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[PMID]:28872527
[Au] Autor:Challa ST; Hargens AR; Uzosike A; Macias BR
[Ad] Endereço:1Department of Orthopaedic Surgery, UC San Diego Medical Center, University of California, San Diego, San Diego, California.
[Ti] Título:Muscle Microvascular Blood Flow, Oxygenation, pH, and Perfusion Pressure Decrease in Simulated Acute Compartment Syndrome.
[So] Source:J Bone Joint Surg Am;99(17):1453-1459, 2017 Sep 06.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The current gold standard for diagnosing acute compartment syndrome (ACS) is an assessment of clinical signs, invasive measurement of intramuscular pressure (IMP), and measurement of local perfusion pressure. However, IMP measurements have several shortcomings, including pain, risk of infection, risk of technique error, plugging of the catheter tip, lack of consensus on the diagnostic pressure threshold, and lack of specificity and sensitivity. The objective of this study was to evaluate muscle hemodynamics, oxygenation, and pH as diagnostic parameters in a human model of ACS. We hypothesized that as IMP increases, muscle microvascular blood flow, oxygenation, and pH decrease in the anterior compartment of a leg at heart level and that they decrease significantly more when the leg is elevated further. METHODS: An external pneumatic leg pressure chamber, combined with a venous stasis thigh cuff, was used to increase IMP and simulate ACS. Eight healthy subjects (5 males and 3 females; mean age, 26 years) had photoplethysmography and near-infrared spectroscopy-pH sensors placed over the middle aspect of the tibialis anterior muscle of the right (experimental) and left (control) legs. Leg chamber pressure conditions (40, 50, and 60 mm Hg) were applied in a randomized order after baseline measurements were taken. Data were collected continuously for each 11-minute pressure condition, with an 11-minute recovery period after each condition, and the average of the last 6 minutes was used for data analyses. The same protocol was repeated with each subject's legs elevated 12 cm above heart level. Data were analyzed using repeated-measures analysis of variance (ANOVA). RESULTS: As IMP increased, muscle microvascular blood flow (p = 0.01), oxygenation (p < 0.001), and pH (p < 0.001) all decreased significantly in the experimental leg compared with the control leg. At all IMP levels, leg elevation significantly decreased muscle oxygenation (p = 0.013) and perfusion pressure (p = 0.03) compared with the control leg at heart level. CONCLUSIONS: These results indicate that muscle microvascular blood flow, oxygenation, pH, and perfusion pressure decrease significantly as IMP increases in a human model of ACS. CLINICAL RELEVANCE: This study identifies hemodynamic and metabolic parameters as potential noninvasive diagnostic tools for ACS.
[Mh] Termos MeSH primário: Síndrome do Compartimento Anterior/fisiopatologia
Músculo Esquelético/irrigação sanguínea
[Mh] Termos MeSH secundário: Adulto
Síndrome do Compartimento Anterior/etiologia
Pressão Sanguínea/fisiologia
Feminino
Seres Humanos
Concentração de Íons de Hidrogênio
Masculino
Microcirculação/fisiologia
Modelos Cardiovasculares
Simulação de Paciente
Fluxo Sanguíneo Regional/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.16.01191


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[PMID]:27451420
[Au] Autor:Zimmermann WO; Helmhout PH; Beutler A
[Ad] Endereço:Department of Training Medicine and Training Physiology, Royal Dutch Army, Utrecht, The Netherlands.
[Ti] Título:Prevention and treatment of exercise related leg pain in young soldiers; a review of the literature and current practice in the Dutch Armed Forces.
[So] Source:J R Army Med Corps;163(2):94-103, 2017 Apr.
[Is] ISSN:0035-8665
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Overuse injuries of the leg are a common problem for young soldiers. This article reviews the literature concerning the prevention and treatment of exercise related leg pain in military settings and presents the latest developments in proposed mechanisms and treatments. Current practice and treatment protocols from the Dutch Armed Forces are reviewed, with an emphasis on the most prevalent conditions of medial tibial stress syndrome and chronic exertional compartment syndrome. The conclusion is that exercise related leg pain in the military is an occupational problem that deserves further study.
