Impending Compartment Syndrome Research Articles

A Single Large Center Experience of Medically Treating Impending Compartment Syndrome of Tibia with Deflazacort

Abstract Background: Acute compartment syndrome (ACS) is a rare condition characterized by increased pressure in the closed compartments of the limbs resulting in ischemic tissue necrosis. Most of the patients present following limb fractures. Apart from surgical options such as fasciotomy, which has inherent complication of myonecrosis and severe infection, conservative management with corticosteroids hasshown to be useful. We conducted this study to understand the changes in intra-compartment pressures in ACS after regular monitoring following corticosteroids treatment. Materials and Methods: Consecutive patients of ACS following closed fractures lower limb fractures of tibia or fibula from June 2021 to February 2022 were included. The intra-compartment pressure was measured using a manometer at the time of presentation and after 3, 6, 12, 24, 48, 72, and 96 h of treatment with tab Deflazacort 6 mg × 1 Tablet × Tds. The efficacy of treatment was assessed on the basis of changes in intra-compartmental pressure and improvement in the clinical signs and symptoms of ACS. Results: The study included 60 patients, most (63.3%) suffering from fracture of proximal tibia or fibula (36.7%), presenting with ACS. The mean age was 32.4 ± 8.6 years and most (53%) were males. We observed a statistically significant change (P < 0.05) in the intra-compartment pressures from the baseline to 3 h, 24 h, 48 h, 72 h, and 96 h after corticosteroid treatment. None of these patients suffered from ischemic necrosis or any other complication of ACS. Conclusion: Our results suggest that the timely diagnosis of ACS in patients with lower limb fractures and early initiation of conservative management with corticosteroids can be a mainstay of treatment in these patients. This conservative approach can avoid surgical intervention and reduce the cost of management.

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.

Clinical Laboratory Investigations and Antivenom Administration after Malayan Pit Viper (Calloselasma rhodostoma) Envenoming: A Retrospective Study from Southernmost Thailand.

The Malayan pit viper (MPV: Calloselasma rhodostoma) is a medically important venomous snake causing numerous envenomations in Thailand. Administration of specific snake antivenom is the only effective treatment for MPV-envenomed patients. However, inappropriate administration or misuse of snake antivenom is problematic in some remote areas of tropical countries where the snakebite envenoming rate is notable. Currently, the indications for administration of MPV antivenom are focused mainly on hematological factors. These include 1) venous clotting time > 20 min, 2) unclotted 20-minute whole-blood clotting time, 3) international normalized ratio > 1.2, 4) platelet count < 50 × 103/μL, 5) systemic bleeding, and 6) impending compartment syndrome. We aimed to determine the association between laboratory data and antivenom administration in MPV-envenomed patients. A retrospective study of data from 2016 to 2021 in Narathiwat Province, the southernmost province in Thailand, was conducted. A total of 838 MPV-bitten patients were included in this study. Local effects and systemic effects were observed in 58.8% and 27.7% of patients, respectively. Coagulopathies, which range from abnormal blood clotting to systemic bleeding, represented the majority of systemic effects. Acute kidney injury developed in 2.5% of patients. In this study, 57.3% of patients were considered appropriate antivenom recipients. Interestingly, the present study revealed that local bleeding and mild to moderate thrombocytopenia became the independent factors for inappropriate use of MPV antivenom. Reeducation and supervision regarding the rational use of snake antivenom are needed to minimize the misuse of antivenom.

Electrical impedance myography for the early detection of muscle ischemia secondary to compartment syndrome: a study in a rat model

