Treatment of compartment syndrome of the thigh associated with acute renal failure after the Wenchuan earthquake.

Compartment syndrome of the thigh is a rare emergency often treated operatively. The purpose of this study was to evaluate the effects of nonoperative treatment for compartment syndrome of the thigh associated with acute renal failure after the 2008 Wenchuan earthquake. Nonoperative treatment, which primarily involves continuous renal replacement therapy, was performed in 6 patients (3 men and 3 women) who presented with compartment syndrome of the thigh associated with acute renal failure. The mean mangled extremity severity score (MESS) and laboratory data regarding renal function were analyzed before and after treatment, and the clinical outcome was evaluated at 17-month follow-up. Laboratory data regarding renal function showed improvements. All 6 patients survived with the affected lower limbs intact after nonoperative treatment. Follow-up revealed active knee range of motion and increased muscle strength, as well as a recovery of sensation. A positive linear correlation was found between MESS and the time required to achieve a reduction in swelling, as well as the time required for the recovery of sensation and knee range of motion (r>0.8; P<.05). Satisfactory clinical outcomes were obtained in patients with compartment syndrome of the thigh associated with acute renal failure.Urine alkalization, electrolyte and water balance, and continuous renal replacement therapy have played an important role in saving lives and extremities. Nonoperative treatment should be considered in the treatment of compartment syndrome of the thigh associated with acute renal failure.

[Anterior interosseus nerve syndrome]. / Nervus interosseus anterior-syndrom.

A prolonged period of illness in a patient showing symptoms of reflexdystrophy is described. After going through several examinations and finally being referred to a pain clinic the patient demanded a second opinion from an orthopaedic surgeon. Her symptoms turned out to have been caused by a compression syndrome of the anterior interosseus nerve.

The anterior compartment syndrome in the lower leg. Review and role of the EMG examination.

The Anterior Compartment Syndrome is a relatively rare affection with a wide spectrum of etiologies. Like every compartment syndrome, it is a condition in which high pressure in a rigid osteofascial space reduces capillary blood perfusion so that tissue viability is threatened. When pressure remains sufficiently high for a number of hours, normal muscle and nerve functions become disturbed which may lead to myoneural necrosis. Therefore, an early decompression by means of fasciotomy is essential. Clinical examination is of critical importance in reaching a diagnosis: first of all a painful swelling occurs, followed by muscular paresis or paralysis, and finally loss of sensation and a "silent" electromyogram (EMG). In some cases pressure measurements are necessary, in which tissue pressures over 30 to 40 mm Hg are considered abnormal. The EMG-examination is useful in order to achieve a diagnosis and to assess the degree of injury. It may be an important guide for further rehabilitation.

Post-traumatic acute anterior spinal cord syndrome.

Thirteen patients with motor complete but sensory incomplete lesions following vertebral and spinal cord injuries are described. Sensory dissociation was present with more impairment of pain than touch or proprioception. The loss of pain sensation was complete in seven patients, but was incomplete in the other six subjects four of whom showed major motor recovery. The major point of interest of this study is to show that patients who retain not only touch but also pain sensation have a definitely better prognosis for neurological recovery.