[Mh] Termos MeSH primário: Síndrome do Compartimento Anterior/prevenção & controle
Transtornos Traumáticos Cumulativos/prevenção & controle
Exercício
Síndrome da Tensão Tibial Medial/prevenção & controle
Medicina Militar
Militares
Doenças Profissionais/prevenção & controle
[Mh] Termos MeSH secundário: Síndrome do Compartimento Anterior/terapia
Transtornos Traumáticos Cumulativos/terapia
Seres Humanos
Perna (Membro)
Traumatismos da Perna/prevenção & controle
Traumatismos da Perna/terapia
Síndrome da Tensão Tibial Medial/terapia
Dor Musculoesquelética/prevenção & controle
Dor Musculoesquelética/terapia
Países Baixos
Doenças Profissionais/terapia
Dor/prevenção & controle
Esforço Físico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160725
[St] Status:MEDLINE
[do] DOI:10.1136/jramc-2016-000635


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[PMID]:28027611
[Au] Autor:Balius R; Bong DA; Ardèvol J; Pedret C; Codina D; Dalmau A
[Ad] Endereço:Consell Catalá de l'Esport, Generalitat de Catalunya, Barcelona, Spain.
[Ti] Título:Ultrasound-Guided Fasciotomy for Anterior Chronic Exertional Compartment Syndrome of the Leg.
[So] Source:J Ultrasound Med;35(4):823-829, 2016 Apr.
[Is] ISSN:1550-9613
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Chronic exertional compartment syndrome is characterized by exertional pain and elevated intracompartmental pressures affecting the leg in physically active young people. In patients who have failed conservative measures, fasciotomy is the treatment of choice. This study presents a new method for performing fasciotomy using high-resolution ultrasound (US) guidance and reports on the clinical outcomes in a group of these patients. Over a 3-year period, 7 consecutive patients with a total of 9 involved legs presented clinically with anterior compartment chronic exertional compartment syndrome, which was confirmed by intracompartmental pressure measurements before and after exercise. After a US examination, fasciotomy under US guidance was performed. Preoperative and postoperative pain and activity levels were assessed as well as number of days needed to "return to play." All patients had a decrease in pain, and all except 1 returned to presymptomatic exercise levels with a median return to play of 35 days.
[Mh] Termos MeSH primário: Síndrome do Compartimento Anterior/diagnóstico por imagem
Síndrome do Compartimento Anterior/cirurgia
Traumatismos em Atletas/diagnóstico por imagem
Traumatismos em Atletas/cirurgia
Fasciotomia/métodos
Ultrassonografia de Intervenção/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Doença Crônica
Seguimentos
Seres Humanos
Perna (Membro)/diagnóstico por imagem
Perna (Membro)/cirurgia
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161228
[St] Status:MEDLINE
[do] DOI:10.7863/ultra.15.04058


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[PMID]:27780511
[Au] Autor:Jiang LF; Li H; Xin ZF; Wu LD
[Ad] Endereço:Department of Orthopedics Surgery, Second Hospital of Medical College, Zhejiang University, Hangzhou, China.
[Ti] Título:Computed tomography angiography and magnetic resonance imaging performance of acute segmental single compartment syndrome following an Achilles tendon repair: A case report and literature review.
[So] Source:Chin J Traumatol;19(5):290-294, 2016 Oct 01.
[Is] ISSN:1008-1275
[Cp] País de publicação:China
[La] Idioma:eng
[Ab] Resumo:Acute compartment syndrome of the lower extremity is a serious postinjury complication that requires emergency treatment. Early diagnosis is of paramount importance for a good outcome. Four muscle compartments in the calf (anterior, lateral, deep posterior, and superficial posterior) may be individually or collectively affected. Acute segmental single-compartment syndrome is an extremely rare condition characterized by high pressure in a single compartment space with threatening of the segmental tissue viability. In this case report, we describe a young man with Achilles tendon rupture who complained of postoperative pain in the anterior tibial region. Emergent computed tomography angiography and magnetic resonance imaging revealed local muscle edema. Segmental anterior compartment syndrome was diagnosed and fasciotomy was performed.
[Mh] Termos MeSH primário: Tendão do Calcâneo/cirurgia
Síndrome do Compartimento Anterior/diagnóstico por imagem
Angiografia por Tomografia Computadorizada/métodos
Imagem por Ressonância Magnética/métodos
Complicações Pós-Operatórias/diagnóstico por imagem
Traumatismos dos Tendões/cirurgia
[Mh] Termos MeSH secundário: Tendão do Calcâneo/lesões
Doença Aguda
Adulto
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170509
[Lr] Data última revisão:
170509
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161027
[St] Status:MEDLINE


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[PMID]:27342963
[Au] Autor:Tian S; Lu Y; Liu J; Zhu Y; Cui Y; Lu J
[Ad] Endereço:Department of Emergency Traumatic Surgery, Shanghai Pudong New District Zhoupu Hospital, Shanghai University of Medicine and Heath Sciences, Shanghai, China.