Acute Compartment Syndrome (ACS) is one of the most devastating orthopedic conditions, affecting any of the body’s many compartments, which, if sufficiently severe, may result in disability and amputation. Currently, intra-compartmental pressure measurements serve as the gold standard for diagnosing ACS. Diagnosing limbs at risk for ACS before irreversible damage to muscle and nerve is critical. Standard approaches for diagnosing impending compartment syndrome include clinical evaluation of the limb, such as assessment for “tightness” of the overlying skin, reduced pulses distally, and degree of pain, none of which are specific or sensitive. We have proposed a novel method to detect ACS via electrical impedance myography (EIM), where a weak, high-frequency alternating current is passed between one pair of electrodes through a region of tissue, and the resulting surface voltages are measured via a second pair. We evaluated the ability of EIM to detect early muscle ischemia in an established murine model of compression-induced muscle injury, where we collected resistance, reactance, and their dimensionless product, defined as Relative Injury Index (RII) during the study. Our model generated reproducible hypoxia, confirmed by Hypoxyprobe™ staining of endothelial regions within the muscle. Under conditions of ischemia, we demonstrated a reproducible, stable, and significant escalation in resistance, reactance, and RII values, compared to uninjured control limbs. These data make a reasonable argument for additional investigations into using EIM for the early recognition of muscle hypoperfusion and ischemia. However, these findings must be considered preliminary steps, requiring further pre-clinical and clinical validation.

A Novel Approach in the Management of Tibial Plateau Fractures with Compartment Syndrome.

Compartment syndrome in tibial plateau fractures presents a formidable challenge for treating orthopedic surgeons. The most common strategy is early fasciotomy and external fixation, followed by a second stage definitive fixation. We conducted a prospective study of tibial plateau fractures of Schatzker Type V and VI with impending compartment syndrome treated by single-stage double incision fasciotomy and dual internal fixation and Vacuum-Assisted Closure (VAC). The study was between May 2014 and February 2019. 21 patients with impending compartment syndrome who underwent single-stage double incision fasciotomy and Open Reduction and Internal Fixation (ORIF) with dual plate were included in the study. The functional and radiological outcome was measured using the modified Rasmussen functional and radiological scoring and The Western Ontario and McMaster Universities Arthritis Index (WOMAC). The mean age of patients was 38.7years (Standard deviation of ± 9.48). The mean follow-up period was 27months (Standard deviation of ± 6.51). The mean functional and radiological modified Rasmussen score was 27.28 (range 21 to 29) & 8 (range 7 to 10), respectively. 4 patients had excellent outcomes, and 17 patients had good results. The mean WOMAC score was 8.04 (Standard deviation of ± 5.35). Five patients had a score of 0, 14 patients had a score of 1-10 and 2 had a score of 11-20. The early double incision fasciotomy and definitive internal fixation with dual plate and VAC as single-stage surgery in patients with impending compartment syndrome help to obtain excellent to good functional outcomes with reduced complications.

Evaluation of Radiological and Functional Outcome of Intra-articular Proximal Tibia Plateau Fracture Treated with Plating.

Proximal tibial plateau fractures are one of the major problems in orthopaedic surgery and are associated with high complication rates. Intra-articular proximal tibia plateau fractures represent approximately 1% of fractures in adults. Various modalities of proximal tibial plateau fracture management have been considered, ranging from simple external fixators in impending compartment syndrome to periarticular proximal tibia plates and inter-locking nails with poller screws. Purpose of this study is to determine clinical outcomes of proximal tibial plateau fractures treated with plate. We did this study of proximal tibial plateau fracture according to Schatzker's classification treated with proximal tibial periarticular plates in 53 patients prospectively admitted at the author's institute from June 2018 to May 2020 with follow-up period of 6 months. In our study, the average knee score was 89.30 (ranging from 79 to 93) and functional knee score was 97.92 (ranging from 75 to 100). Fifty-one (51) patients (96.23%) showed excellent results and 2 patients (3.77%) showed good results according to Knee Society Score, which suggest that internal fixation of proximal tibia plateau fracture with plating provides better results. Out of 53 patients, 9 patients had post-operative complications. Average radiological union was seen at 14 weeks. Locking compression plate in proximal tibia plateau fractures act as a good biological fixation provide stable fixation, articular reduction and limb alignment even in difficult fracture situations. Fixation of proximal tibia plateau fractures with plate gives excellent to good knee society score, with satisfactory functional and radiological outcome.

