Orthopaedic Complications (Subscribe)
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- Complications Abstracts (2)
- Abstracts on orthopedic complications from proceedings of orthopaedic meetings & societies
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Compartment Syndromes
Wheeless' Textbook of Orthopaedics
compartment syndrome is elevation of interstitial pressure in closed fascial compartment that results in microvascular compromise;
- as duration & magnitude of interstitial pressure increase, myoneural function is impaired & necrosis of soft tissues eventually develops;
Complex regional pain syndrome A review
Review of CRPS (Reflex Sympathetic Dystrophy) Journal of Postgraduate Medicine 50(4)2004
Antibiotics for preventing infection in open limb fractures popular
Summary: Antibiotics are effective in preventing early infection in open fractures of the limbs
Wound and bone infections are common complications following open fractures of the limbs. For more than 20 years, in developed countries, the use of antibiotics has been a part of a standard management protocol that also includes irrigation, surgical debridement, and stabilisation when indicated. The review of trials found that antibiotics are effective in decreasing the incidence of wound infections, as compared to no antibiotics or placebo. No studies on bone infection or long-term morbidity were identified. (Cochrane Review)
Gosselin RA, Roberts I, Gillespie WJ. Antibiotics for preventing infection in open limb fractures. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD003764.
Gosselin RA, Roberts I, Gillespie WJ. Antibiotics for preventing infection in open limb fractures. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD003764.
Audit of Deep Wound Infection following Hip Fracture Surgery
From Journal RCSE
Acute Compartment Syndrome Of The Leg
BMJ editorial BMJ 2002;325:557-558
Acute limb compartment syndrome is a surgical emergency characterised by raised pressure in an unyielding osteofascial compartment. Sustained elevation of tissue pressure reduces capillary perfusion below a level necessary for tissue viability, and irreversible muscle and nerve damage may occur within hours. Causes include trauma, revascularisation procedures, burns, and exercise. Regardless of the cause, the increased intracompartmental pressure must be promptly decompressed by surgical fasciotomy. Missed diagnosis and late decompression are associated with significant morbidity due to irreversible ischaemic necrosis of the muscles and nerves in the compartment. Increased awareness of the syndrome and the advent of measurements of intracompartmental pressure have raised the possibility of early diagnosis and treatment. Recent publications have, however, highlighted some of the problems associated with measurements of intracompartmental pressure. 1 2 Furthermore, late or poorly performed fasciotomies may contribute to morbidity
Antibiotic Prophylaxis
Perioperative Prophylactic Antibiotics:
- it is essential that antibiotics be given prior to incision;
- in most cases, patients should receive 1-2 gm of IV Ancef 30 min prior to the incision
Wheeless' Textbook of Orthopaedics
- it is essential that antibiotics be given prior to incision;
- in most cases, patients should receive 1-2 gm of IV Ancef 30 min prior to the incision
Wheeless' Textbook of Orthopaedics
Antithrombotic Therapy
Antithrombotic Therapy. SIGN Guideline. SIGN Publication No. 36
ISBN 1899893 76 8
Published March 1999
Chronic And Exertional Compartment Syndromes
Wheeless Textbook of Orthopaedics. Notes on:
Anterior Compartment Syndrome:
Posterior Compartment Syndrome
Lateral Compartment Syndrome
Non Operative Treatment
Indications for Surgery
Technique: (chronic anterior compartment syndrome)
Anterior Compartment Syndrome:
Posterior Compartment Syndrome
Lateral Compartment Syndrome
Non Operative Treatment
Indications for Surgery
Technique: (chronic anterior compartment syndrome)
Compartment Syndrome Diagnosis
Medscape Journal Scan April 2004 Review of articles on missed diagnosis of compartment syndrome
Compartment Syndrome Of The Foot
Wheeless Textbook of Orthopaedics
compartment syndromes can occur in the foot as in other parts of body;
- mechanism of injury is severe local trauma, & assoc skeletal injury
may be minimal;
- classic symptoms & signs are progressive pain, numbness in toes, and
decreased motion, however, these are the same symptoms that one would
expect to find w/ concomitant foot fractures and injury;
- tense tissue bulging may be the most reliable symptom;
- compartmental pressures will be elevated;
- note that compartment syndromes of the foot are associated w/ compartment
syndromes of the deep posterior compartment;
Compartment Syndrome Of The Thigh
Wheeless' Textbook of Orthopaedics
- compartment syndrome is uncommon in thigh because of large-volume that the thigh requires to cause a pathological increase in
interstitial pressure;
- fascial compartments of thigh blend anatomically w/ muscles of hip,potentially allowing extravasation of blood outside compartment;
- compartment syndrome may be caused by a decrease in compartmental volume, increase in compartmental contents, or externally pressure;
Compartment Syndrome Resulting From Tibial Fracture
compartment syndrome following tibia fractures are most common in closed frx (upto 20% of frx) but may also occur following open frx;
- cast immobilization may increase pressure;
- it remains unclear whether IM nailing will increase or decrease compartment pressures, but on occassion the surgeon may find
a significant decrease in pressure measurements following nailing;
- references:
- Compartment syndrome in open tibial fractures.
- Compartment syndrome after intramedullary nailing of the tibia.
- compartment pressures measurements:
- most common finding is isolated elevation in the deep posterior compartment followed by isolated elevation in the anterior compartment;
- be sure to measure pressure in the deep posterior compartment as well as anterior & superficial compartments;
- associated factors:
- cast immobilization may increase pressure;
- intramedullary nailing:
- it remains unclear whether IM nailing will increase or decrease compartment pressures, but on occassion the surgeon may find
a significant decrease in pressure measurements following nailing;
- compartment pressures measurements:
- most common finding is isolated elevation in the deep posterior compartment
followed by isolated elevation in the anterior compartment;
- be sure to measure pressure in the deep posterior compartment as well as anterior & superficial compartments;
- compartment pressure measurements should be taken as close to the frx site as possible (since these will give the highest readings);
- peak compartment pressures will be located within 5 cm of frx;
- measurements away from the frx site may underestimate compartment pressure;
- sterile technique is a must when compartments are measured, otherwise the frx hematoma may become infected;
Compartment Syndromes Of The Hand And Forearm
Wheeless Textbook of Orthopaedics
Compartment Syndromes Of The Upper Extremity
SOA - Orthopaedic Care.net Textbook
The purpose of this chapter is to provide an overview of acute upper extremity compartment syndrome. It will review the causes, the pathophysiology, the diagnosis, and the treatment of this condition. Some discussion of chronic compartment syndrome is also presented.
Compartmental Syndromes
Compartmental Syndromes
A compartmental syndrome is a condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space. This condition is a cause of major loss of function, limb and even life. It can result from trauma, prolonged recumbancy (in surgery or resulting from drugs or alcohol), or physical activity. It is common enough to affect thousands of individuals each year, yet rare enough that each physician may encounter it only once or twice during his or her career.
A compartmental syndrome is a condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space. This condition is a cause of major loss of function, limb and even life. It can result from trauma, prolonged recumbancy (in surgery or resulting from drugs or alcohol), or physical activity. It is common enough to affect thousands of individuals each year, yet rare enough that each physician may encounter it only once or twice during his or her career.
Editors
- Chris Oliver