[Ti] Título:Comparison of 2 available methods with Bland-Altman analysis for measuring intracompartmental pressure.
[So] Source:Am J Emerg Med;34(9):1765-71, 2016 Sep.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Acute compartment syndrome (ACS) is the result of increased intracompartmental pressure (ICP), and to avoid a delay in diagnosis requires ICP measurement. This study was designed to compare 2 available methods with Bland-Altman analysis for measuring ICP in experimental animal models, healthy volunteers, and patients with suspected ACS to evaluate their agreement and interchangeability. METHODS: In 20 New Zealand White rabbits, we inflated a tourniquet to stop arterial blood flow to establish ACS rabbit models, of which ICP was measured and recorded by the Whitesides apparatus and the invasive arterial blood pressure monitor system (IABPMS) before and after modeling. The same 2 measurements were applied to the tibialis anterior compartment's ICP of 30 healthy volunteers. The experimental data were analyzed using the Bland-Altman method. Once it was considered to be a substitute for the Whitesides apparatus based on statistical analysis, we used IABPMS to measure the ICP of the patients suspected of having ACS to estimate its clinical prospect. RESULTS: The rabbit models' ICP estimated by the Whitesides apparatus and IABPMS were 9.60±2.74 and 9.55±2.33 mm Hg, with an increase to 30.20±4.44 and 30.05±4.58 mm Hg after modeling, respectively. The limits of agreement for the ICP were -2.01/2.11 and -2.41/2.71 mm Hg before and after model establishment. The healthy volunteers' ICP were 10.92±6.06 and 10.85±5.87 mm Hg; the limits of agreement for the ICP were -2.53/2.66 mm Hg. With IABPMS to continuously monitor the ICP increasing (40.45±10.42 vs 13.82±4.94 mm Hg) and ΔP (34.54±11.77 mm Hg) to guide the diagnosis of ACS, 5 of 11 patients underwent the emergency fasciotomy for decompression. CONCLUSION: The invasive pressure monitoring via IABPMS can be used as an alternative to the Whitesides method, thanks to the sufficient agreement between the 2 methods in ICP measurement, and also for its advantages recommended as a novel diagnostic approach to ACS in experimental and clinical applications.
[Mh] Termos MeSH primário: Síndrome do Compartimento Anterior/diagnóstico
Pressão Arterial
Monitores de Pressão Arterial
[Mh] Termos MeSH secundário: Adulto
Animais
Síndrome do Compartimento Anterior/cirurgia
Síndromes Compartimentais/diagnóstico
Síndromes Compartimentais/etiologia
Síndromes Compartimentais/cirurgia
Descompressão Cirúrgica
Fasciotomia
Feminino
Traumatismos do Antebraço/complicações
Voluntários Saudáveis
Seres Humanos
Masculino
Meia-Idade
Modelos Animais
Pressão
Coelhos
Coxa da Perna
Torniquetes
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160626
[St] Status:MEDLINE


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[PMID]:27333459
[Au] Autor:Ebraheim NA; Siddiqui S; Raberding C
[Ad] Endereço:Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH.
[Ti] Título:A Single-Incision Fasciotomy for Compartment Syndrome of the Lower Leg.
[So] Source:J Orthop Trauma;30(7):e252-5, 2016 Jul.
[Is] ISSN:1531-2291
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Lower leg fasciotomy may be performed with a single lateral incision with or without fibulectomy, or by a double incision technique, with most surgeons preferring the later. The aim of this article is to describe a variation of an existing single-incision technique that will allow for the release of all four compartments with 1 incision. Our approach uses a paratibial route to release the deep posterior compartment (DPC) rather than a transfibular or parafibular route that has already been discussed in the literature. We approach the DPC from the anterior compartment, whereas the parafibular approach uses the posterior aspect of the fibula to reach the DPC. This affords a faster fasciotomy with a smaller flap, avoids potential damage to neurovascular bundle and among other advantages, makes its especially pragmatic for bedside fasciotomy, without the risk of injury to the peroneal nerves, which is common with dissection at the posterior aspect of the fibula.
