Diagnostico del sindrome compartimental inducido por el ejercicio mediante resonancia magnetica post-esfuerzo / Post-exercise MRI for diagnosis of chronic exertional compartmental syndrome

RESU MEN: El SCIE representa la causa del 27% de los cuadros de dolor anterior de pierna en atletas. El origen del dolor en este cuadro es aún discutido. La medición de la presión intracompartimental es el gold standard en el diagnóstico, aunque es un estudio invasivo. El desarrollo e interpretación de nuevas secuencias en RMN, aportaron una alternativa en el diagnóstico incruento del SCIE. La RMN post-esfuerzo es una opción atractiva y atraviesa en la actualidad su proceso de validación. MATERIAL Y MÉT ODOS Se evaluaron 22 pacientes con diagnóstico clínico de síndrome compartimental inducido por el ejercicio, con una media de seguimiento de 5 años (1-10 años). Todos fueron evaluados mediante examen clínico, RM pre y post actividad física y medición de presión intracompartimental pre y post actividad física. La resonancia magnética se realizó en reposo y luego de la prueba de esfuerzo. La medición de presión intracompartimental se realizó con la técnica de Whitesides, el diagnóstico se realizó con los criterios de Pedowitz. RESULTADOS De los 22 pacientes, 19 tuvieron una medición intracompartimental positiva (15 masculino, 4 femenino) y 3 una medición negativa. Todos los pacientes tuvieron una RMN normal en reposo. En los 3 pacientes que tuvieron medición intracompartimental negativa, la RMN post-esfuerzo fue normal. De los 19 pacientes restantes, la RMN detectó señal hiperintensa en T2 y STIR en 15 de ellos (78,95%). CONCLUSIONES La RMN podría tener un lugar en el diagnóstico, para lo cual debería mejorarse la sensibilidad de este método. No obstante, la medición intracompartimental pre y post-esfuerzo sigue siendo el gold-standard. Nivel de evidencia: IV

BACKGROUND: Chronic exertional compartment syndrome (CECS) is the cause of 27% of anterior leg pain in athletes. The source of pain in this condition is still debated. Measurement of intracompartmental pressure is the gold standard diagnosis, albeit an invasive study. The development and interpretation of new MRI sequences has provided a non-invasive alternative to CECS diagnosis. Post-exercise MRI is an attractive option which is currently undergoing its validation process. METHODS: 22 patients with a clinical diagnosis of CECS were included, with a median follow-up of 5 years (1-10 years). All the patients were evaluated by clinical examination, pre- and post-exercise MRI and pre-and post-exercise intracompartmental pressure measurement. Pressure was measured with Whitesides technique, and diagnosis was carried out by Pedowitz criteria. RESULTS: Out of the total 22 patients, 19 had positive intracompartmental measurement (15 male, 4 female) and 3 had negative measurement. All the patients had a normal MRI at rest. The three patients who had negative intracompartmental measurement had a normal post-stress MRI. Out of the remaining 19 patients, the MRI detected hyperintense signal in T2 and STIR weighted in 15 of them (78,95%). CONCLUSIONS: MRI could be relevant for diagnosis, for which case the sensitivity of this method should be improved. Nevertheless, pre- and post-stress intracompartmental measurement continues to be the gold-standard. Level of evidence: IV

Sindrome compartimental en miembro inferior - Pierna: consideraciones anatomo - quirúrgicas / Lower limb compartment syndrome - leg: anatomical and surgical considerations

Introducción: El síndrome compartimental es una situación en la cual el incremento de la presión dentro de un espacio cerrado, por encima de la presión de perfusión, afecta la circulación y altera la función de los tejidos que están dentro de dicho espacio comprometiendo la vitalidad de los mismos. Objetivos: Evaluar el conocimiento anatómico de los compartimientos de la pierna con posibilidad de sufrir un síndrome compartimental para la realización de abordajes quirúrgicos de urgencia. Material y Método: Encuestas anónimas realizadas a cirujanos en formación del Servicio de Cirugía General del Hospital Aeronáutico Central y a ayudantes de anatomía de la III Cátedra de Anatomía de la Facultad de Medicina dela Universidad de Buenos Aires en el período de Marzo-Mayo/2015. Resultados: 45 (100%) encuestados. 15 (33.33%) cirujanos en formación: 5 (33,33%) contestaron correctamente las 10 preguntas, 3 (20 %) contestaron 6, 3 (20 %) contestaron 3 y 2 (13,33 %) ninguna correctamente. 30 (66.66%) ayudantes de anatomía: 15(50%) contestaron correctamente las 10 preguntas, 7 (23,33%) contestaron 6, 4 (13,33 %) contestaron4, 2 (6,67%) sólo una y 2 (6,67%) ninguna correctamente. Conclusiones: El estudio acabado de anatomía de los compartimientos que son susceptibles de padecer un síndrome compartimental, en este caso en miembro inferior, y de las estructuras que los componen, resulta de vital importancia a la hora de tomar una conducta

