Development Of Compartment Syndrome Research Articles

Analysis of Medical Rehabilitation Needs of 2023 Kahramanmaraş Earthquake Victims: Adıyaman Example.

Natural disasters, particularly earthquakes, result in numerous injuries, including spinal cord injuries, traumatic brain injuries, limb amputations, fractures, and peripheral nerve injuries. This study aimed to investigate the types of orthopedic injuries sustained by earthquake survivors who require long-term rehabilitation, as well as to assess the rehabilitation programs, orthoses, prostheses, and assistive devices employed. This descriptive analysis was conducted at a physical medicine and rehabilitation clinic. Data on earthquake survivors were recorded retrospectively. The study included survivors who presented to the clinic between April 15, 2023, and May 1, 2024, with injuries sustained during the Kahramanmaraş earthquakes that occurred on February 6, 2023. The types of orthopedic injuries, rehabilitation programs, and orthoses-prostheses used were documented. Data from 223 earthquake survivors were analyzed. Among these, 97 (43.5%) had compartment syndrome, 65 (29.1%) had amputations, 57 (25.6%) had fractures, 20 (9%) had peripheral nerve injuries, 12 (5.4%) had soft tissue injuries, and two (0.9%) had dislocations. Physiotherapy was provided to 211 (94.6%) patients, occupational therapy to 56 (25.1%), amputation rehabilitation to 65 (29.1%), and electrotherapy to 12 (5.3%). Prostheses were fitted for 37 (16.5%) amputees, orthoses were used by 57 (25.6%) patients, and 103 (46.1%) required assistive devices. Among earthquake-related injuries requiring medical rehabilitation, compartment syndrome was the most common. The rehabilitation process of patients who developed compartment syndrome and amputation continues 1year after the earthquake. Adults were the most frequently affected age group. The data obtained in this study will help plan local health services to coordinate medical rehabilitation in earthquakes.

Fiberglass cast application in immediate post-operative period after an ankle fracture surgery: review of safeguards

An ankle fracture after stabilization may normally need post-operative support immobilization in a cast in the early phase to allow for the associated soft tissue ligamentous injury to recover. The cast may allow for an early rehabilitation of the operated ankle fractures with protected weight bearing potential. A cast immobilization in the immediate post-operative period following an ankle surgery has used gypsum plasters with great caution and care. The concerns of poor wound healing, infection, pressure ulcer, skin maceration due to soakage, development of compartment syndrome and thrombosis may present in the immediate post-operative period for ankle fractures following a cast application. The technique for fiberglass cast application in the immediate post-operative period may provide an advantage. The cast application needs an emphasis to understand the safeguards, avoid any abnormal pressure and do monitoring of wound care to attain a favorable desired outcome. The aspects of cast application have been reviewed to present the necessary safeguards.

Incidence of Compartment Syndrome Following Peri-Pandemic Intervention for Non-traumatic Acute Limb Ischemia.

During the pandemic, our institution anecdotally observed a significant proportion of acute limb ischemia (ALI) patients developing compartment syndrome (CS) following revascularization compared to pre-pandemic rates. To determine whether this perceived increase was occurring globally, we utilized the TriNetX database to evaluate the incidence of CS secondary to ALI intervention in both the pre-pandemic (2017-2019) and pandemic eras (2020-2022). We conducted a multicenter query using the TriNetX global research network for ALI patients receiving treatment. Incidence of CS diagnosis within 1 calendar day of ALI intervention was calculated for each era. Demographics and comorbidities were then compared between CS and non-CS patients within each era. Risk of adverse outcomes within 30 days of CS diagnosis was also determined for each era, including mortality, major amputation, and re-intervention. The pre-pandemic cohort contained 7736 patients while the pandemic era cohort included 8,306, for 16,042 total patients. A significant increase in CS incidence (risk ratio (RR) = 1.23, P = 0.0026) was demonstrated within the pandemic era. An increased prevalence of comorbidities such as dyslipidemia (pre-pandemic: P = 0.0022; pandemic: P = 0.0026) and peripheral vascular disease (P < 0.0001, both eras) was observed in the non-CS cohort within both eras. 30-day mortality was significantly increased in CS patients (pre-pandemic: RR = 3.057; pandemic: RR = 2.710; P < 0.0001 both eras) compared to non-CS patients. CS patients were more likely to receive major amputation (pre-pandemic: RR = 3.734; pandemic: RR = 2.809; P < 0.0001 both eras) and/or re-intervention within 30 days (pre-pandemic: RR = 1.871, P < 0.0001; pandemic: RR = 1.370, P = 0.0218) over non-CS patients. The incidence of CS following revascularization for ALI rose worldwide during the pandemic. Patients who developed CS are younger with fewer comorbidities than non-CS patients. Despite a more favorable comorbid profile, CS patients demonstrate significantly higher rates of adverse outcomes. Further investigation is necessary to determine the specific underlying mechanisms driving this increased incidence in CS among ALI patients.

