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An atypical presentation of compartment syndrome is reported in a chronic schizophrenic patient with a closed upper tibial fracture. The features of this case and a review of the literature pertaining to pain perception in this group of patients are presented to raise clinical awareness of this combination of disorders, which may lead to delayed treatment of a surgical emergency, consequent on lack...
Compartment syndrome is probably underdiagnosed particularly when the mechanism of injury is indirect. This case is unusual in that the syndrome occurred as a consequence of suction injury and illustrates the benefits of early tissue pressure measurement and surgical decompression.
In this review the aetiology, clinical signs, diagnosis and therapy of the acute compartment syndrome of the limb is discussed. It is a limb- and untreated life threatening emergency. For good results, early detection is necessary. It is important to educate those taking care of patients of risk, especially in the early symptoms and signs. In uncooperative, unconscious and sedated patients pressure...
Background: Acute compartment syndrome of the thigh is a rare condition, and the basic causes of high pressure within a muscle compartment have been considered to be intramuscular haematoma and soft-tissue oedema. However, the importance of arterial injury has not been well recognized. Methods: Among 3658 blunt trauma patients admitted to our Level 1 Trauma Centre between 1994 and 2001, there were...
Introduction: High occupancy rates of NHS beds has meant that increasing numbers of trauma patients find themselves on non-orthopaedic wards. Nursing staff on these wards may not have the specialist training to nurse such patients and may not recognise complications should they arise. The failure to recognise compartment syndrome was highlighted in a Clinical Governance meeting, leading to an assessment...
Plaster casts are often split to accommodate swelling following injury. This is not influenced by the axis of the split. The aim of this study was to compare the mechanical properties of plasters split along different axes.Full plasters were applied to mannequin forearms, and then split along dorsal, volar, radial or ulnar sides. Following this the plasters were loaded in a dorsal direction.We found...
In this review the aetiology, clinical signs, diagnosis and therapy of the acute compartment syndrome of the limb is discussed. It is a limb- and untreated life threatening emergency. For good results, early detection is necessary. It is important to educate those taking care of patients of risk, especially in the early symptoms and signs. In uncooperative, unconscious and sedated patients pressure...
Experimental evaluation of intracompartmental pressures in a fresh above knee amputated human leg.To determine what effect raised pressure in one compartment of the lower leg had upon its neighbour.There has been no previous reports of isolated compartment pathology, following low velocity trauma, causing a compartment syndrome in all four compartments of the lower leg.Immediately after leg amputation,...
Casting materials are commonly used in a trauma and post-operative setting in orthopaedic practice. Swelling after trauma or surgery is universal, hence, the importance of understanding the pressure–volume dynamics of various materials commonly used for casting. This study attempts to define the pressure response of casts made from three commonly used materials to increasing volume, using a cylindrical...
A delay in the diagnosis of an acute compartment syndrome can be devastating to the patient. The increasing use of regional anaesthesia in the management of orthopaedic and trauma patients raises concerns about the potential for delay in the diagnosis of acute compartment syndrome. We undertook a postal survey to assess the usage of regional anaesthesia in patients with lower limb fractures. The study...
There is an increase in aircraft transportation of patients with lower limb fractures. Current practice is variable. Our aim was to study current practice and to analyse the situation in an experimental simulated aircraft flight.Current advice supplied by commercial airline offices in the UK was noted. Postal questionnaires were sent to Orthopaedic Consultants in the UK to obtain their current practice...
Acute compartment syndrome represents a severe complication after trauma of the lower extremity. To date, there is limited knowledge about the outcome of compartment syndrome of the lower limb in patients with multiple injuries. We hypothesised that multiple injuries worsen the long term results of compartment syndrome of the lower leg. Patients who underwent fasciotomy for established compartment...
This paper reviews the current concepts of soft-tissue injury in orthopaedic trauma. Six topics are described in this Injury Supplement, including influencing factors and mechanisms, co-morbidities, biological responses, diagnosis and treatment of closed soft-tissue injury, compartment syndrome and gunshot wounds. Since one of the current AO principles emphasises respect for soft tissue when performing...
A cohort of 109 consecutive patients with a tibial fracture who underwent continuous compartment pressure monitoring of the anterior compartment of the leg were reviewed and compared to a historical control group of the immediate previous 109 patients who were clinically monitored. Of these patients 33 underwent fasciotomies for acute compartment syndrome in association with tibial diaphyseal fractures...
Intractable pain out of proportion to the injury sustained is considered to be the earliest and most reliable indicator of a developing compartment syndrome. We report 4 cases where competent sensate patients developed compartment syndromes without any significant pain. The first patient developed a painless compartment syndrome in the well leg following surgery for femoral fracture on the other side...
Compartment syndrome is a devastating complication after trauma to the extremities. Prompt fasciotomy is essential for avoiding disability and limb loss. The purpose of this study was to determine the incidence and predictors for the need for fasciotomy after extremity trauma.All trauma patients sustaining extremity injuries admitted to the LAC+USC Medical Centre during a 10-year period ending in...
The aim of the present study was to comparatively analyse certain outcome measures of open tibial fractures, stratified per grade of open injury and method of treatment. For this purpose, a systematic review of the English literature from 1990 until 2010 was undertaken, comprising 32 eligible articles reporting on 3060 open tibial fractures. Outcome measures included rates of union progress (early...
Acute compartment syndrome (ACS) in tibial diaphyseal fractures has been associated with such complications as infection, delayed fracture healing or non-union, sensory and motor deficits, deformities, and poor functional outcome. Essential condition of an uncomplicated recovery is early diagnosis with prompt decompression. A comprehensive review of the literature was performed to evaluate the impact...
Ischemia reperfusion (IR) injury occurs when tissue is reperfused following a period of ischemia, and results from acute inflammation involving various mechanisms. IR injury can occur following a range of circumstances, ranging from a seemingly minor condition to major trauma. The intense inflammatory response has local as well as systemic effects because of the physiological, biochemical and immunological...
Missed compartment syndrome can have devastating long-term impact on a patient's function. Femoral fracture has been reported in 52–58% of acute thigh compartment syndromes in the existing literature. Time to diagnosis of compartment syndrome is cited as a key determinant of outcome. Use of femoral nerve blocks in splinting of femoral fractures may mask signs of early compartment syndrome. We present...
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