[Mh] Termos MeSH primário: Síndrome do Compartimento Anterior/cirurgia
Fasciotomia/métodos
Fraturas da Tíbia/complicações
[Mh] Termos MeSH secundário: Adulto
Idoso
Síndrome do Compartimento Anterior/etiologia
Estudos de Coortes
Descompressão Cirúrgica/métodos
Feminino
Seres Humanos
Traumatismos da Perna/complicações
Traumatismos da Perna/diagnóstico
Traumatismos da Perna/cirurgia
Masculino
Meia-Idade
Prognóstico
Estudos Retrospectivos
Medição de Risco
Fraturas da Tíbia/diagnóstico
Fraturas da Tíbia/cirurgia
Resultado do Tratamento
Cicatrização/fisiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170317
[Lr] Data última revisão:
170317
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160623
[St] Status:MEDLINE
[do] DOI:10.1097/BOT.0000000000000542


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[PMID]:27144819
[Au] Autor:Tornetta P; Puskas BL; Wang K
[Ad] Endereço:Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA.
[Ti] Título:Compartment Syndrome of the Leg Associated With Fracture: An Algorithm to Avoid Releasing the Posterior Compartments.
[So] Source:J Orthop Trauma;30(7):381-6, 2016 Jul.
[Is] ISSN:1531-2291
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The purpose of this study is to report on a prospective series of patients in whom an algorithm was used to attempt to avoid releasing the posterior compartments in patients with lower leg compartment syndrome (CS) and the safety of such a practice. DESIGN: Prospective cohort study. SETTING: Level 1 trauma center. PATIENTS: A consecutive series of 39 patients was managed by one surgeon for CS using the reported protocol. INTERVENTION: Patients diagnosed with a CS of the leg were managed with a single operative protocol. After a standard anterior and lateral compartment release through a full-length lateral incision was performed, the superficial and deep posterior compartments were measured with the heel resting on a bolster. Using the preoperative diastolic blood pressure, a ΔP < 30 was considered to be a positive finding warranting a separate medial incision for release of the posterior compartments. If the ΔP was ≥30, the posterior compartments were not released. MAIN OUTCOME MEASUREMENTS: Need for medial release or development of posterior CS or sequelae. RESULTS: A consecutive series of 39 patients were managed by 1 surgeon for CS using the described protocol. Two patients with an isolated posterior CS were excluded. The other 37 had clinical symptoms or compartment pressures consistent with anterior compartment involvement. Of 37 patients, 21 had (57%) symptoms suggesting posterior compartment involvement. The preoperative pressure measurements averaged 41 mm Hg with an average ΔP of 38. After full-length release of the anterior and lateral compartments, only 3/37 (8%) required a posterior release for a ΔP of <30 mm Hg. The lowest ΔP in the posterior compartments of the remaining 34 patients averaged 59 (32-86). The compartment pressures in the superficial and deep posterior compartments decreased by 22 mm Hg and 24 mm Hg, respectively, after the anterolateral release. None of the patients who had only an anterolateral release developed sequelae of a missed posterior CS. CONCLUSIONS: The use of the reported algorithm is effective in avoiding posterior compartment release. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Algoritmos
Síndrome do Compartimento Anterior/cirurgia
Descompressão Cirúrgica/métodos
Fixação Interna de Fraturas/efeitos adversos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Síndrome do Compartimento Anterior/etiologia
Síndrome do Compartimento Anterior/fisiopatologia
Estudos de Coortes
Feminino
Fraturas do Fêmur/complicações
Fraturas do Fêmur/cirurgia
Seguimentos
Fixação Interna de Fraturas/métodos
Seres Humanos
Traumatismos da Perna/complicações
Traumatismos da Perna/cirurgia
Masculino
Meia-Idade
Pressão
Estudos Prospectivos
Índice de Gravidade de Doença
Fraturas da Tíbia/complicações
Fraturas da Tíbia/cirurgia
Centros de Traumatologia
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170317
[Lr] Data última revisão:
170317
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160505
[St] Status:MEDLINE
[do] DOI:10.1097/BOT.0000000000000624


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[PMID]:26978131
[Au] Autor:Blair JA; Stoops TK; Doarn MC; Kemper D; Erdogan M; Griffing R; Sagi HC
[Ad] Endereço:*Department of Orthopaedics and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX; †Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; ‡Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa, FL; §Kaiser Permanente, Walnut Creek, CA; ‖Department of Orthopaedics and Traumatology, Ondokuz Mayis Üniversitesi, Samsun, Turkey; and ¶Department of Orthopedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
[Ti] Título:Infection and Nonunion After Fasciotomy for Compartment Syndrome Associated With Tibia Fractures: A Matched Cohort Comparison.