Ранние и отдаленные результаты профилактики абдоминального компартмент-синдрома у пациентов с W3 вентральными грыжами

Abdominal compartment syndrome is a severe pathology requiring special preventive and treatment measures. The development of methods for the prevention of abdominal compartment syndrome is important in patients with W3 ventral hernias and loss of the domain. The study analyzed the results of treatment of 71 patients with W3 hernias of the anterior abdominal wall. Before surgery, all patients were calculated the size of the hernia implant necessary for the prevention of compartment syndrome. To calculate the size of the required hernia implant, radiography, ultrasonography and anthropometric data of the patient were used. The patients underwent hernioplasty with sublay, inlay and, developed by the authors, in a combined method. In the groups with inlay and combined method hernioplasty, the development of compartment syndrome was not observed. The combination of the developed methods of preoperative calculation of the hernia implant and the combined method of hernioplasty showed a low number of early and late postoperative complications, the same as in other study groups. The results obtained indicate the effectiveness of the developed methods for the prevention of abdominal compartment syndrome.

Fasciocutaneous bridge flap to cover defects on the lower leg after compartment syndrome with acomplication-prone course : An "almost" forgotten safe flap procedure

This article reports on acomplicated case of asoft tissue defect with challenging soft tissue coverage on the lower leg. After alower leg fracture and treatment with atibial nail, a29-year-old man developed compartment syndrome due to massive secondary bleeding with alesion of the common peroneal nerve and muscle necrosis around the fibular muscles. The initial coverage with split skin showed no tendency to heal, so the patient was admitted to this hospital with asoft tissue defect of approximately 25 cm × 10 cm on the lateral lower leg with an exposed tibia over a length of 15 cm. The primary attempt was coverage with a split-thickness skin graft after secondary granulation; however, due to the previously damaged vascular supply, the wound demonstrated adelayed incomplete healing over 8 months. In addition, X‑ray imaging revealed anonunion and aresulting screw fracture of the two distal locking screws. The indications for revision surgery to treat the fracture and change the implant were fulfilled. In the same procedure, the residual cutaneous defects were closed. Given the previously complication-prone course and adifficult local blood flow situation, the choice of reconstruction procedures was limited. Abridge flap of the medial lower leg was performed in an interdisciplinary approach. The lifting defect was covered with split-thickness skin. In this way, the wound was finally adequately covered after 1year.

Clinical, etiological, and electrophysiological characteristics of patients with peripheral nerve damage caused by the February 6 earthquake in Türkiye

Objectives: This study aimed to analyze the clinical, etiological, and electrophysiological characteristics of the February 6 earthquake victims referred to our center due to nerve damage. Patients and methods: In this retrospective study, the demographic characteristics and findings of clinical examinations of 36 earthquake victims (25 females, 11 males; mean age: 31.6±15.5 years; range, 5 to 61 years) referred to our electrophysiology laboratory during the four-month period following the February 6 earthquake were investigated. The patients’ time spent under rubble, affected extremities, and electrophysiological findings were evaluated, and the locations of their lesions were determined using electromyography. Results: The mean time spent under rubble was 14.94±18.62 h, and 31 (86.1%) patients experienced partial nerve damage. Nerves were affected peripherally in 23 (74.2%) patients, at the lumbosacral plexus level in four (12.9%) patients, and at the brachial plexus level in another four (12.9%). Patients who were under rubble for more than 6.5 h had an increased risk of developing crush syndrome (p=0.014), and those under rubble for more than 8.5 h had an increased risk of developing compartment syndrome (p=0.008). Conclusion: The duration of exposure to rubble has been identified as a significant factor in the severity of nerve injury, as well as the development of compartment syndrome and crush syndrome. Therefore, the potential for peripheral nerve injury, which is a significant cause of morbidity, should be considered in the follow-up of patients who have survived earthquakes.