Functional outcome of hybrid external fixator in proximal tibial fractures Schatzker type V and VI with impending compartment syndrome

Purpose: To study the functional outcome of Hybrid external fixator in Proximal Tibial Fractures Schatzker type 5 and 6 with impending compartment syndrome.Methods: Prospective Interventional Study: A total of 18 patients with Proximal Tibial fractures Schatzker type 5 and 6 with impending compartment syndrome were included in our study. Out of 18 patients, 8 had Proximal tibial fracture Schatzker type 5 and 10 had type 6. Patients were followed up weekly for first month and monthly for 6 months with both clinical examination and imaging. Clinical outcomes were evaluated using Neer’s rating system for evaluation of knee.Results: The results - bony union, range of movements, and associated complications were assessed. All fractures united in an average time period of 20 weeks. Excellent outcome was noted in 44%, Good in 33%, fair in 11% and failure in 11% cases. 90% of patients had clinical and radiological union in 20 weeks.Conclusion: Hybrid external fixation is a reliable fracture fixation method that leads to satisfactory functional outcomes, while reducing the infection rate and wound dehiscence, allowing arthroplasty to be performed in the future if needed.

Assessment of Functional Outcome of Bicolumnar Dual Plating for Bicondylar Fractures of Tibial Plateau

Introduction: Operative treatment of bicondylar fractures of tibial plateau is challenging and controversial.&#x0D; Aims: The aim of this study is to reveal the functional outcome of it by using bicolumnar dual plates and screws.&#x0D; Methods: This is a prospective hospital based interventional study carried out in the department of Orthopaedics of Nepalgunj Medical College Teaching Hospital. Thirty two Schatzker type V or AO (Association of Osteosynthesis) type 41 C1 &amp; C2 fractures were treated between January 2016 and December 2019 with bicolumnar dual plating. The functional clinical outcomes were analyzed and evaluated using modified Rasmussen score.&#x0D; Results: Thirty two patients were included in the study. Out of which twenty four were male and eight were female. Average age was 32.21 years, eighteen were right sided and fourteen were left sided. Duration of surgery was 106 mins (range 90-120 mins) and the average duration of hospitalization was 7.81 days (range 4-14 days). Five patients of impending compartment syndrome and three patients with common peroneal nerve palsy were managed conservatively and also were included in the study. Two patients with superficial wound infection needed minimal debridement. One patient had varus angulation of 100 at third follow up after he fell from bed but surgical intervention were not needed. All fractures united. The average time for fracture healing was 21.5 weeks (range 16-32 weeks). At the Eighteen months follow up, the average knee range of motion was 1310(range 1100-1400). The functional outcome were evaluated using modified Rasmussen scoring system, which was 27.34 (range 22-30).&#x0D; Conclusion: Bicolumnar dual plating for bicondylar fractures of tibial plateau can provide excellent and stable fixation allowing early range of motion and gives excellent to good functional outcome.

An Unwonted, Pedagogic Case Report on Effort Thrombosis of Right Brachial Vein

Deep vein thrombosis (DVT) is one or more blood clots formed inside the deep vein in the body resulting in complete or partial blockage of blood flow through the affected vein. Upper Extremity DVT (UEDVT) accounts for 5% - 10% of all cases of DVTs. Previously it was thought to be a rare disorder. However in recent years with the advent of various indwelling intravenous devices, hypercoagulable state like COVID-19, secondary UEDVT did not remain infrequent presentation anymore. Though primary UEDVT, also known as Effort Thrombosis, that takes place without any underlying obvious pathology is a rare form till now. We presented a case of 46 years female who presented to the emergency with complaints of progressively increasing pain (7 days) and swelling (3 days) of her right forearm since last 7 days following strenuous and heavy work by her dominant/ right hand during the period of festival. She initially ignored her condition because of the Durga Puja festival. As her symptoms deteriorated she eventually had to attend the emergency department. Eventually an urgent ultrasonography color Doppler was done on emergency basis which diagnosed underlying DVT of her right brachial vein. She was managed with low molecular weight heparin, urgent fasciotomy owning to her impending compartment syndrome. Other tests ruled out any secondary underlying pathology. She improved and discharged without any complications on oral anticoagulant. Exigent events in her history were trauma followed by fall on her right elbow 2 months back and then presenting signs & symptoms commencing at the same region following strenuous, tedious activities over 7 days and consequential effort thrombosis of her right brachial vein. All of that compelled us to ruminate on rare differentials of her presentation and eventually come to this rare diagnosis. The author hence brought this pedagogic case to the readers, especially emergency & primary care physicians and emphasised the importance of being intuitive about rare but deadly differentials which come from proficiency & experience in the field of medicine.

