Asunto(s)
Síndromes Compartimentales , Fijación Intramedular de Fracturas , Fracturas de la Tibia , Humanos , Fracturas de la Tibia/cirugía , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Síndromes Compartimentales/diagnóstico , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/efectos adversos , Clavos Ortopédicos , Complicaciones Posoperatorias/etiología , Enfermedad Aguda , Masculino , FemeninoRESUMEN
PURPOSE: The purpose of this study was to determine the rates of compartment syndrome and other early complications following outpatient open reduction and internal fixation (ORIF) of tibial plateau fractures. METHODS: This was a retrospective cohort at a single US level I academic trauma centre of patients with tibial plateau fractures managed operatively. Inpatients received their definitive ORIF during their index hospital stay and were admitted post-operatively following ORIF. Outpatients were scheduled for ambulatory surgery during definitive ORIF. Exclusion criteria for outpatient surgery included compartment syndrome, polytrauma, open types IIIb/IIIc, and patients who received any internal fixation during index presentation. The primary outcome measure was post-operative compartment syndrome. Secondary outcomes were return to the 90-day return to the ED, 90-day readmission, surgical wound infection, thromboembolism, and 90-day mortality. An intention-to-treat (ITT) and as-treated (AT) analyses were performed. RESULTS: Totally, 71 inpatients and 47 outpatients were included. There were no cases of post-operative compartment syndrome. In the ITT analysis, there were no differences for inpatients vs outpatients for 90-day re-admission (22.5% vs 12.8%, p = 0.275), 90-day return to the ED (35.2% vs 17.0%, p = 0.052), infection (12.7% vs 2.1%, p = 0.094), DVT (7% vs 4.3%, p = 0.819), or PE 1.4% vs 0.0%, p = 1.000). The AT analysis showed a significantly higher 90-day re-admission (26.9% vs 2.5%, p = 0.003) and 90-day ED visit (38.5% vs 7.5%, p = 0.001) rate in the inpatient group. CONCLUSIONS: Appropriately selected patients with isolated tibial plateau fractures can have non-inferior rates of compartment syndrome and post-operative complications when compared to inpatients.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Síndromes Compartimentales , Fijación Interna de Fracturas , Readmisión del Paciente , Complicaciones Posoperatorias , Fracturas de la Tibia , Humanos , Fracturas de la Tibia/cirugía , Masculino , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Femenino , Estudios Retrospectivos , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Persona de Mediana Edad , Adulto , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Readmisión del Paciente/estadística & datos numéricos , Reducción Abierta/métodos , Reducción Abierta/efectos adversos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Tromboembolia/etiología , Anciano , Fracturas de la Meseta TibialRESUMEN
Peripheral nerve blocks are typically avoided for high-speed tibial plateau fractures due to their ability to mask the paresthesias and pain associated with the feared complication of acute compartment syndrome (ACS). We present a case in which sciatic nerve and adductor canal catheters were placed utilizing low-volume infusions allowing for neurovascular assessment. These catheters served as a valuable portion of the multi-modal pain regimen in this patient with a Schatzker VI tibial plateau fracture.
Asunto(s)
Bloqueo Nervioso , Nervio Ciático , Fracturas de la Tibia , Humanos , Fracturas de la Tibia/cirugía , Nervio Ciático/lesiones , Masculino , Catéteres/efectos adversos , Persona de Mediana Edad , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Fracturas de la Meseta TibialRESUMEN
PURPOSE: To assess the utility of a marginal full thickness blepharotomy (MFTB) for the treatment of orbital compartment syndrome. METHODS: An experimental study design employing a cadaver model for orbital compartment syndrome was used to assess the efficacy of an MFTB. Elevated orbital compartment pressures were created in 12 orbits of 6 fresh cadaver heads. Intraocular pressure, as an analog of orbital pressure, was measured before and after inferior and superior MFTBs were performed. Statistical analysis was performed on the collected data to assess the efficacy of the procedure. RESULTS: Both procedures were found to significantly lower the orbital compartment pressure. MFTB of the inferior lateral eyelid decreased orbital compartment pressure by an average of 62.2 mm Hg (95% CI, 56.9-67.5). MFTB of the superior lateral eyelid following MFTB of the inferior lateral eyelid decreased the orbital compartment pressure by an additional average of 10.3 mm Hg (total average reduction of 72.5 mm Hg; 95% CI, 68.1-76.9). CONCLUSIONS: Orbital compartment syndrome is a time-sensitive vision-threatening emergency that requires prompt diagnosis and intervention to prevent irreversible vision loss. The authors describe the MTFB, a simple one-step procedure that when performed correctly results in a significant decrease in orbital compartment pressure, making it a viable option when canthotomy and cantholysis fails or is unable to be performed.