Acute Kidney Injury in Hospitalized Patients With Exertional Rhabdomyolysis

An association between serum creatine kinase (CK) levels and the risk of kidney failure in patients with exertional rhabdomyolysis (ERM) has been suggested. However, the actual incidence of AKI in hospitalized patients with ERM along with the contributing cofactors that may increase the risk of AKI have rarely been investigated. To examine the incidence of kidney injury in hospitalized patients with ERM and to identify additional cofactors that might contribute to the development of kidney injury in patients with ERM. This retrospective cohort study was conducted in a diverse community population of patients 18 years or older with ERM who were hospitalized across Kaiser Permanente Northern California between January 1, 2009, and December 31, 2019. Patients were initially identified through electronic screening for all-cause rhabdomyolysis admissions, followed by manual medical record reviews to verify their eligibility for the study. The diagnosis of AKI and chronic kidney disease (CKD) was determined using KDIGO (Kidney Disease Improving Global Outcomes) criteria and confirmed by medical record review. Data analysis was performed from October 1, 2023, to January 31, 2024. History of strenuous physical exercise before hospitalization for ERM. Development of AKI, CKD, and compartment syndrome and number of deaths. Among 3790 patients hospitalized for rhabdomyolysis between 2009 and 2019 in Kaiser Permanente Northern California, 200 (mean [SD] age, 30.5 [8.5] years; 145 [72.5%] male) were confirmed to have ERM via medical record review. Seventeen patients (8.5%) developed AKI, none developed CKD, 1 (0.5%) developed compartment syndrome, and there were no fatalities. There was no association between serum CK levels and the risk of AKI. However, the risk of AKI was significantly higher in patients with ERM who used nonsteroidal anti-inflammatory drugs (NSAIDs) before admission (11 of 17 with AKI [64.7%] vs 40 of 183 without AKI [21.9%], P < .001) or experienced dehydration (9 of 183 without AKI [52.9%] vs 9 of 17 with AKI [4.9%], P < .001). This analysis suggests that eliminating preadmission NSAID use and dehydration could reduce the risk of potential AKI in patients with ERM by 92.6% (95% CI, 85.7%-96.1%) in this population. The findings of this cohort study of hospitalized patients with ERM suggest that serum CK elevation alone is insufficient as an indicator of AKI in patients with ERM. Concurrent risk factors, such as NSAID use or dehydration, may be associated with AKI development in patients with ERM.

BIOCHEMICAL INDICATORS OF MILITARY BLOOD ON THE ISCHEMIC AND DENERVATION PROCESS IN MUSCLES AFTER A MINE-EXPLOSIVE INJURYS