Revisiting Management Strategies for Popliteal Artery Injuries.

Popliteal artery injuries (PAIs) were reported to own the highest rates of limb loss in vascular injuries of extremities. The complex nature of PAIs makes the treatment more difficult. We aimed to present our cases using our proposed algorithm and revisit the strategies for management. A retrospective study of 45 cases with PAIs managed at the Kaohsiung Chang Gung Memorial Hospital over a 10-year period was conducted. The proposed algorithm for decision making was applied, which contains variables including the interval before surgery, the revascularization being delayed or not, the presence of fasciotomy, the acquisition of preoperative angiography, and the existence of collateral circulation. Whether the injured limbs were salvaged successfully avoiding amputation was recorded. Of all the included 45 patients, the rate of a successful salvage of the injured limb from amputation was 71.1%. Six patients did not receive revascularization because of their poor conditions of the injured limbs. In terms of limb salvage in PAIs, the interval before surgery, the revascularization being delayed or not, the presence of fasciotomy, or the acquisition of preoperative angiography did not make a significant difference (P > 0.05). Instead, an existence of collateral circulation at the distal injured limb was correlated to a significant higher rate of salvage, regardless of having revascularization or not (P = 0.001 and < 0.001, respectively). Seven patients had the injured vessels repaired directly and all were prevented from amputation. In other patients who underwent vascular repair using a graft, vein graft (n = 20) showed a higher successful rate in salvage significantly than Gore-Tex graft (n = 9, P < 0.001). Collateral circulation determines much of the fate of limb salvage in PAIs. As a result, a delayed revascularization could be accepted as long as there is existence of collateral circulation at the distal injured limb. An autologous vein graft is favored when a direct repair is not able to be performed for revascularization. Although fasciotomy was not found to be associated with a successful salvage in this study, its importance could not be neglected and it should be performed when there is an observed or impending compartment syndrome.

Importance of MDCT for evaluating proximal tibia fractures

Proximal tibia fractures are most challenging fractures treated by surgeons, usually caused mainly due to high velocity trauma as motor vehicle accidents, sports injuries, due to varus or valgus load with or without axial loading or high energy trauma. Early diagnosis and better visualisation through recent radiological modalities can result in good prognosis in form of anatomical reduction and osteosynthesis and preventing impending compartment syndrome and later joint stiffness ,early mobilisation and finally good outcomes in form of patient and surgeon satisfaction. Initial diagnosis is usually made with plain skiagram in both anteroposterior and lateral views. NCCT knee with 3d reconstruction are newer modalities which help surgeon in planning for maintainance of articular surface and bone fragments than plain skiagrams. Material and methods: 30 patients were included in the study with isolated proximal tibia fractures. MDCT with plain skiagram was performed for deciding management as per Schatzker classification and were planned and managed accordingly Results: Out of thirty patients , majority of the patient classified as schatzker type 2 . The patients were managed accordingly as per fracture pattern. Conclusion: The importance of MDCT for proximal tibia fracture is very crucial in diagnosing as per classification and for better planning. Keywords: MDCT, Proximal fractures, Tibia

Safety and Efficacy of Prophylactic Closed Incision Negative Pressure Therapy after Acute Fracture Surgery