[So] Source:J Orthop Trauma;30(7):392-6, 2016 Jul.
[Is] ISSN:1531-2291
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The objective was to compare the rates of union and infection in patients treated with and without fasciotomy for acute compartment syndrome (ACS) in operatively managed tibia fractures. DESIGN: This was a retrospective review. SETTING: The study was conducted at both a Level 1 and Level II trauma center. PATIENTS/PARTICIPANTS: Patients operated for tibial plateau fractures (group 1) and tibial shaft fractures (group 3) with ACS requiring fasciotomy were matched to patients without ACS (plateau: group 2, shaft: group 4) in a 1:3 ratio for age, sex, fracture pattern, and open/closed injury. INTERVENTION: Surgical treatment was provided with plates/screws (plateau fractures) or intramedullary rod (shaft fractures). Patients with ACS were treated with a 2-incision 4-compartment fasciotomy. MAIN OUTCOME MEASUREMENTS: Time to union and incidence of deep infection, nonunion, and delayed union. RESULTS: One hundred eighty-four patients were included-group 1: 23 patients, group 2: 69 patients, group 3: 23 patients, and group 4: 69 patients. Time to union averaged 26.8 weeks for groups 1 and 3 and 21.5 weeks for groups 2 and 4 (P > 0.05). Nonunion occurred in 20% for groups 1 and 3 and in 5% for groups 2 and 4 (P = 0.003). Deep infection developed in 20% for groups 1 and 3 and in 4% for groups 2 and 4 (P = 0.001). There was a significant increase in infection in group 1 versus group 2 and nonunion in group 3 versus group 4. There were significantly more smokers for those with fasciotomies (46%) than without (20%, P < 0.001), though all statistical results remained similar after a binary regression analysis. CONCLUSION: Four-compartment fasciotomies in patients with tibial shaft or plateau fractures is associated with a significant increase in infection and nonunion. LEVEL OF EVIDENCE: Prognostic level III. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Síndrome do Compartimento Anterior/cirurgia
Fasciotomia/efeitos adversos
Fraturas não Consolidadas/epidemiologia
Infecção da Ferida Cirúrgica/epidemiologia
Fraturas da Tíbia/complicações
Fraturas da Tíbia/cirurgia
[Mh] Termos MeSH secundário: Adulto
Distribuição por Idade
Síndrome do Compartimento Anterior/etiologia
Estudos de Casos e Controles
Fasciotomia/métodos
Feminino
Seguimentos
Fixação de Fratura/efeitos adversos
Fixação de Fratura/métodos
Fraturas Expostas/complicações
Fraturas Expostas/patologia
Fraturas Expostas/cirurgia
Fraturas não Consolidadas/diagnóstico
Seres Humanos
Incidência
Masculino
Meia-Idade
Sistema de Registros
Estudos Retrospectivos
Medição de Risco
Distribuição por Sexo
Infecção da Ferida Cirúrgica/diagnóstico
Fraturas da Tíbia/patologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170317
[Lr] Data última revisão:
170317
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160316
[St] Status:MEDLINE
[do] DOI:10.1097/BOT.0000000000000570


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[PMID]:26913594
[Au] Autor:Allmon C; Greenwell P; Paryavi E; Dubina A; OʼToole RV
[Ad] Endereço:Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
[Ti] Título:Radiographic Predictors of Compartment Syndrome Occurring After Tibial Fracture.
[So] Source:J Orthop Trauma;30(7):387-91, 2016 Jul.