Asunto(s)
Cadáver , Síndromes Compartimentales , Párpados , Presión Intraocular , Enfermedades Orbitales , Humanos , Síndromes Compartimentales/cirugía , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/fisiopatología , Síndromes Compartimentales/etiología , Párpados/cirugía , Presión Intraocular/fisiología , Enfermedades Orbitales/cirugía , Enfermedades Orbitales/diagnóstico , Órbita/cirugía , Procedimientos Quirúrgicos Oftalmológicos/métodosRESUMEN
Introduction: Local tissue destruction following envenomation from North American snakes, particularly those within the Crotalinae subfamily, has the potential to progress to compartment syndrome. The pathophysiology of venom-induced compartment syndrome (VICS) is a debated topic and is distinct from trauma/reperfusion-induced compartment syndrome. Heterogeneity exists in the treatment practices of VICS, particularly regarding the decision to progress to fasciotomy. Associations with functional outcomes and evolution in clinical practice since the introduction of Crotalidae polyvalent immune Fab (FabAV) have not been well defined. Our goal was to identify the potential gaps in the literature regarding this phenomenon, as well as illuminate salient themes in the clinical characteristics and treatment practices of VICS. Methods: We conducted this systematic scoping-style review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Records were included if they contained data surrounding the envenomation and hospital course of one or more patients who were envenomated by a snake species native to North America and were diagnosed with compartment syndrome from 1980-2020. Results: We included 19 papers: 10 single- or two-patient case reports encompassing 12 patients, and nine chart reviews providing summary statistics of the included patients. In case reports, the median compartment pressure when reported was 60 millimeters of mercury (interquartile range 55-68), 66% underwent fasciotomy, and functional outcomes varied. Use of antivenom appeared to be more liberal with FabAV than the earlier antivenin Crotalidae polyvalent. Rapid progression of swelling was the most commonly reported symptom. Among the included retrospective chart reviews, important data such as compartment pressures, consistent laboratory values, and snake species was inconsistently reported. Conclusions: Venom-induced compartment syndrome is relatively rare. Existing papers generally describe good outcomes even in the absence of surgical management. Significant gaps in the literature regarding antivenom dosing practices, serial compartment pressure measurements, and functional outcomes highlight the need for prospective studies and consistent standardized reporting.
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Antivenenos , Síndromes Compartimentales , Mordeduras de Serpientes , Animales , Humanos , Antivenenos/uso terapéutico , Síndromes Compartimentales/tratamiento farmacológico , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Fasciotomía , Fragmentos Fab de Inmunoglobulinas/uso terapéutico , Mordeduras de Serpientes/complicaciones , Mordeduras de Serpientes/tratamiento farmacológico , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: Purpose of the study was to answer the question, if there are common fracture or injury characteristics, which help to identify patient at risk for a secondary compartment syndrome. MATERIALS AND METHODS: Between 2003 and 2022 all children and adolescents who were treated for a traumatic compartment syndrome in a lower extremity were retrospectively evaluated. Patient's demographics were recorded, the underlying trauma mechanism identified. Fractures were classified, treatment and complications were analyzed. We differentiated two groups of patients (early onset vs. late onset) and compared trauma mechanism, fracture location, classification and treatment between those two entities. RESULTS: Our collective consisted of 56 children and adolescents with 67 compartment syndromes, with an average age of 14.1 years (5-17). 41 (73.2 %) of the patients were male and 15 (26.8 %) female. Most people in our sample had previously been involved in traffic accidents (64.3 %), with the most common mechanism of injury being "motorbike accident" (34.3 %) and "pedestrian/cyclist accident against car" (26.9 %). There was an accumulation of fractures of the lower leg, in particular tibial shaft fractures (AO 42 and 43A; 49.3 %). In our survey, dislocated fractures and fractures of the foot always led to an early onset of compartment syndrome. The tibial shaft fracture and the surgical treatment with intramedullary nailing showed a significant frequency in the late onset group. CONCLUSIONS: Special attention should be paid to pediatric and adolescent patients with tibial shaft fracture and surgical treatment with intramedullary nailing in order to detect and treat a possible late onset of a compartment syndrome at an early stage.
