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Ugeskrift For Laeger Jul 2021This review summarises the present knowledge of acute compartment syndrome, which is a time-critical diagnosis threatening both life and limb of the affected patients.... (Review)
Review
This review summarises the present knowledge of acute compartment syndrome, which is a time-critical diagnosis threatening both life and limb of the affected patients. Acute compartment syndrome is a clinical diagnosis, which in equivocal cases can be supported by direct intra-compartmental pressure measurement and laboratory values. Imaging can detect fractures; and non-invasive monitoring is under investigation but has not yet found clinical use. The treatment is a surgical fasciotomy, and this should be performed acutely. If diagnosis is made more than 24-48 hours after onset of symptoms, non-operative treatment should be considered.
Topics: Compartment Syndromes; Extremities; Fasciotomy; Humans
PubMed: 34219642
DOI: No ID Found -
Medicine Jul 2019Acute compartment syndrome (ACS) is defined as a clinical entity originated from trauma or other conditions, and remains challenging to diagnose and treat effectively.... (Review)
Review
BACKGROUND
Acute compartment syndrome (ACS) is defined as a clinical entity originated from trauma or other conditions, and remains challenging to diagnose and treat effectively. The review was aim to present the controversy in diagnosing, treating ACS. It was found that there was no criterion about the ACS, and result unnecessary osteotomy. The presence of clinical assessment (5P) always means the necrosis of muscles and was the most serious or irreversible stage of ACS. Besides pressure methods, the threshold of pressure identifying ACS was also controversial.
METHODS
Immediate surgical fasciotomy was important to prevent severe suquelae of the ACS. However, there was still controversy about the right time that fasciotomy should be done to avoid irreversible ischemic changes. The most important thing to treat ACS was comprehension to the true injury mechanism, but a systemic classification about traumatic mechanism in most literature was not clear.
RESULTS
After observations to fracture patients with blister, we recommended that surgeons dealing with such emergencies should be vigilant, and the indication for fasciotomy should be strictly controlled following with injury mechanism especially for patients without severe soft tissue injury.
CONCLUSION
For those crushing and soft tissue injuries, the current evidence based strategies for managing patients was useful, but for those fracture related injury, more examination was necessary to avoid overtreatment especially for those patients with blister observed. In facing patients, medical history, injured mechanism should be paid special attention, and rigorous classification about traumatic etiology was the key for the treatment of these patients.
Topics: Acute Disease; Compartment Syndromes; Diagnostic Imaging; Fasciotomy; Humans; Prognosis; Wounds and Injuries
PubMed: 31277147
DOI: 10.1097/MD.0000000000016260 -
Critical Care (London, England) Mar 2020This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at... (Review)
Review
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
Topics: Abdominal Cavity; Compartment Syndromes; Critical Illness; Disease Management; Humans; Intensive Care Units; Intra-Abdominal Hypertension
PubMed: 32204721
DOI: 10.1186/s13054-020-2782-1 -
The New England Journal of Medicine Nov 2017
Topics: Adult; Compartment Syndromes; Decompression, Surgical; Edema; Humans; Male; Time-to-Treatment
PubMed: 29117495
DOI: 10.1056/NEJMicm1701729 -
Journal of Orthopaedic Surgery (Hong... Jan 2017We evaluated the risks and success rates of the three major techniques for compartment syndrome fasciotomy closure by reviewing all literature published to date....
We evaluated the risks and success rates of the three major techniques for compartment syndrome fasciotomy closure by reviewing all literature published to date. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically evaluated the Medline (PubMed) database until July 2015, utilizing the Boolean search sting "compartment syndrome OR fasciotomy closure." Two authors independently assessed all studies published in the literature to ensure validity of extracted data. The data was compiled into an electronic spreadsheet, and the wound closure rate with each technique was assessed utilizing a proportion random model effect. Success was defined as all wounds that could be closed without skin grafting, amputation, or death. The highest success rate was observed for dynamic dermatotraction and gradual suture approximation, whereas vacuum-assisted closure had the lowest complication rate.
Topics: Humans; Compartment Syndromes; Fasciotomy; Wound Closure Techniques
PubMed: 28176601
DOI: 10.1177/2309499016684724 -
Biomedical Papers of the Medical... Sep 2017Acute compartment syndrome (ACS) is a potential orthopaedic/traumatology emergency. Without prompt, precise diagnosis and immediate treatment with surgical decompressive... (Review)
Review
Acute compartment syndrome (ACS) is a potential orthopaedic/traumatology emergency. Without prompt, precise diagnosis and immediate treatment with surgical decompressive fasciotomy it can lead to neurological dysfunction and disability. The role of regional anaesthesia (RA) in patients at risk for ACS/ and in those with developed ACS is controversial. The aim of this critical review was to answer the question, whether regional anaesthesia can delay the diagnosis. The authors use an evidence-based approach to discuss these high risk patients in considering RA as a method of choice for effective analgesia. To the date of data collection, there was no single case report identified where RA alone led to delay in ACS diagnosis and surgical treatment. In four clinical cases, epidural analgesia can be associated with delayed ACS diagnosis. Frequent clinical evaluation and breakthrough pain despite a functional RA in combination with intracompartment pressure measurement remains the keystone of recommended management for patients at risk of ACS.
