Compartment Syndrome Due to Reperfusion Injury from an Axillary Artery Occlusion: A Case Report and Review of the Literature.

Introduction: While commonly caused by traumatic injury and fracture, compartment syndrome can also result from reperfusion injury. Very few cases of prophylactic fasciotomy are mentioned when considering time to revascularization after prolonged vascular ischemia. We present a case of a patient who underwent multiple compartment prophylactic fasciotomies following reperfusion injury in the upper extremity. Case Report: We report a 72-year-old male that suffered from an anterior shoulder dislocation after a ground-level fall. After reduction, pulses were not measurable, and angiography indicated an axillary artery occlusion. Immediately after operative reperfusion, compartments became tense. Orthopedic surgeons subsequently performed arm anterior, posterior, and forearm volar and mobile wad compartment fasciotomies, after 13 h of ischemia. The patient tolerated the procedure, and at the latest follow-up, was working to improve strength in the extremity. Conclusion: Even when the circumstances of injury seem to be less traumatic as in this case of a ground-level fall, we document the importance of prompt recognition and intervention of suspected compartment syndrome following prolonged ischemia and revascularization of the upper extremity.

The last days: The medical response of United States and allied military teams during the Afghanistan Exodus.

OBJECTIVES: The objective of this study is to describe the United States and allied military medical response during the withdrawal from Afghanistan. BACKGROUND: The military withdrawal from Afghanistan concluded with severe hostilities resulting in numerous civilian and military casualties. The clinical care provided by coalition forces capitalized on decades of lessons learned and enabled unprecedented accomplishments. METHODS: In this retrospective, observational analysis, casualty numbers, and operative information was collected and reported from military medical assets in Kabul, Afghanistan. The continuum of medical care and the trauma system, from the point of injury back to the United States was captured and described. RESULTS: Prior to a large suicide bombing resulting in a mass casualty event, the international medical teams managed distinct 45 trauma incidents involving nearly 200 combat and non-combat civilian and military patients over the preceding 3 months. Military medical personnel treated 63 casualties from the Kabul airport suicide attack and performed 15 trauma operations. US air transport teams evacuated 37 patients within 15 hours of the attack. CONCLUSION: Lessons learned from the last 20 years of combat casualty care were successfully implemented during the culmination of the Afghanistan conflict. Ultimately, the effort, teamwork, and system adaptability exemplify not only the attitudes and character of service members who provide modern combat casualty care but also the paramount importance of the battlefield learning health care system. A continued posture to maintain military surgical preparedness in unique environments remain crucial as the US military prepares for the future.Retrospective observational analysis. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level V.

Volumetric Considerations for Valving Long-Arm Casts: The Utility of the Cast Spacer.

Fiberglass casts are frequently valved to accommodate swelling following injury or surgery. The use of cast spacers has been recommended to bridge this gap between pressure reduction and cast strength, but no studies have assessed their effect on cast pressure. We applied 30 long-arm fiberglass casts to adult volunteers, divided between a univalve group and a bivalve group. A pediatric blood pressure bladder was applied under the cast to simulate soft tissue swelling. Valved casts were secured using an elastic wrap, 10-mm cast spacer, or 15-mm cast spacer. Measurements of cast pressure and circumference were performed at each stage and compared on the basis of type of valve and securement. Our results indicated that cast univalving resulted in an approximately 60% reduction in cast pressures, with a 75% reduction seen in the bivalve group. The addition of cast spacers resulted in significant pressure reductions for both valving groups. The univalve group secured with a 10-mm cast spacer produced reductions in cast pressure similar to those of the elastic-wrapped bivalve cast, both with the cast padding intact and with it released. The use of cast spacers results in significant cast pressure reductions, regardless of valving technique. A univalved cast secured with a cast spacer can produce decreases in cast pressures similar to those seen with an elastic-wrapped bivalved cast, and it is a viable option for reducing cast pressure without compromising cast structural integrity with a bivalve technique.

Effect of Casting Material on the Cast Pressure After Sequential Cast Splitting.

BACKGROUND: Circumferential casting is a vital component of nonoperative fracture management. These casts are commonly valved to release pressure and decrease the risk of complications from swelling. However, little information exists regarding the effect of different casting supplies on the pressure within the cast. METHODS: Seventy-five long-arm casts were performed on human volunteers, divided between 5 experimental groups with 15 casts in each groups. Testing groups consisted of 2 groups with a plaster short-arm cast overwrapped with fiberglass to a long arm with either cotton or synthetic cast padding. The 3 remaining groups included fiberglass long-arm casts with cotton, synthetic, or waterproof cast padding. A pediatric blood pressure cuff bladder was placed within the cast and inflated to 100 mm Hg. After inflation, the cast was sequentially released with pressure reading preformed after each stage. Order of release consisted of cast bivalve, cast padding release, and cotton stockinet release. After release, the cast was overwrapped with a loose elastic bandage. Difference in pressure readings were compared based upon the cast material. RESULTS: Pressures within the cast were found to decrease with sequential release of cast. The cast type had no effect of change in pressure. Post hoc testing demonstrated that the type of cast padding significantly affected the cast pressures with waterproof padding demonstrating the highest pressure readings at all time-points in the study, followed by synthetic padding. Cotton padding had the lowest pressure readings at all time-points. DISCUSSION: Type of cast padding significantly influences the amount of pressure within a long-arm cast, even after bivalving the cast and cutting the cast padding. Cotton cast padding allows for the greatest change in pressure. CLINICAL RELEVANCE: Cotton padding demonstrates the greatest change in pressure within a long-arm cast after undergoing bivalve. Synthetic and waterproof cast padding should not be used in the setting of an acute fracture to accommodate swelling.

Hemodialysis-Associated Spondylodiscitis of the Cervical Spine: A Case Report.

CASE: A fifty-seven-year-old, hemodialysis-dependent man presented with a one-month history of progressive neck pain and paresthesias of the upper extremities. Radiographic examination demonstrated collapse of the C5 and C6 vertebrae with resultant kyphosis and spinal cord compression. CONCLUSION: The patient underwent a staged anterior debridement with C5 and C6 corpectomies, cage placement, and plate fixation of C4 to C7, followed by a posterior arthrodesis from C4 to C7. He completed a six-week course of intravenous antibiotics for the treatment of Staphylococcus epidermidis spondylodiscitis, followed by suppressive oral antibiotics. At one year of follow-up, he had no residual neck pain or neurological signs or symptoms.