Asunto(s)
Síndromes Compartimentales , Humanos , Adolescente , Masculino , Femenino , Niño , Estudios Retrospectivos , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Preescolar , Extremidad Inferior/lesiones , Extremidad Inferior/cirugía , Fracturas Óseas/cirugía , Fracturas Óseas/epidemiología , Traumatismos de la Pierna/cirugía , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/complicaciones , Factores de Riesgo , Accidentes de Tránsito/estadística & datos numéricosRESUMEN
PURPOSE: Currently no guidance exists within the literature regarding diagnostic criteria or the long-term outcomes for paediatric patients with acute compartment syndrome (ACS). We conducted a retrospective cohort study reviewing all cases of paediatric ACS managed at a single tertiary referral centre with the aim of characterising the factors responsible for the eventual outcomes. METHODS: The patient cohort was identified retrospectively by interrogating the hospital coding system for all paediatric patients between January 2014 and November 2022. The electronic emergency department, inpatient and operative notes as well as clinic letters for each patient were reviewed and data collected regarding presentation, associated injuries, management and subsequent complications plus length of follow-up. The data was analysed to determine if differences in presentation or management affected long term outcome. RESULTS: The final cohort consisted of 34 patients with a mean age of ten years at the time of presentation. The mean time from presentation to fasciotomy was 27.6 h (range 3.0 - 66.6). There was an overall complication rate of 37.5% with a mean follow-up period of 21 months. Patients who had direct closure of their fasciotomy wounds had a significantly lower complications rate and fewer operations compared to those who healed via other wound coverage methods or secondary intention (p < 0.05). CONCLUSIONS: Significantly higher complication rates were observed in patients who were unable to have direct wound closure following emergency fasciotomy. This information may be utilised to rationalise long term treatment plans and in counselling of patients and parents.
Asunto(s)
Síndromes Compartimentales , Fasciotomía , Complicaciones Posoperatorias , Humanos , Fasciotomía/métodos , Niño , Estudios Retrospectivos , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/epidemiología , Masculino , Femenino , Preescolar , Adolescente , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Resultado del Tratamiento , LactanteRESUMEN
OBJECTIVE: Tibial tubercle avulsion fractures (TTAFs) represent 0.4% to 2.7% of pediatric physeal injuries. These injuries are thought to confer a risk of acute compartment syndrome (ACS), and these patients are often admitted for compartment monitoring and, in many cases, undergo prophylactic fasciotomy. This study sought to review our institution's experience with TTAF and associated compartment syndrome in pediatric patients. METHODS: All patients aged 8 to 18 years with TTAF at our institution from January 1, 2017 to January 1, 2023 were retrospectively reviewed. Patient demographics, injury mechanism, fracture morphology, and postinjury course were reviewed. ACS was diagnosed by clinical exam or necessitating therapeutic compartment fasciotomy. RESULTS: A total of 49 TTAFs in 47 patients were included in the final analysis. The mean age was 14.5 ± 1.2 years (range: 11 to 17), and males were significantly older than females (14.6 ± 1.1 vs 13.3 ± 1.3 y, P = 0.01). The average body mass index was 27.1 ± 7.0, and males had a significantly lower body mass index than females (26.3 ± 6.5 vs 34.1 ± 8.5, P = 0.03). Basketball was the most common mechanism of injury (49%), followed by soccer (13%), football (11%), trampoline (6%), fall (6%), jumping (4%), lacrosse (4%), running (4%), and softball (2%). The Ogden fracture types were as follows: I: 10%; II: 16%; III: 41%; IV: 24%; V: 8%. Thirty-four patients (69%) were admitted to the hospital for at least one night after presentation. Forty-six (96%) underwent surgical fixation an average of 3.5 days after injury. No patients developed ACS during their post-injury or postoperative course. Three patients underwent the removal of hardware. No other complications were observed. The average follow-up duration was 238 days. CONCLUSIONS: The results of this study suggest that the risk of ACS in pediatric patients with TTAF may be small enough to allow for same-day discharge after diagnosis or operative management in patients deemed to be sufficiently low risk by clinical judgment. LEVEL OF EVIDENCE: Level III-retrospective comparative study.
