetic Dystrophy/diagnosis , Reflex Sympathetic Dystrophy/physiopathology , Reflex Sympathetic Dystrophy/psychology , Risk Factors
2.
Injury ; 40(2): 213-9, 2009 Feb.
Article in English | MEDLINE | ID: mdl-19070847

ABSTRACT

AIMS AND OBJECTIVES: To measure long-term functional outcome and health-related quality of life following tibial fracture in association with the full spectrum of soft tissue injury. METHODS: One hundred and thirty patients with different types of tibial injury were selected from our trauma database. This included 33 patients with compartment syndrome (no underlying fracture), 30 with closed diaphyseal tibial fractures, 45 with grade IIIB/IIIC open fractures and 22 requiring below knee amputation. Mean time to final follow-up was 37.4 months. The EQ-5D (EuroQol) questionnaire was used to assess these patients at this point. Patients had been treated according to standard unit protocols. Open fractures were jointly managed under the care of local plastic and orthopaedic surgeons using a policy of obtaining early soft tissue cover. RESULTS: Patients with reconstructed IIIB fractures reported problems with pain and carrying out their normal activities more frequently than amputees whilst still reporting problems with mobility just as frequently. Anxiety and depression were more common in the patients with open fractures and amputees as were problems with self-care, though the latter were unusual overall. Stepwise logistic regression revealed that tibial injury type was significantly predictive of all measured outcomes except self-care (p<0.0001). Age, ISS, sex and time to follow-up were not significant predictors of response. CONCLUSIONS: These results show that patients with these injuries still report long-term problems with their health-related quality of life, though to varying degrees. This information is useful when determining the treatment options for these patients and it is important that it is shared with the patient prior to surgery where possible.


Subject(s)
Amputation, Surgical/psychology , Compartment Syndromes/psychology , Quality of Life/psychology , Tibia/injuries , Tibial Fractures/psychology , Adolescent , Adult , Aged , Compartment Syndromes/surgery , Female , Fracture Healing/physiology , Fractures, Open/psychology , Fractures, Open/surgery , Humans , Male , Middle Aged , Reoperation/psychology , Surveys and Questionnaires , Tibia/surgery , Tibial Fractures/surgery , Time Factors , Trauma Severity Indices , Treatment Outcome , Wound Healing/physiology , Young Adult
3.
Nervenarzt ; 76(3): 327-30, 2005 Mar.
Article in German | MEDLINE | ID: mdl-15759162

ABSTRACT

Psychogenic polydipsia can lead to compartment syndromes, which is too infrequently considered in psychiatric patients who binge-drink on hypotonic fluids. If masked by the leading clinical presentation of cerebral edema, compartment syndromes of the extremities may be diagnosed too late or remain undetected. Based on a literature review and case report, we discuss additional factors and the specific features of diagnosis and treatment.


Subject(s)
Compartment Syndromes/diagnosis , Compartment Syndromes/etiology , Drinking Behavior , Psychophysiologic Disorders/complications , Psychophysiologic Disorders/diagnosis , Water Intoxication/complications , Water Intoxication/diagnosis , Adult , Compartment Syndromes/psychology , Humans , Male , Psychophysiologic Disorders/psychology , Water Intoxication/psychology
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