Topics: Anesthesia, Epidural; Compartment Syndromes; Decompression, Surgical; Delayed Diagnosis; Evidence-Based Medicine; Fasciotomy; Humans; Monitoring, Physiologic; Risk Factors; Time-to-Treatment
PubMed: 28539673
DOI: 10.5507/bp.2017.025 -
BMJ Case Reports May 2022A man in his 30s with a history of cocaine and intranasal heroin use presented to the emergency department with severe leg pain and weakness. Physical examination...
A man in his 30s with a history of cocaine and intranasal heroin use presented to the emergency department with severe leg pain and weakness. Physical examination findings were significant for tachycardia, absence of dorsalis pedis pulses, tense and painful calf muscles along with absence of plantar reflexes in bilateral lower extremities. Laboratory investigations were significant for positive urinary drug screen for cocaine, severe rhabdomyolysis and acute kidney injury. Given the absence of dorsalis pedis pulses in bilateral lower extremities and radiological evidence of oedematous changes in calf muscles with perimuscular oedema, a diagnosis of compartment syndrome was made. He was treated with bilateral lower extremity four-compartment fasciotomies and haemodialysis for acute kidney injury. Rhabdomyolysis has been attributed to cocaine use; however, compartment syndrome is a very rare complication, especially in the absence of trauma or prolonged immobilisation.
Topics: Acute Kidney Injury; Cocaine; Compartment Syndromes; Fasciotomy; Humans; Male; Pain; Rhabdomyolysis
PubMed: 35589265
DOI: 10.1136/bcr-2022-249413 -
Frontiers in Immunology 2023Our primary purpose was to explore the landscape of inflammation-related proteins, and our second goal was to investigate these proteins as potential biomarkers of acute...
PURPOSE
Our primary purpose was to explore the landscape of inflammation-related proteins, and our second goal was to investigate these proteins as potential biomarkers of acute compartment syndrome (ACS), which is a serious complication of tibial fractures.
METHODS
We collected sera from 15 healthy subjects (control group, CG) and 30 patients with tibial fractures on admission day, comprising 15 patients with ACS (ACS group, AG) and 15 patients without ACS (fracture group, FG). Ten samples in each group were analyzed by the inflammation panel of Olink Proteomics Analysis, and all samples were verified by an ELISA. Receiver-operating characteristic (ROC) curve analysis was performed to identify the diagnostic ability and cutoff values of potential biomarkers.
RESULTS
Our findings showed that the levels of IL6, CSF-1, and HGF in the FG were significantly higher than those in the CG. Similar results were found between the AG and CG, and their cutoff values for predicting ACS compared with the CG were 9.225 pg/ml, 81.04 pg/ml, and 0.3301 ng/ml, respectively. Furthermore, their combination had the highest diagnostic accuracy. Notably, compared with FG, we only found a higher expression of CCL23 in the AG. Additionally, we identified 35.75 pg/ml as the cutoff value of CCL23 for predicting ACS in patients with tibial fractures.
CONCLUSION
We identified CCL23 as a potential biomarker of ACS in comparison with tibial fracture patients and the significance of the combined diagnosis of IL6, CSF-1, and HGF for predicting ACS compared with healthy individuals. Furthermore, we also found their cutoff values, providing clinicians with a new method for rapidly diagnosing ACS. However, we need larger samples to verify our results.
Topics: Humans; Macrophage Colony-Stimulating Factor; Interleukin-6; Proteomics; Compartment Syndromes; Inflammation; Biomarkers; Tibial Fractures
PubMed: 38045696
DOI: 10.3389/fimmu.2023.1293826 -
BMJ Case Reports Dec 2021
Topics: Child; Compartment Syndromes; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Intensive Care Units, Pediatric; Plastic Surgery Procedures
PubMed: 34857592
DOI: 10.1136/bcr-2021-246013 -
Acta Medica (Hradec Kralove) 2020Acute compartment syndrome occurs most frequently in connection with injuries, terminal or chemical damage of tissues, ischemia, the activity of toxins or in patients...
Acute compartment syndrome occurs most frequently in connection with injuries, terminal or chemical damage of tissues, ischemia, the activity of toxins or in patients with tissue ischemia or muscle necrosis. Clinical findings have found pronounced pain, followed by paresthesias, pallor, and paresis. Decreased pulsation of arteries has also been a frequent finding. In severe forms decompressive fasciotomy has been indicated within the first 12-24 hours after diagnosis. In the following paper, the authors present the case report of a 68-year woman who swallowed 1500 mg of trazodone as an attempt at suicide. After 12 hours her husband found her lying on the carpet with compression of the left arm under the trunk. The patient was treated conservatively and followed clinically, examined by ultrasonography, EMG and finally MRI.
Topics: Aged; Antidepressive Agents, Second-Generation; Compartment Syndromes; Computed Tomography Angiography; Conservative Treatment; Female; Forearm; Humans; Magnetic Resonance Imaging; Neurologic Examination; Paresis; Suicide, Attempted; Trazodone; Treatment Outcome; Ultrasonography
PubMed: 33002399
DOI: 10.14712/18059694.2020.26