Asunto(s)
Síndromes Compartimentales , Fracturas por Avulsión , Fracturas de la Tibia , Humanos , Estudios Retrospectivos , Adolescente , Masculino , Femenino , Niño , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/complicaciones , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Fracturas por Avulsión/cirugía , Fasciotomía/métodos , Factores de Riesgo , Enfermedad Aguda , Traumatismos en Atletas/cirugía , Traumatismos en Atletas/complicacionesRESUMEN
BACKGROUND: Compartment syndrome is a well-known phenomenon that is most commonly reported in the extremities. However, paralumbar compartment syndrome is rarely described in available literature. The authors present a case of paralumbar compartment syndrome after high intensity deadlifting. CASE PRESENTATION: 53-year-old male who presented with progressively worsening low back pain and paresthesias one day after high-intensity deadlifting. Laboratory testing found the patient to be in rhabdomyolysis; he was admitted for intravenous fluid resuscitation and pain control. Orthopedics was consulted, and Magnetic Resonance Imaging revealed significant paravertebral edema and loss of muscle striation. Given the patient's lack of improvement with intravenous and oral pain control, clinical and radiographic findings, there was significant concern for acute paralumbar compartment syndrome. The patient subsequently underwent urgent fasciotomy of bilateral paralumbar musculature with delayed closure. CONCLUSION: Given the paucity of literature on paralumbar compartment syndrome, the authors' goal is to promote awareness of the diagnosis, as it should be included in the differential diagnosis of intractable back pain after high exertional exercise. The current literature suggests that operative cases of paralumbar compartment syndromes have a higher rate of return to pre-operative function compared to those treated non-operatively. This case report further supports this notion. The authors recommend further study into this phenomenon, given its potential to result in persistent chronic exertional pain and irreversible tissue damage.
Asunto(s)
Síndromes Compartimentales , Humanos , Masculino , Persona de Mediana Edad , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Dolor de la Región Lumbar/etiología , Rabdomiólisis/etiología , Rabdomiólisis/diagnóstico por imagen , Elevación/efectos adversosRESUMEN
PURPOSE: Acute compartment syndrome (ACS) remains a devastating complication of orthopaedic trauma. The tibial diaphysis is especially implicated in the development of ACS, both at the time of injury and after operative management. Identification of risk factors for ACS for these distinct scenarios has been investigated in a large cohort of patients. METHODS: This is a retrospective cohort study of all adults (age 18 years and older) presenting to a level 1 trauma centre with a diaphyseal tibia fracture. ACS was determined by a combination of clinical signs and symptoms and compartmental pressure monitoring. Potential risk factors were subject to univariate analysis with significant variables undergoing binary logistic regression analysis. RESULTS: 1147 tibial diaphyseal fractures over a twelve year period were studied. Age, multifragmented fracture pattern, male gender, high energy mechanism and intra- articular extension all showed a statistically significant association for ACS. Increasing body mass index (BMI) and treatment with an intramedullary nail favoured development of ACS post-operatively. CONCLUSION: Risk factors for the development of ACS specifically in tibial diaphyseal fractures have been highlighted. Patients managed with IMN or high BMI may warrant particular observation following operative intervention.