The injuries received are accompanied by massive damage to the soft tissues of the limbs, main vessels and nerves, and the development of compartment syndrome. Violation of muscle function in the case of a limb injury can be both a consequence of denervation — as a result of damage to peripheral nerves, and ischemia with subsequent necrosis and fibrosis — as a result of direct or indirect damage to muscles, «tenotomy syndrome» — in case of traumatic damage to tendons and muscles yams, with the simultaneous combination of denervation and ischemia. Markers for assessing the state of muscle tissue — levels of Na+, K+ and Ca++ electrolytes, indicators of kidney function (urea, creatinine); glucose and the products of its transformations — lactate (lacticacid) and pyruvate (pyruvic acid) and, finally, muscle enzymes, namely creatine kinase (CK) and lactate dehydrogenase (LDH). Objective. To study the biochemical indicators of blood (activity of energy metabolism enzymes and electrolyte content) of military personnel with ischemic contracture and muscle denervation after a mine-explosive injury. Methods. The blood serum of 45 people, who were divided into IV groups, was analyzed. The average age of patients of the II group was 33.75 ± 3.46; III — 37 ± 3.66; IV — 35.86 ± 2.35. The results. The activity of LDH and CK and the content of electrolytes Na+, K+, Ca++ were determined in blood serum. Conclusions. LDH plays a key role in lactate metabolism and maintenance of energy balance in skeletal muscle. Its increased activity indicates the presence of hypoxia due to ischemic contracture of the limb and damage to peripheral nerves. KK enzyme protects cell membranes from damage. The tendency to decrease the activity of CC is a negative sign that reflects the initial process of destruction of the cell membranes of muscles damaged by a mine-explosive injury. The obtained results can be used to determine the severity of pathological processes in patients after traumatic damage to peripheral nerves and ischemic contracture, as well as when assessing the expediency of surgical intervention.

Intra-Abdominal Hypertension and Abdominal Compartment Syndrome in COVID-19: Diagnosis, Prevention, Treatment

Introduction. New COVID-19 coronavirus infection negatively influenced the surgical service. Clinical recommendations for the treatment of surgical patients were adjusted to the new conditions of unfavorable epidemiologic conditions with reorientation to urgent minimally invasive surgical care. Therefore, the generally accepted diagnostic and treatment programs could not be applied due to the overwhelming admission of patients in extremely severe condition. Such programs embrace treatment and prevention of intra-abdominal hypertension and abdominal compartment syndrome. Aim. To analyze the treatment results of patients with COVID-19 infection in covid hospitals, complicated by abdominal surgical pathology and associated with abdominal surgical disease, in terms of diagnosis, treatment and prevention of pathological conditions leading to increased intra-abdominal pressure. Materials and methods. The study analyzed the treatment results of 1900 patients in covid hospitals with different surgical capabilities, where they were provided with diagnostic, therapeutic and preventive measures in order to prevent abdominal compartment syndrome, i.e. management of intra-abdominal hypertension and abdominal compartment syndrome was performed according to the diagnostic and treatment program. Results and discussion. 67 patients (3.5%) in the clinical group developed an abdominal surgical complication, or covid infection was associated with an acute abdominal surgical disease. In case of indications for emergency surgery, surgical tactics consisted in minimally invasive techniques and regional anesthesia; a development of compartment syndrome was managed with emergency decompressive laparotomy. Conclusion. The implementation of the diagnostic and treatment program of intra-abdominal hypertension and abdominal compartment syndrome management in the clinical group of COVID-patients enabled compartment syndrome to be prevented in 3.5% of patients and early decompressive laparotomy to be performed in 1.5% of patients in case of its development. The mortality associated with abdominal complications of COVID-19 comprised 1.3% in the clinical group.

Redisplacement of reduced distal radius fractures in adults: does the type of casting play a role? The CAST study, a multicentre cluster randomized controlled trial.

It is not clear which type of casting provides the best initial treatment in adults with a distal radial fracture. Given that between 32% and 64% of adequately reduced fractures redisplace during immobilization in a cast, preventing redisplacement and a disabling malunion or secondary surgery is an aim of treatment. In this study, we investigated whether circumferential casting leads to fewer the redisplacement of fewer fractures and better one-year outcomes compared with plaster splinting. In a pragmatic, open-label, multicentre, two-period cluster-randomized superiority trial, we compared these two types of casting. Recruitment took place in ten hospitals. Eligible patients aged ≥ 18 years with a displaced distal radial fracture, which was acceptably aligned after closed reduction, were included. The primary outcome measure was the rate of redisplacement within five weeks of immobilization. Secondary outcomes were the rate of complaints relating to the cast, clinical outcomes at three months, patient-reported outcome measures (PROMs) (using the numerical rating scale (NRS), the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores), and adverse events such as the development of compartment syndrome during one year of follow-up. We used multivariable mixed-effects logistic regression for the analysis of the primary outcome measure. The study included 420 patients. There was no significant difference between the rate of redisplacement of the fracture between the groups: 47% (n = 88) for those treated with a plaster splint and 49% (n = 90) for those treated with a circumferential cast (odds ratio 1.05 (95% confidence interval (CI) 0.65 to 1.70); p = 0.854). Patients treated in a plaster splint reported significantly more pain than those treated with a circumferential cast, during the first week of treatment (estimated mean NRS 4.7 (95% CI 4.3 to 5.1) vs 4.1 (95% CI 3.7 to 4.4); p = 0.014). The rate of complaints relating to the cast, clinical outcomes and PROMs did not differ significantly between the groups (p > 0.05). Compartment syndrome did not occur. Circumferential casting did not result in a significantly different rate of redisplacement of the fracture compared with the use of a plaster splint. There were comparable outcomes in both groups.