Introduction: Compartment syndrome is a condition in which increased pressure within a closed space affects circulation and alters the function of tissues. Objectives: To evaluate the anatomic or magazines leg with possibility of having a compartment syndrome for performing surgical approaches urgency knowledge. Material and method: Anonymous surveys to training surgeons of the General Surgery Department at the Hospital Aeronáutico Central and to anatomy assistants of the III Chair of Anatomy of the Faculty of Medicine at the University of Buenos Aires during the period March-May 2015. Results: 45 respondents (100%). 15 (33,33%) training surgeons: 5 (33,33%) correctly answered 10 questions, 3 (20%) answered 6, 3 (20%) answered 3and 2 (13,33%) no right answers. 30 (66,66%) anatomy assistants: 15 (50%) correctly answered 10 questions, 7(23,33%) answered 6, 4 (13,33%) 4 questions, 2 (6,67%) correctly answered only one question and 2 (6,67%) no right answer. Conclusions: Complete study of the compartments' anatomy Susceptible of having a compartment syndrome is vital when taking behavior

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 / 中华创伤杂志(英文版)

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.

Intento de suicidio por intoxicación con organofos-forado bajo administración parenteral (síndrome compartimental): reporte de un caso / Attempt of suicide by intoxication with organophosphorus under parenteral administration (compartmental syndrome): report of a case

INTRODUCCIÓN: La ideación e intento de suicidio constituyen entidades emergentes para el profesional de la salud mental; la ingesta de organofosforados (OF) es una de las maneras más frecuentes de intoxicación debido a su disponibilidad y fácil acce-sibilidad en nuestro medio (Ecuador); es común que quienes recurren a estas sustancias con fines auto líticos lo hacen por vía oral. Encontrar que alguien utilice la vía parenteral con esta finalidad es poco frecuente y es escasa la literatura al respecto, motivo por el cual se considera de importancia la publicación del siguiente caso. OBJETIVO: Describir los aspectos psicopatológicos del paciente que presentó un intento de suicidio con uso de organofosforados administrados por vía parenteral. MÉTODO: revisión, presentación y análisis de caso clínico. RESULTADOS: El paciente de 32 años fue internado en el Hospital Homero Castanier Crespo de la ciudad de Azogues (Ecuador) tras la severidad de sus lesiones causadas por la administración parenteral de OF; la valoración del estado mental del pa-ciente llevó al diagnóstico de intento de suicidio psicodisplásico con trastorno del estado de ánimo y trastorno límite de la personalidad; fue diagnosticado además de absceso en miembro superior derecho y síndrome compartimental en miembro superior izquierdo, por lo que fue ne-cesaria la realización del drenaje y fasciotomía respectivamente. CONCLUSIÓN: Los envenenamientos por plaguicidas como OF son los méto-dos más utilizados, se conoce que la ingesta de los OF es común, más no la administración parenteral como en el presente caso, que implicó un tratamiento tanto del área física y de la esfera mental.