Asunto(s)
Síndromes Compartimentales , Diáfisis , Fracturas de la Tibia , Humanos , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/epidemiología , Fracturas de la Tibia/complicaciones , Masculino , Femenino , Factores de Riesgo , Estudios Retrospectivos , Adulto , Síndromes Compartimentales/etiología , Síndromes Compartimentales/epidemiología , Síndromes Compartimentales/cirugía , Síndromes Compartimentales/diagnóstico , Persona de Mediana Edad , Diáfisis/lesiones , Adolescente , Anciano , Adulto Joven , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/métodos , Índice de Masa Corporal , Enfermedad Aguda , Estudios de Cohortes , Anciano de 80 o más AñosRESUMEN
PURPOSE: To identify a cohort of isolated medial tibial plateau fractures treated with surgical fixation and to categorize them by Moore and Wahlquist classifications in order to determine the rate of complications with each fracture morphology and the predictive value of each classification system. We hypothesized there would be high rates of neurovascular injury, compartment syndrome, and complications overall with a higher incidence of neurovascular injury in Moore type III rim avulsion fractures and Wahlquist type C fractures that enter the plateau lateral to the tibial spines. METHODS: Patients who presented to six Level I trauma centers between 2010 and 2021 who underwent surgical fixation for isolated medial tibial plateau fractures were retrospectively reviewed. Data including demographics, radiographs, complications, and functional outcomes were collected. RESULTS: One hundred and fifty isolated medial tibial plateau fractures were included. All patients were classified by the Wahlquist classification of medial tibial plateau fractures, and 139 patients were classifiable by the Moore classification of tibial plateau fracture-dislocations. Nine percent of fractures presented with neurovascular injury: 5 % with isolated vascular injury and 6 % with isolated nerve injury. There were no significant differences in neurovascular injury by fracture type (Wahlquist p = 0.16, Moore p = 0.33). Compartment syndrome developed in two patients (1.3 %). The average final range of motion was 0.8-122° with no difference by Wahlquist or Moore classifications (p = 0.11, p = 0.52). The overall complication rate was 32 % without differences by fracture morphology. The overall rate of return to the operating room (OR) was 25 %. CONCLUSIONS: Isolated medial tibial plateau fractures often represent fracture-dislocations of the knee and should receive a meticulous neurovascular exam on presentation with a high suspicion for neurovascular injury. No specific fracture pattern was found to be predictive of neurovascular injuries, complications, or final knee range of motion. Patients should be counseled pre-operatively regarding high rates of return to the OR after the index surgery.
Asunto(s)
Fijación Interna de Fracturas , Rango del Movimiento Articular , Fracturas de la Tibia , Humanos , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/complicaciones , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Fijación Interna de Fracturas/métodos , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiología , Anciano , Lesiones del Sistema Vascular/fisiopatología , Lesiones del Sistema Vascular/cirugía , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Centros Traumatológicos , Radiografía , Fracturas de la Meseta TibialAsunto(s)
Amputación Quirúrgica , Analgésicos Opioides , Síndromes Compartimentales , Humanos , Síndromes Compartimentales/cirugía , Síndromes Compartimentales/etiología , Amputación Quirúrgica/estadística & datos numéricos , Factores de Riesgo , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Femenino , MasculinoRESUMEN
The positioning-related compartment syndrome is a well-known rare but absolutely avoidable event and is therefore often the subject of legal disputes. That is why medical personnel need to have detailed knowledge of the causes, pathophysiology, treatment and above all prevention.
Asunto(s)
Síndromes Compartimentales , Posicionamiento del Paciente , Humanos , Síndromes Compartimentales/etiología , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/cirugía , Síndromes Compartimentales/fisiopatología , Posicionamiento del Paciente/efectos adversosRESUMEN
INTRODUCTION: North American pit viper envenomation occurs over 4,000 times annually in the United States, with polyvalent Fab antivenom being the primary treatment. Fasciotomy is occasionally performed due to concerns about compartment syndrome. We utilized our direct access to Texas Poison Center Network data to create a new snakebite abstraction form and database on relevant available information between 2004 and 2021 and to identify, describe, and estimate the incidence of fasciotomy following pit viper envenomation in Texas. METHODS: We searched the Texas Poison Center Network database for cases during 2004-2021 using keywords such as fasciotomy, surgery, compartment pressure, and compartment syndrome. Descriptive statistics summarized the data. RESULTS: Of 16,911 reported envenomations, 0.69 percent involved fasciotomies (n = 117). Most common bite sites were digits/hands and lower extremities. Patients who underwent fasciotomy were typically male, aged 20-59, and 10 years younger than the total snakebite population. Only 6 percent of reported compartment syndrome cases had a compartment pressure measurement. Antivenom was administered in 101 (86.3 percent) cases, 92 (91.1 percent) of which received only Fab antivenom product. Patients with bites from rattlesnakes (47.9 percent) were associated with most fasciotomies. DISCUSSION: Our findings suggest a potential increase in snakebite exposures, accompanied by a decrease in fasciotomies. Overall, copperheads constituted the majority of snakebites, but most fasciotomies were from rattlesnake envenomations (47.9 percent). In this cohort, compartment syndrome diagnosis and decisions regarding fasciotomy were primarily based on clinical evaluation/surgeon expertise without compartment pressure measurements. Despite the efficacy of antivenom, only 86.3 percent of patients in our study received antivenom. CONCLUSIONS: Fasciotomy after North American pit viper envenomation in Texas is uncommon (0.69 percent) and has decreased over time, possibly due to increased antivenom use or surgeon comfort with nonsurgical management.