A case series of forearm compartment syndrome complicating transradial cardiac catheterization

BackgroundAcute compartment syndrome following a transradial coronary approach is rare. However, as the incidence of coronary arterial disease increases due to lifestyle factors and multiple comorbidities, transradial coronary angiography has become more common for diagnostic and therapeutic purposes in cardiovascular centers. Despite its rarity, we encountered two cases of acute compartment syndrome within a 1-week interval in the cardiology unit of a tertiary hospital.Case presentationThe first case involved a 75-year-old woman diagnosed with non-ST elevation myocardial infarction (NSTEMI). A coronary angiogram was performed via an uncomplicated right radial artery puncture. Following the procedure, the patient experienced significant swelling in the right forearm. An emergency fasciotomy release of the right forearm was conducted, revealing a gushing hematoma upon entering the flexor compartment. Fortunately, the wound healed well two months postoperatively with no functional deficits. In the second case, an 80-year-old man presented with severe angina pectoris upon exertion and was diagnosed with NSTEMI. The following day, he developed compartment syndrome in the left forearm, necessitating an emergency fasciotomy. Intraoperative examination revealed muscle bulging within the forearm compartments accompanied by extensive hematoma. Postoperatively, a deranged coagulation profile caused oozing from the wound. However, since there was no arterial bleeding, a compression dressing was applied. This led to a gradual drop in hemoglobin levels and worsened his heart condition. Despite resuscitative efforts and attempts to correct the coagulopathy, the patient experienced cardiorespiratory arrest and succumbed to ischemic heart disease in failure.ConclusionClinicians must remain vigilant in identifying this potentially limb-threatening condition. Patients with pre-existing anticoagulant therapy and underlying atherosclerotic disease are at a higher risk of bleeding complications. Implementing effective hemostasis techniques and promptly managing swelling can help prevent the occurrence of compartment syndrome. Timely assessment and maintaining a high level of clinical suspicion are paramount. If necessary, early consideration of decompressive fasciotomy is essential to avert catastrophic outcomes.

Evaluation and Management of Exertional Rhabdomyolysis Following a Spin Class

Exertional rhabdomyolysis (ER) has become prevalent over the last decade after performing spin classes. ER is characterized by the plasma elevation of creatine kinase as a marker of severe muscle damage. This case study highlights a 26-year-old healthy male that suffered from ER after performing their first ever spin class. The acute and chronic management of the ER is described, along with follow-up assessments that tracked the recovery following discharge from the hospital. Symptoms, such as localized swelling with complete loss of mobility and pain disproportionate to soreness, were characteristic in this individual with ER. Examining the concentration of plasma creatine kinase and monitoring urine output and color provided a good measure to determine when to discharge the patient. Management wise, ambulation should be minimized, and complete bed rest is ideal in conjunction with fluid replacement therapy. Although the individual in this case study did not develop compartment syndrome, its occurrence is always a possibility that should be routinely screened for. Lastly, further research is warranted to determine if there are any dietary interventions to promote a steadfast recovery from ER.

An Innovative Non-Invasive Method for Early Detection and Monitoring of Acute Compartment Syndrome.