IntroductionSoft tissue swelling after acute fracture surgery is a challenge which may increase wound dehiscence, delay early range of motion, and increase infection rate postoperatively. This study investigates closed incision negative pressure therapy (ciNPT) using wide-range cover over the incision site and the peripheral swelling trauma zone to promote early active motion and to mitigate joint stiffness, bulla formation, and tendon adhesion. MethodsTwenty-nine patients were enrolled between January 2018 and December 2018. Patients with high-energy soft tissue trauma and comminuted fractures over distal end of limbs (hand and foot; wrist and ankle) or muscle scarcity areas (tibial shaft or patella) were included. ciNPT was applied over closed incisions in the operating room and subatmospheric pressure (-125 mmHg) initiated continuously for 5~7 days. ResultsIn hand and foot patients (n= 8), active motion over all fingers or toes occurred after post-operative Day 2. Mild swelling without any bullous formation was observed over the dorsal aspect of hand. In wrist and ankle patients (n= 16), flexion angle over the finger joints over 90 degrees was observed after 5 days post-surgery. For patients with tibial shaft comminuted fractures with impending compartment syndrome, early active motion of knee and ankle joint was observed as soft tissue swelling and distension pain had subsided after surgery. ConclusionThe prophylactic ciNPT use in the trauma area after surgery reduced postoperative distension pain and improved early range of motion of the tendon and joint in these patients.

Acute distal radius epiphyseal osteomyelitis in a 12year old boy presented as an impending compartment syndrome: A case report

A 12-year-old boy developed acute epiphyseal osteomyelitis of the distal radius following a fall. Despite a delay of 6days for the diagnosis, the patient was successfully treated with surgery and antibiotics. Clinical examination, complete blood count, erythrocyte sediment rate were crucial for the differential diagnosis, and intraoperative findings were the definitive diagnosis.

Impending hand compartment syndrome in an infant: is clinical evaluation enough to perform a fasciotomy?

The purpose of this case report is to raise awareness of the early diagnosis and treatment of compartment syndrome in children. Late diagnosis can lead to irreversible outcomes, including myonecrosis, neurologic injury, functional problems, and even amputation. In this age group, clinical judgment may be enough to proceed with fasciotomy.

Functional outcome of 59 patients of bicondylar tibial plateau fractures treated with internal vs external fixation: Selection criteria

Background: The purpose of this prospective study was to evaluate the Functional results of Internal versus External fixation of bicondylar tibial plateau fractures decided on specific selection criteria.Materials and Methods: Fifty nine patients with tibial condyle fractures (Schatzker type V and VI) were recruited in the study between Nov 2013 and Dec 2015 at our tertiary care hospital in Bengaluru, India. Open reduction and internal fixation with Dual Buttress plates, Buttress plate and CC screws was done in 38 patients (closed, Type I & II open with good skin conditions). Hybrid External fixation was done in 21 patients (closed, Type I & II open with bad skin conditions, Impending compartment syndrome). They were followed up at six weeks, six months and twelve months and was evaluated for the functional outcomes by Hospital for special surgery knee scoring system (HSS). Result: 86% of our patients had good to Excellent results according to HSS score. The outcomes between both modes of fixation were not significantly different at 1 year follow up. There was no difference in total arc of knee motion. Mean range of knee flexion in internal fixation was 115.79 + 21.290, External fixation was 115.24 + 13.370. Average HSS Score at final follow up for internal fixation was 78.87 + 10.94 and external fixation was 78.71 + 9.05. 2 patients needed flap surgery due to wound complications, 3 patients experienced infection following internal fixation compared to external fixator. 1 patient experienced non union following external fixation.Conclusion: Both methods of fixation in Bicondylar tibial plateau fractures gives a favourable functional outcome provided selection criteria is followed strictly. Level of Evidence: Level 3.

Interventional Management of Subcapsular Hepatic Hematoma with Hepatic Compartment Syndrome After Laparoscopic Adrenalectomy.

Hepatic compartment syndrome is an increase in intrahepatic pressure sufficient to cause compromised hepatic perfusion. Early recognition and prompt management are essential for preventing catastrophic consequences including ischemic liver failure and hypovolemic shock. This is the rare case of laparoscopic adrenalectomy resulting in subcapsular hepatic hematoma with hepatic compartment syndrome. Contrast-enhanced computed tomography demonstrated extensive subcapsular hepatic hematoma with collapse of portal vein and inferior vena cava suggesting impending compartment syndrome. Diagnostical catheter angiography of the liver revealed innumerable foci of petechial extravasation from disrupted isolated arteries. Emergent percutaneous catheter decompression and transarterial embolization were successful.