INTRODUCTION: The ideation and attempted suicide are emer-ging entities for a mental health professional; the intake of organophosphate (OP) is one of the most common ways of poisoning due to their availability and easy accessibility in our country (Ecuador); it is common that people who use these substances, do auto lytic purposes orally. Find someone who uses the parenteral path for this purpose is rare and there is little literature on the subject, for this reason it is considered impor-tant the publication of the following case.OBJECTIVE: To describe the psychopathological aspects of the patient who had attempted suicide with use of organophosphate administered parenterally. METHOD:Review, presentation and analysis of the clinical case. RESULTS: The patient aged 32 was admitted to the Ho-mero Castanier Crespo Hospital in Azogues city (Ecuador) due to the severity of their injuries caused by the OP parenteral administration; the assessment of the patient's mental state led to a diagnosis of attempted psycho-dysplastic sui-cide with mood disorder and borderline perso-nality disorder; He was diagnosed in addition to abscess in the right arm and compartment syn-drome in the left upper limb, so the performan-ce was necessary drainage and fasciotomy res-pectively. CONCLUSION:The OP pesticide poisonings are the most used methods, it is known that the intake of the OP is common, but not parenteral administration as in the present case, which involved treatment of physical area and the mental sphere.

Síndrome compartimental en el antebrazo: consideraciones anatomo-quirúrgicas / Compartment syndrome in forearm: anatomical and surgical considerations

Introducción: El síndrome compartimental es una situación en lacual el incremento de la presión dentro de un espacio cerrado,porencima de la presión de perfusión, afecta la circulación de lostejidos que están dentro de dicho espacio, comprometiendo lavitalidad de los mismos y ocasionando lesión tisular. En miembrosuperior se describen numerosos compartimientos en los queIntroducción: El síndrome compartimental es una situación en lacual el incremento de la presión dentro de un espacio cerrado,porencima de la presión de perfusión, afecta la circulación de lostejidos que están dentro de dicho espacio, comprometiendo lavitalidad de los mismos y ocasionando lesión tisular. En miembrosuperior se describen numerosos compartimientos en los quepodría ocurrir dicho fenómeno ,y es particularmente el antebrazouna de las regiones anatómicas donde suele suceder con mayorfrecuencia. Objetivo: Evaluar el conocimiento anatómico de los compartimientos en el antebrazo con posibilidad de sufrir unsíndrome compartimental para la realización de abordajesquirúrgicos de urgencia. Material y Método: Se realizaron encuestas anónimasevaluando el conocimiento anatómico sobre el tema a 11médicos cirujanos en formación y a 25 ayudantes de anatomía...

Introduction: Compartment syndrome is a situation in which increassed pressure within a closed space above perfusión pressure affects the tissues’ circulation into that space,compromising the vitality of them and causing tissue injury.In upper limb there are many compartments where this fenomenous may occur, and the forearm is one of the anatomicregions where normally occure more frequently. Objectives: To evaluate the anatomic knowledge of the forearm compartements with possibility of having a compartmentsyndrome for the realization of urgent surgical approaches. Material and Methods: Anonymous surveys were conducted toevaluate the anatomical knowledge of the subject to 11 trainingsurgeons and 25 anatomy assistants...

Foot drop following lumbar disc herniation / Pié caído luego de hernia del núcleo pulposo lumbar

Introdução: Foot drop é uma fraqueza do músculo tibial anterior e pode ser sinal de hérnia discal lombar, lesão do nervo peroneal, distrofia muscular ou lesão cerebral parasagital. Lesão da raiz do quinto nervo lombar ou lesão do nervo peroneal são as causas mais freqüentes. Os autores apresentam um caso de “foot drop” em um paciente portador de hérnia discal no segmento L3-L4. Discutem sua fisiopatologia, diagnóstico, tratamento e prognóstico. Relato do caso: PTS. Masculino, 38 anos de idade, pedreiro. História de fraqueza no pé direito há três meses. Exame neurológico: Marcha claudicante à direita, diminuição da força muscular à direita (++/++++) e hipoestesia no trajeto radicular de L3 do membro inferior direito. TC e RM de coluna lombar demonstraram hérnia discal extrusa no espaço L3-L4. Resultado: Submetido à hemilaminectomia lombar e excisão da hérnia discal extrusa. Submetido à fisioterapia motora e ortese, com recuperação do pé caído. Conclusão: O foot drop pode ser decorrente lesão periférica (nervo peroneal), neurônio motor inferior, lesão cortical e distrofia muscular. Seu diagnóstico é através de eletroneuromiografia, TC, mieloTC e RM. Seu prognóstico tem sido considerado bom quando operado precocemente. Em nosso paciente houve demora na recuperação do quadro devido ao tempo de evolução do caso.

