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E-book Compartment Syndrome : A Guide to Diagnosis and Management

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Penilaian

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The diagnosis and management of compartment syndrome represents a dilemma for clinicians. A major cause of concern in treating compartment syndrome is the potentially devastating outcome if not treated effectively. Compartment syndrome results in ischemia within a fascial compartment that eventuates into necrosis of the tissues it encompasses. Sequelae of missed compartment syndrome include loss of function, contracture of joints, limb deformity, and painful neuropathies [1, 2]. These complications persist and significantly reduce quality of life. In light of this, the timely diagnosis and treatment of compartment syndrome is a focus of orthope-dic surgery training. However, an inconsistency in practice remains. O’Toole et al. [3] demonstrated a wide variation between orthopedic surgeons, even within a sin-gle practice of orthopedic trauma specialists at a level I trauma center. A diagnostic rate of compartment syndrome for tibia fractures ranged from 2% to 24% depend-ing on the surgeon who was on call. This demonstrates the lack of consensus and clarity with regard to diagnosis. The prognosis is grave in cases of missed compartment syndrome, but there are even severe repercussions for a diagnosis delayed by a matter of hours. If the treat-ing surgeon correctly recognizes compartment syndrome, but attempts late release of the fascia over a necrotic compartment, the patient is subject to a high risk of infection and life-threatening complications [4]. Sheridan and Matsen report an infection rate of 46%, and an amputation rate of 21% after fasciotomy was delayed by 12 hours [5]. Only 2% of those patients treated on a delayed basis had a normal functioning extremity at final follow up, compared to 68% in those treated earlier. Reperfusion after severe muscle necrosis may further increase systemic effects. As myonecrosis develops and reperfusion is achieved, myoglobin is released into cir-culation, further contributing to myoglobinuria, metabolic acidosis, and hyperkale-mia. This may lead to renal failure, shock, and cardiac events [6, 7]. Although fascial release is the appropriate treatment of acute compartment syndrome, clinicians must be aware of the dangers of late surgical intervention.In addition to the serious consequences of missed or delayed treatment of acute compartment syndrome, clinicians and patients may face complications even in the setting of treatment with the correct technique and timing. A retrospective study looking at the long-term outcomes of fasciotomy placement by Fitzgerald et al. does not convey a completely benign procedure [8]. Reviewed outcomes of 164 patients over an 8-year period showed pain (10%), altered sensation (77%), dry skin (40%), pruritis (33%), discoloration (30%), swelling (13%), and muscle herniation (23%). Scarring of the extremities caused patients to keep extremity covered (23%), changed hobbies (28%), and even changed occupation (12%). Fasciotomy sites may also require the patient to undergo multiple interventions of attempted wound clo-sure or grafting. In the setting of operative fractures, the placement of fasciotomy incisions may complicate surgical approach and increase risk of infection and non-union of fracture sites.

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Ketersediaan

Informasi Detail

Judul Seri

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No. Panggil

617.47 AIY c

Penerbit

Switzerland : Springer Nature., 2019

Deskripsi Fisik

186 hlm

Bahasa

English

ISBN/ISSN

9783030223311

Klasifikasi

617.47

Tipe Isi

text

Tipe Media

computer

Tipe Pembawa

online resource

Edisi

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Subjek

Surgery by Musculoskeletal, Integument

Info Detail Spesifik

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Pernyataan Tanggungjawab

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Versi lain/terkait

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