Asunto(s)
Antivenenos , Síndromes Compartimentales , Fasciotomía , Mordeduras de Serpientes , Mordeduras de Serpientes/epidemiología , Texas/epidemiología , Humanos , Antivenenos/uso terapéutico , Masculino , Adulto , Animales , Femenino , Persona de Mediana Edad , Síndromes Compartimentales/etiología , Síndromes Compartimentales/epidemiología , Síndromes Compartimentales/cirugía , Adulto Joven , Niño , Adolescente , Crotalinae , Preescolar , Anciano , Centros de Control de Intoxicaciones/estadística & datos numéricos , Venenos de Crotálidos/antagonistas & inhibidores , Bases de Datos FactualesRESUMEN
CASE: This report describes the case of quadriceps contusion progressing to acute compartment syndrome (ACS) of the thigh. A 17-year-old football player presented the morning after a direct impact injury to the anterior thigh in intractable pain and pain with short arc motion. He was diagnosed with ACS and underwent successful fasciotomy, ultimately returning to play at 4 months. CONCLUSION: ACS is rare but potential catastrophic progression of quadriceps contusion. Accurate and timely diagnosis followed by appropriate rehabilitation is necessary for optimal outcomes.
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Síndromes Compartimentales , Contusiones , Músculo Cuádriceps , Volver al Deporte , Humanos , Masculino , Adolescente , Síndromes Compartimentales/cirugía , Síndromes Compartimentales/etiología , Músculo Cuádriceps/lesiones , Fútbol Americano/lesiones , Fútbol/lesionesAsunto(s)
Síndromes Compartimentales , Hiperemia , Aplicación de Sanguijuelas , Esclerodermia Sistémica , Humanos , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/terapia , Hiperemia/etiología , Hiperemia/terapia , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Síndromes Compartimentales/terapia , Femenino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Retrobulbar haematoma is a rare emergency that can potentially lead to blindness. Common causes include facial trauma and surgery. Timely surgical evacuation of the haematoma improves visual outcomes. In rural communities, patients often present to hospital after many hours and this increases the risk of poor visual outcomes. Radiological evaluation which is often not available in rural communities, results in further delay in surgical treatment. This case report highlights the need for urgent surgical intervention over radiological evaluation in patients with retrobulbar haematoma and orbital compartment syndrome.
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Descompresión Quirúrgica , Hemorragia Retrobulbar , Humanos , Descompresión Quirúrgica/métodos , Hemorragia Retrobulbar/cirugía , Uganda , Órbita/lesiones , Órbita/cirugía , Órbita/diagnóstico por imagen , Masculino , Población Rural , Resultado del Tratamiento , Hematoma/cirugía , Tomografía Computarizada por Rayos X , Ceguera/etiología , Ceguera/cirugía , Femenino , Adulto , Síndromes Compartimentales/cirugía , Síndromes Compartimentales/etiologíaRESUMEN
Compartment syndrome (CS) is a well-known surgical emergency with high morbidity including potential long-term disability and limb loss. The most important factor determining the degree of morbidity with CS is time to treatment; therefore, early diagnosis and surgery are vital. We present a patient who fell off his bicycle and sustained cervical spine fractures causing near complete quadriplegia. He was found by the road over 12 hours later, so his creatine phosphokinase (CPK) was trended and serial examinations were performed. We identified tight deltoid, trapezius, and latissimus compartments and brought him to the operating room for fasciotomies. Although lab values and compartment pressures can be helpful, they should not guide treatment. It is important to consider atypical sites for CS and complete a head to toe physical examination. Patients should proceed to the operating room if clinical suspicion exists for CS because of the morbidity associated with a missed diagnosis.