Background: Acute compartment syndrome is a major surgical emergency with complex pathophysiology and a highly unpredictable pattern of evolution. We hypothesized that the onset of acute compartment syndrome of the leg or forearm is associated with variations in the surface temperature of the distal segment (foot or hand) with a distinct pattern, which acts as an early warning sign. Materials and Methods: We developed a monitoring device that consists of two thermic sensors attached to a modular limb splint, which continuously measure the temperature difference between the proximal and distal regions of the limb (i.e., arm-hand, thigh-foot). Firstly, we investigated both the arm-hand and thigh-foot temperature gradients of hospitalized patients' healthy limbs (43 patients, 56 upper limbs, 64 lower limbs) in order to establish a baseline. Secondly, we examined the correlation between the thermic gradients and intracompartmental pressure values in compartment syndrome limbs (20 patients, 6 upper limbs, 14 lower limbs). Results: For the control group, the mean values for the normal limb thermic gradients were -0.17 °C for the upper limbs. and 0.03 °C for the lower limbs. In the impending compartment syndrome group (defined by intracompartmental pressure values), the mean index was -0.38 °C. In the fully developed compartment syndrome group, the mean value was 4.11 °C. Discussions: Analysis was performed using the ANOVA one-way statistical method. This showed significant differences between the compartment syndrome group and the impending and control groups. A decreasing trend in the thermic gradient in patients with impending compartment syndrome compared with the control group was noted. Conclusions: The thermic gradient of limbs presenting signs of impending compartment syndrome decreases as a result of the increased temperature of the distal segment. This pattern can be used as an early diagnostic method for acute compartment syndrome. This technique is non-invasive and bears no risk to the patient, allowing facile continuous monitoring during immobilization.

ARE NEUROVASCULAR CHARTS APPROPRIATE FOR DIAGNOSING COMPARTMENT SYNDROME?

IntroductionCompartment syndrome can be a life changing consequence of injury to a limb. If not diagnosed and treated early it can lead to permanent disability. Neurovascular observations done on the ward by nursing staff, are often our early warning system to those developing compartment syndrome. But are these adequate for detecting the early signs of compartment syndrome? Our aim was to compare the quality and variability of charts across the UK major trauma network.Materials &amp; MethodsAll major trauma centres in England and Scotland were invited to supply a copy of the neurovascular chart routinely used. We assessed how such charts record relevant information. Specific primary data points included were pain scores, analgesia requirements, pain on passive stretch and decreased sensation in the first web space specifically. As secondary objectives, we assessed how late signs were recorded, whether clear instructions were included, quantitative scores and the use of regional blocks recorded.ResultsA response rate of 46% was achieved. Of the charts reviewed, 25% documented pain scores or pain on passive movement. Pain on movement and analgesia requirements were documented in 33% and 8% respectively. Specific sensation within the 1st webspace was recorded in 16%. No charts recorded use of regional block. All charts recorded global sensation, movement (unspecified), pulse and colour whilst 66% documented capillary refill and 83% temperature. Instructions were included in 41% of charts.ConclusionsIn 2016, the BOA supported publication of an observation chart for this purpose however, it is not widely used. In our study, late signs of compartment syndrome were generally well recorded. However, documentation of early signs and regional blocks was poor. This may lead to delays in diagnosis with significant clinical and medicolegal consequences. Standardisation of documentation by updating and promoting the use of the pre-existing chart would ensure highest quality care across the network.

Evaluation of obesity and age as a predictive factor of lower extremity compartment syndrome: A national trauma data bank analysis

BackgroundRisk factors of acute compartment syndrome (ACS) of the leg include tibial fractures followed by soft tissue injuries. MethodsData collected from the National Trauma Data Bank (NTDB) between 2017 and 2019 were analyzed for adult patients with lower extremity fractures, including proximal tibia, tibial shaft, and distal tibia. The primary outcome was a diagnosis of ACS. ResultsThere were 1052/220,868 patients with lower extremity fractures with a concomitant diagnosis of compartment syndrome. Our study has shown that patients with a BMI of ≥30 had a lower incidence of compartment syndrome when compared with patients with a BMI of 25–29 and controlled for fracture type. Increased age ≥55 in males, and females between 65 and 84, also demonstrated a decreased risk. Proximal tibial fractures (n ​= ​54,696) were significantly associated with ACS compared to midshaft (n ​= ​42,153) and distal (n ​= ​100,432), p ​< ​0.0001. ConclusionWe found that being overweight decreases risk for development of compartment syndrome in patients with lower extremity fractures. This big data study aids in establishing risk factors for development of ACS in adult trauma patients.

