RESUMO
OBJECTIVES: Chronic exertional compartment syndrome is one of the main causes of exertional leg pain. Diagnosis is based on the history and intracompartmental muscle pressure testing during exercise prior to consideration of fasciotomy for treatment. We present the data gathered at Defence Medical Rehabilitation Centre Headley Court during the first year of a revised protocol on dynamic pressure testing from May 2007. METHODS: The exercise protocol involved exercising patients using a representative military task: the Combat Fitness Test with a 15 kg Bergen on a treadmill, set at 6.5 km/h with zero incline up to 15 min and if completed, a further 5 min at 7.5 km/h. Subjects informed us when the exertional leg pain was 7/10 on a visual analogue scale and were instructed to carry on till failure (pain 10/10) or till the test finished. Mean pressure during this time period (7/10 to 10/10) was calculated by computer. RESULTS: Over 1 year, we performed 151 intracompartmental pressure studies in 76 patients. 120 were successful in 68 patients, with 31 technical failures. All studies were performed in the anterior or deep posterior muscle compartments as these were the symptomatic compartments; no patients had symptoms in the lateral or superficial posterior compartments and these were not tested. There was only one complication with a posterior tibial artery puncture. In 119 compartment studies, the mean pressure was 97.8 mm Hg (SD 31.7). These data are normally distributed (Shapiro Wilk test, W=0.98 p=0.125). CONCLUSIONS: Our data based on this exercise protocol are comparable with the few studies that record dynamic pressure during running-based exercise. There is no accepted diagnostic pressure or exercise protocol. Due to the uncertainty of diagnostic criteria, it is necessary to perform a study measuring dynamic pressures in normal asymptomatic subjects.
Assuntos
Síndromes Compartimentais/diagnóstico , Teste de Esforço , Militares , Esforço Físico , Adulto , Catéteres , Doença Crônica , Humanos , Extremidade Inferior , Manometria , Medição da Dor , Transdutores de Pressão , Reino UnidoRESUMO
BACKGROUND: Chronic instability of the acromiocavicular joint is relatively common and normally occurs following a fall onto the point of the shoulder. Reconstruction of the joint [Weaver-Dunn procedure] using the coracoacromial ligament is often required in service personnel, and a number of methods to augment this repair have been used. Many of these operative methods require a second operation to remove the metalwork, and in addition can be associated with a failure rate of up to 30%. The 'Surgilig' was originally designed for use in the revision of failed Weaver-Dunn procedures. However this study evaluates its use in the primary operation, reinforcing the autologous graft, in an attempt to reduce the failurerate. DATA COLLECTION AND ANALYSIS: We prospectively followed up the Modified Weaver Dunn procedures using Surgilig. The post-operative x-rays were reviewed at six weeks, three months and then six months to assess the radiological success of the procedure. Our patients were discharged at six months. RESULTS: We have performed this procedure in 11 patients. One of the 11 patients was excluded from the study as the Surgilig graft was used in addition to a hook plate. The remaining ten patients have all reached the six-month post-operative time with no incidence of radiological failure of the graft. After six months they were discharged from clinic follow-up asthe coracoacromial graft had sufficient strength to no longer rely on the augment for mechanical stability of the joint. All 10 patients had a good clinical and radiological result. One patient even had inadvertent stress/ weight-bearing x-rays taken at six weeks, with no discernable detrimental effect to outcome. CONCLUSION: Although a small study, these initial results for primary fixation of acromioclavicular joint disruption with Surgilig are extremely encouraging. The results suggest that Surgilig should continue to be used in its current role. As patient numbers increase, a follow-up study to evaluate these preliminary findings should be conducted.
Assuntos
Articulação Acromioclavicular/lesões , Luxações Articulares/cirurgia , Instabilidade Articular/cirurgia , Ligamentos/cirurgia , Procedimentos Ortopédicos/instrumentação , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/cirurgia , Doença Crônica , Humanos , Luxações Articulares/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Ligamentos/diagnóstico por imagem , Ligamentos/lesões , Militares , Procedimentos Ortopédicos/métodos , Estudos Prospectivos , Próteses e Implantes/normas , Radiografia , Fatores de TempoRESUMO
We have assessed a number of ballistic fracture classifications but were unable to identify one that could adequately grade the severity of the injury, assist in determining the optimal treatment or predict outcome. Many of the existing classifications are based on experimental studies or radiological appearance and do not take into account the soft tissue injury, which is usually the main prognostic indicator. In addition few differentiated between different bones, and some were specific to only one bone. We would suggest that ballistic fractures are treated on an individual basis, specifically considering the soft tissue injury, the anatomical location of the injury and any involvement of joints. The specific weapon or muzzle velocity are not of prime importance, and classifications should not be based on these.
Assuntos
Fraturas Ósseas/classificação , Ferimentos por Arma de Fogo/classificação , Fraturas Ósseas/diagnóstico por imagem , Humanos , Escala de Gravidade do Ferimento , Articulações/lesões , Salvamento de Membro , Prognóstico , Radiografia , Lesões dos Tecidos Moles/classificação , Ferimentos por Arma de Fogo/diagnóstico por imagemRESUMO
BACKGROUND: War wounds produce a significant burden on medical facilities in wartime. Workload from the recent conflict was documented in order to guide future medical needs. METHODS: All data on war injuries were collected prospectively. This information was supplemented with a review of all patients admitted during the study period. RESULTS: During the first 2 weeks of the conflict, the sole British field hospital in the region received 482 casualties. One hundred and four were battle injuries of which nine were burns. Seventy-nine casualties had their initial surgery performed by British military surgeons and form the study group. Twenty-nine casualties (37 per cent) sustained gunshot wounds, 49 (62 per cent) suffered wounds from fragmentation weapons and one casualty detonated an antipersonnel mine. These 79 patients had a total of 123 wounds that were scored prospectively using the Red Cross Wound Classification. Twenty-seven (34 per cent) of the wounded were non-combatants; eight of these were children. Four patients (5 per cent) died. CONCLUSION: War is changing; modern conflicts appear likely to be fought in urban or remote environments, producing different wounding patterns and placing non-combatants in the line of fire. Military medical skills training and available resources must reflect these fundamental changes in preparation for future conflicts.
Assuntos
Guerra , Ferimentos Penetrantes/epidemiologia , Traumatismos Abdominais/epidemiologia , Adolescente , Adulto , Amputação Cirúrgica/estatística & dados numéricos , Traumatismos por Explosões/epidemiologia , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Feminino , Humanos , Lactente , Escala de Gravidade do Ferimento , Iraque , Kuweit/epidemiologia , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/epidemiologia , Estudos Prospectivos , Traumatismos Torácicos/epidemiologia , Ferimentos por Arma de Fogo/epidemiologiaRESUMO
Two hundred and seventy-five consecutive patients over the age of 50 years admitted with a hip fracture were prospectively studied in detail, to assess the impact of a hip fracture on their functional ability and their need for social support. One hundred and eighty-three (66.9%) patients survived to 1 year. Mortality was highest amongst those least able to perform the recorded activities. One hundred and fifty-eight (86%) of the survivors were resident in the same level of accommodation after 1 year. There was a reduction in mobility and related functions of 20-25% and a reduction of 5% in tasks not related to hip function. It is therefore estimated that in the year after a hip fracture there will be decline in functionally abilities of about 5% unrelated to the hip fracture and about 15-20% directly related to the hip fracture. There was an increase in the requirement for social support amongst survivors individually, but overall the total economic burden on social services and institutional care was not significantly changed by hip fracture.