[Is] ISSN:1531-2291
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Compartment syndrome (CS) is a potentially devastating injury associated with tibial fractures. Few data exist regarding radiographic indicators of CS. We hypothesized that radiographic signs are associated with development of CS. DESIGN: Retrospective review. SETTING: Level I trauma center. PATIENTS: Consecutive series of adult patients with tibial fractures with (n = 56) and without (n = 922) CS. INTERVENTION: None. OUTCOMES: AO/OTA fracture classification, Schatzker type, fracture length, fibular fracture, CS diagnosis. RESULTS: The odds of CS increased by 1.67 per 10% increase in the ratio of fracture length to tibial length when considering all fractures. CS was most likely to occur with plateau fractures at 12% (shaft fractures, 3%; pilon fractures, 2%). Schatzker VI fractures were more likely to develop CS than any other Schatzker type. Fibular fracture was predictive of CS with plateau fractures only. Segmental fractures (AO/OTA type 42-C2) were not more likely to develop CS than other shaft fractures. CONCLUSIONS: Several objective and easily reproducible radiographic indicators should raise suspicion for CS. CS was more likely in plateau fractures, especially when fracture length was >20% of the tibial length, in the presence of fibular fracture, and classified as Schatzker VI. Conversely, segmental tibial shaft fractures were not more likely than other shaft fractures to develop CS. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Síndrome do Compartimento Anterior/cirurgia
Fixação Interna de Fraturas/efeitos adversos
Radiografia
Fraturas da Tíbia/diagnóstico
Fraturas da Tíbia/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Síndrome do Compartimento Anterior/diagnóstico
Síndrome do Compartimento Anterior/etiologia
Estudos de Coortes
Descompressão Cirúrgica/métodos
Feminino
Fixação Interna de Fraturas/métodos
Seres Humanos
Masculino
Meia-Idade
Valor Preditivo dos Testes
Prognóstico
Curva ROC
Estudos Retrospectivos
Medição de Risco
Índice de Gravidade de Doença
Fraturas da Tíbia/complicações
Centros de Traumatologia
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170317
[Lr] Data última revisão:
170317
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160226
[St] Status:MEDLINE
[do] DOI:10.1097/BOT.0000000000000565


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[PMID]:26738904
[Au] Autor:Rennerfelt K; Zhang Q; Karlsson J; Styf J
[Ad] Endereço:Department of Orthopaedics, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Switzerland kajsa.rennerfelt@vgregion.se.
[Ti] Título:Changes in Muscle Oxygen Saturation Have Low Sensitivity in Diagnosing Chronic Anterior Compartment Syndrome of the Leg.
[So] Source:J Bone Joint Surg Am;98(1):56-61, 2016 Jan 06.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Near-infrared spectroscopy measures muscle oxygen saturation (StO2) in the skeletal muscle and has been proposed as a noninvasive tool for diagnosing chronic anterior compartment syndrome (CACS). The purpose of this study was to investigate the diagnostic value of changes in StO2 during and after exercise in patients with CACS. METHODS: The study comprised 159 consecutive patients with exercise-induced leg pain. Near-infrared spectroscopy was used to measure StO2 continuously before, during, and after an exercise test. One minute post-exercise, intramuscular pressure was recorded in the same muscle. The cohort was divided into patients with CACS (n = 87) and patients without CACS (n = 72) according to the CACS diagnostic criteria. Reoxygenation at rest after exercise was calculated as the time period required for the level of muscular StO2 to reach 50% (T50), 90% (T90), and 100% (T100) of the baseline value. RESULTS: The lowest level of StO2 during exercise was 1% (range, 1% to 36%) in the patients with CACS and 3% (range, 1% to 54%) in the patients without CACS. The sensitivity was 34% and the specificity was 43% when an StO2 level of ≤8% at peak exercise was used to indicate CACS. The sensitivity and the specificity were only 1% when an StO2 level of ≤50% at peak exercise was used to indicate CACS. The time period for reoxygenation was seven seconds (range, one to forty-three seconds) at T50, twenty-eight seconds (range, seven to seventy-seven seconds) at T90, and forty-two seconds (range, seven to 200 seconds) at T100 in the patients with CACS and ten seconds (range, one to forty-nine seconds) at T50, thirty-two seconds (range, four to 138 seconds) at T90, and forty-eight seconds (range, four to 180 seconds) at T100 in the patients without CACS. When thirty seconds or more at T90 was set as the cutoff value for a prolonged time for reoxygenation, indicating a diagnosis of CACS, the sensitivity was 38% and the specificity was 50%. CONCLUSIONS: Changes in muscle oxygen saturation during and after an exercise test that elicits leg pain cannot be used to distinguish between patients with CACS and patients with other causes of exercise-induced leg pain.
[Mh] Termos MeSH primário: Síndrome do Compartimento Anterior/diagnóstico
Teste de Esforço/métodos
Músculo Esquelético/metabolismo
Consumo de Oxigênio/fisiologia
[Mh] Termos MeSH secundário: Estudos de Casos e Controles
Doença Crônica
Eletromiografia/métodos
Tolerância ao Exercício/fisiologia
Feminino
Seres Humanos
Perna (Membro)
Masculino
Dor Musculoesquelética/etiologia
Dor Musculoesquelética/fisiopatologia
Medição da Dor
Valores de Referência
Espectroscopia de Luz Próxima ao Infravermelho
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1605
[Cu] Atualização por classe:160107
[Lr] Data última revisão:
160107
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160108
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.N.01280



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