Delayed Compartment syndrome after total knee replacement: A case report with short review

Purpose: We would like to report a case which developed delay anterior thigh compartment syndrome after total knee replacement surgery and review the underlying risk factors. Method: A 67years old lady was suffered from delay thigh anterior compartment syndrome 4 days after total knee replacement surgery. Urgent fasciotomy was performed. Later work up showed a large intramuscular haematoma within the anterior compartment which required drainage. Discussion: Short review was performed to identify the risk factors for developing compartment syndrome after total knee replacement surgery. Management strategy and prognosis was also discussed. Conclusion: Compartment syndrome should be diagnosed and treated promptly. Patient with underlying risk factors must be identified and with close monitoring of this rare complication in post-operative period.

Acute compartment syndrome of the thigh after total knee arthroplasty: a case report

IntroductionAcute compartment syndrome of the thigh after total knee arthroplasty is a rarely described complication. After the assessment of the diagnosis, immediate surgical intervention is necessary to prevent further tissue damage. Since only a few cases have been described and because of the high complication rate, early detection is essential for ensuring patient outcomes.Case presentationAfter total knee arthroplasty in a high-volume university hospital, a 57-year-old Caucasian female patient experienced strong, disproportional pain in the ventromedial thigh of the affected leg, which did not respond to an adequate adjustment in pain medication. Imaging revealed a distinct swelling of the vastus intermedius muscle. This resulted in acute compartment syndrome of the thigh, which was immediately surgically treated. Apart from receiving surgery distal from the affected compartment and continuous intake of acetylsalicylic acid, the patient had no risk factors for developing compartment syndrome. The patient’s recovery was uneventful, with timely wound closure and discharge to outpatient care without significant functional limitations.ConclusionAcute compartment syndrome of the thigh represents a rare, but severe complication that can occur after orthopedic surgery. In our case, no triggering factors for the development of acute compartment syndrome, such as the use of a tourniquet, were detected. Even in unusual locations, compartment syndrome should be considered as a differential diagnosis. With sufficient evidence, immediate fasciotomy should be indicated.

Factors Associated with Development of Thigh Compartment Syndrome Following Subtrochanteric and Diaphyseal Femoral Fractures.

Acute compartment syndrome of the thigh (CST) is an ongoing challenge for orthopaedic surgeons as the diagnosis is often difficult to establish. Currently, there is a shortage of studies investigating risk factors for the development of thigh compartment syndrome following subtrochanteric and diaphyseal femoral fractures. This study aimed to identify risk factors associated with the development of CST following femoral fractures. Retrospective review performed in a level one trauma center from January 2011 to December 2020 for all patients with non-pathological acute subtrochanteric or diaphyseal femoral fractures. Variables collected included demographics, injury severity score (ISS) scores, mechanism of injury, classification of femoral fracture, open versus closed injuries, development of compartment syndrome, time to compartment syndrome diagnosis, number of subsequent surgeries, and primary wound closure versus split-thickness skin graft. The statistical analysis of this study included descriptive analysis, simple logistic regression, paired T-test, and Wilcoxon Signed Rank. Thirty-one (7.7%) patients developed thigh compartment syndrome following 403 subtrochanteric or diaphyseal femoral fractures. The mean (SD) age for those who developed CST was 27.35 (8.42). For every unit increase in age, the probability of developing CST decreased. Furthermore, male gender had 18.52 times greater probability of developing CST (P <0.001). AO/OTA 32-C3 and subtrochanteric femoral fracture patterns demonstrated 15.42 (P = 0.011) and 3.15 (P <0.001) greater probability of developing CST, respectively. Patients who presented to the hospital following a motor vehicle accident (MVA) or gunshot wound (GSW) had 5.90 (P= 0.006) and 14.87 (P < 0.001) greater probability of developing CST, respectively. Patients who were male, younger in age, and had a 32-C3 and subtrochanteric femoral fractures were at increased probability of developing CST. High energy trauma also increased the risk of developing CST. A high index of suspicion should be expressed in patients with these risk factors.