Stonefish (Synanceiea verrucosa) Envenomation in the Kingdom of Bahrain

Fishing, swimming, diving, and other water-based recreational activities are popular in the Kingdom of Bahrain and the Arabian Gulf. In this case report we describe a case of stonefish poisoning encountered by a 44-year-old fisherman on the coasts of Bahrain. Human envenomation is rare, and the Arabian Gulf is not the usual habitat of the stonefish. No accurate data is available on the incidence or international frequency of stonefish envenomation. This article describes the treatment and difficulties encountered with his management. We also review the proper management, medical guidelines, and care of stonefish poisoning. The patient presented with severe excruciating pain and edema of his upper limb. He was administered with intravenous analgesia for pain control and was admitted under surgical care for further management of impending compartment syndrome and underwent a fasciotomy. An antivenom for stonefish may be used, however is not available in Bahrain. He was discharged following treatment after 5 days of hospitalization. Although, stonefish is rare in our region, stonefish sightings have been reported in the Arabian Gulf. Management of stonefish and marine envenomation involves soaking the affected site in warm water to denature the venom, analgesia, and stonefish antivenom.

A prospective study of hybrid external fixation for proximal tibial fractures

INTRODUCTION: Intraarticular fractures of the tibial plateau and periarticular fractures of the proximal tibia, caused by high energy trauma pose a therapeutic dilemma. We present the use of hybrid external fixation system which includes Ilizarov ring fixator and AO rod external fixator connected with indigenously manufactured connecting clamps and short shafts augmented with or without minimal internal fixation1. AIM OF THE STUDY: 1. To assess the performance of the Hybrid External Fixator in the treatment of different types of proximal tibial fractures. 2. To evaluate the functional outcome, soft tissue healing and fracture union and radiological outcome. 3. To evaluate the biomechanical and biological advantage of hybrid external fixator. BIOMECHANICS : The mechanical characteristics of hybrid external fixation system can be called as SOLID ELASTIC. It gives solid enough for stabilization and providing micromotion which enhances good callus formation. MATERIALS: From August 2010 to November 2011, 21 caes of periarticular fractures of the proximal tibia were treated by use of 5/8 th Ilizarov ring, AO tubular external fixator and with indigenously manufactured connecting clamps & short shaft in a hybrid mode. All cases were prospectively followed up and studied. Almost all the cases (99%) had sustained Road traffic Accidents (high velocity injuries) except one case which had sustained injury by fall of cement wall over her leg. Minimum follow up – 1.5 months , maximum follow up – 12 months, mean follow up – 6.42 months .All the patients were in the age group of 26 to 65 years, mean age is 43.09. METHOD: SELECTION OF CASES: Inclusion Criteria: 1. Tibial plateau fractures according to Schatzkar classificafion Type 4, Type 5 and Type 6. 2. Proximal 1/4 extra articular tibial fractures (severely comminuted) 3. Open Proxial tibial fractures according to Gustillo Anderson Classification Gr 2, Gr 3A, 3B, 3C 4. Proximal tibial fracture with compartment syndrome after Fasciotomy. 5. High velocity proximal tibial fracture in impending compartment syndrome. Exclusion Criteria : 1. Schatzkar type 1 , type 2 and type 3. 2. More than 2 weeks old fractures. 3. Proximal tibial fractures with neurological disorder. 4. Proximal tibial fractures with paralytic disorder. SURGICAL TECHNIQUE: Reduce the articular surface initially. Determine the wire position. Minimum of 2 0r 3 wires are needed. Position the wires in the safe zone. Wire should be inserted 14 mm distal to the tibial plateau so that the capsule will not be pierced by wires.Each wire should be placed 30 – 50 degrees wide apart as possible. Olive wires are used to reduce and compress the fragments.place the shanz screws and assemble the frame. RESULTS: After analyzing the above characters we have obtained. Excellent results in 7 patients ( 33. 3% ), Good in 9 (42.35% ), Fair in 4 (19.04% ), Failure in 1(4.76% ) patient. CONCLUSION : The hybrid external fixator method we have applied is safe as regards of soft tissue healing and the limited number of complications associated directly to this method of application. We recommend a mini open reduction with percutaneous cannulated cancellous screw (one or two for securing interfragmentary compression) or olive wires with hybrid external fixator. This is the best method for closed (Schatzkar type 4, 5, 6) as well as open proximal tibial fractures.