Diffusely Invasive Mucormycosis of the Small Bowel in a Patient with Microbiologic Cultures and Tissue Biopsies Negative for Fungal Organisms

Abstract Introduction/Objective Invasive mucormycosis can be a swiftly fatal medical emergency occurring in patients with uncontrolled diabetes. This angioinvasive fungus causes tissue necrosis, hemorrhage, and thrombosis and often develops in the sinonasal cavities where it can extend directly to the CNS or spread systemically to visceral sites like the GI tract. Here, we describe a patient whose small bowel resection shortly before death, revealed diffusely invasive mucormycosis despite that blood and body fluid cultures and tissue biopsies were negative for fungal organisms. Methods/Case Report Our patient is a 39 year old male with a history of uncontrolled diabetes, brought to our hospital in cardiac arrest and found to have fentanyl in his system. His labs showed severe metabolic and electrolyte derangements including diabetic ketoacidosis. His blood cultures revealed bacteremia but no fungal growth, and he was placed on antibiotics for sepsis. The patient developed compartment syndrome of his bilateral forearms, which were amputated and showed necrotic skeletal muscle but no fungal infection. The patient also developed facial necrosis concerning for mucormycosis, but nasal endoscopic and facial skin biopsies were negative for mucor. However, his abdominal CT showed diffuse mural thickening of his small bowel concerning for bowel ischemia, which prompted an exploratory laparotomy that revealed large segments of necrotic jejunum and ileum. While peritoneal fluids collected during the surgery yielded no fungal growth on culture, resected segments of necrotic small bowel showed massive presence of mucor with broad, pauci-septate, ribbon-like hyphae branching at right angles. Small bowel and mesenteric vessels showed angioinvasion by mucor with vasculitis and fibrin thrombi causing ischemic enteritis. Mucor was also noted diffusely invading small bowel muscularis propria, adventitia, and mesenteric fat, and small bowel also showed ulceration, hemorrhage, and transmural and mesenteric fat necrosis. Unfortunately, a few days after his surgery, the patient expired from multi-organ failure and septic shock before he could receive anti-fungal therapy for mucormycosis. Results (if a Case Study enter NA) NA Conclusion Mucormycosis is a rapidly growing, angioinvasive, and potentially lethal fungal infection that must be promptly recognized. This report documents an unusual case of invasive mucormycosis of the small bowel that went undetected in a severely ill patient whose blood and peritoneal cultures and tissue biopsies were all negative for fungal organisms.

Surgical Fasciotomies for Pediatric Acute Compartment Syndrome, and Overview

Introduction: The goal of treatment is firstly to save the patient's life and secondly to save the damaged climb. Fasciectomy is the only accepted treatment for compartment syndrome and should be performed promptly after the diagnosis is made. The results after fasciectomy are best when there is no delay in treatment. Method: Clinically determined according to the "5 P's" and measured Intracompartmental Pressure (ICP) with P ≥ 30 mmHg. Perform traditional Fasciotomies surgery on all patients. Results: There were four patients; Mean age: 54 months ± 31.749; Girl: 03; Boy: 01; Fall from hight: 2; Sport trauma: 01; Pedestrian in a car accident: 01; Mean - Intracompartmental Pressure (ICP): 53.75 mmHg.The most common mechanisms of injury are pedestrians struck by motor vehicles, falls, sports, and vehicle occupants in motor vehicle crashes. Forearm fractures are the most common cause in the upper extremity, and fractures of the tibia and/or fibula are most common in the lower extremity. Conclusions: Fractures significantly increase the risk of developing compartment syndrome in both forearm and leg fractures. The patients were transferred directly from the emergency room to the operating room, suggesting that the remaining developed compartment syndrome after admission or late diagnosis.