Percutaneous mini open fasciotomy for impending acute compartment syndrome of leg: A study of 25 patients

Background: Compartment syndrome can complicate any fracture and is a challenge for orthopedic surgeons. It is an emergency condition which can lead to profound functional disability, ischemia and gangrene of limb if not promptly diagnosed and treated early. The fasciotomy procedure used widely for compartment syndrome of leg fracture is an open fasciotomy. Delay in fasciotomy wound healing, infection, need of secondary procedures may delay definite fracture fixations. Materials and Methods: We performed a prospective study of post traumatic tibia fractures with impending compartment syndrome treated by mini open percutaneous compartment fasciotomy. Results in terms of arrest of progression of the condition, wound complications, need for secondary procedure for wound healing and cosmetic appearance were evaluated Twenty five patients who were operated between 2010 and 2015 were selected for the study. 25 patients with fracture leg with impending compartment syndrome were treated with mini-open fasciotomy. Patients were reviewed post surgically and data was collected regarding symptoms and outcome assessment using specific parameters. Results: In all of our patients we were able to relieve the compartment pressure by this mini-open approach with pain relief in all (n=25) the patients within 6 hours. Mean healing time of the wound was 7 days and there was no wound infection. Percutaneous mini-open fasciotomy can arrest the progression of compartment syndrome. Need for secondary wound procedure like flap cover, skin grafting, vacuum assisted closure is not required. Definitive management of fracture can be done early with less hospital stay with good cosmetic results. Conclusion: Percutaneous mini-open fasciotomy can be used as a definitive procedure for impending compartment syndrome of leg with minimum surgical complications.

Two Staged Management Of Proximal Tibial Fractures With Impending Compartment Syndrome By Temporary External Stabilisation And Fasciotomy And Delayed Definative Fixation

Introduction: High energy proximal tibia fractures with soft tissue involvement presenting with dicolored patches over the leg and severe swelling, compound wounds, blisters with tight compartments and absent or feeble dorsalis pedis or posterior tibial arteries warrant to go in for a staged procedure. In patients with multiple injuries, an external fixator can be applied quickly with minimal blood loss for unstable periarticular fractures around the knee. Two-stage procedures involve (1) early joint spanning external fixators with fasciotomy for the medial and posterior compartments, (2) and late definitive fixation with plates or nails and with skin grafting. Materials and Methods: In our study, we present a short series of 15 proximal tibial fractures with impending compartment syndrome. Patients selected for this study were (1) closed proximal tibia fracture intra- and peri-articular and metaphysis diaphysis junction communited and noncommunited fractures (2) impending compartment syndrome evaluated based on excessive swelling, tight compartments, blisters over skin, feeble or absent dorsalis pedis or posterior tibial pulsations, color Doppler suggestive of severe subcutaneous edema associated with monophasic or absent flow over distal arteries. Exclusion criteria: (1) Low energy proximal tibia fracture without soft tissue insult and compound wounds over the proximal tibia fractures, (2) associated popliteal artery injuries. Conclusion: With the initial application of a bridging external fixator followed by delayed internal fixation protocol for pilon fractures has been successful in reducing the historically high rates of wound complications associated with these high-energy injuries. As well this protocol allows the use of minimally invasive plate osteosynthesis technique which is based on a combination of the principles of stability, restoration of anatomy and early motion while eliminating the need for excessive soft tissue dissection. Keywords: Proximal Tibial fractures, External fixators, Fasciotomy, Definitive fixation.