Introduction: Foot dropt is a tibialis anterior muscle weakness and may be caused by lumbar discopathy, fibular nerve injury, muscular dystrophy or cerebral parasagital lesion. Lesion on the 5th lumbar nerve root or fibular nerve injury are the most common causes. The authors present a case of foot drop associated with a herniated L3-L4 lumbar disc. Physiopathology, diagnosis, treatment and prognosis are discussed. Case Report: 38-year-old man with a 3-month history of right foot weakness. Neurological examination: right-sided claudication during gait, right-sided muscular weakness (++/++++) and L3-dermal territory hypoesthesia on his right leg. Lumbar CT and MRI revealed an extruded L3-L4 herniated disc. Results: Patient was submitted to lumbar hemilaminectomy and extruded herniated disc excision. Motor physiotherapy and orthesis were also performed, with foot drop recovery. Conclusions: Foot drop may be caused by peripheral lesion (fibular nerve), lower motor neuron, cortical lesion or muscular dystrophy. Diagnosis is performed with EMG, CT, mieloCT and MRI. Early surgery is associated with good prognosis. Our patient showed slow recovery due to a long case evolution.

Compartment syndrome in Duchenne muscular dystrophy

Boys with Duchenne muscular dystrophy typically lose the ability to walk independently between the ages of 10 and 12 yr, although this may be prolonged with steroid therapy. The loss of ambulation primarily reflects progressive weakness, although other factors may play a role. We describe a boy with Duchenne muscular dystrophy whose ability to walk was jeopardized at age 10 yr. He had contractures of both Achilles tendons and tight anterior compartments in both legs with discomfort over the anterior compartments bilaterally. Following tendon lengthening and fasciotomy of the anterior compartments his gait, level of functioning and discomfort greatly improved. He continues to ambulate for short distances without assistance at 18 years of age. Anterior compartment syndrome should be considered in boys with Duchenne dystrophy, especially if they have leg pain and are losing the ability to walk earlier than anticipated

Delayed Onset of Acute Limb Compartment Syndrome With Neuropathy After Venoarterial Extracorporeal Membrane Oxygenation Therapy

Acute limb compartment syndrome (ALCS) is defined as compound symptoms resulting from poor oxygenation and decreased nutrition supply to muscles and nerves in a tightly confined compartment. The most common cause of ALCS is tibia fracture, followed by blunt trauma to soft tissue. However, non-traumatic causes are rare. We report an iatrogenic, non-traumatic ALCS case after venoarterial extracorporeal membrane oxygen (VA-ECMO) therapy. A 14-year-old male received VA-ECMO therapy due to cardiorespiratory failure after drowning. Although he had no symptoms during therapy, leg swelling appeared 10 hours after ECMO treatment. Two days after the leg swelling, the patient underwent a fasciotomy. Unfortunately, nerve conduction studies and electromyography showed multiple neuropathies in the lower leg. Despite 2 weeks of rehabilitation with electrical stimulation, an exercise program, and physical therapy, there was no definite change in muscle strength. To our knowledge, this is the first reported case of non-traumatic ALCS after VA-ECMO therapy in Korea.

Surgical management of exertional anterior compartment syndrome of the leg / Tratamiento quirúrgico del síndrome compartimental anterior de la pierna por esfuerzo excesivo

OBJECTIVE: To describe the characteristic presentation of exertional leg pain in athletes and to discuss the diagnostic options and surgical management of exertional anterior compartment syndrome of the leg in this group of patients. METHODS: Data from a series of athletes presenting with exertional leg pain were analysed and categorized according to aetiology. RESULTS: Sixty-six athletes presenting with exertional leg pain in 102 limbs were analysed. Sixteen patients in a first group of 20 patients with a provisional diagnosis of exertional anterior compartment syndrome of the leg underwent a closed fasciotomy with complete resolution of symptoms. A second group of 42 patients were diagnosed as medial tibial stress syndrome and a third group of four patients had confirmed stress fracture of the tibia. CONCLUSION: Exertional leg pain is a common presenting complaint of athletes to sports physicians and physiotherapists. Careful analysis can lead to an accurate diagnosis and commencement of effective treatment. Exertional anterior compartment syndrome can be successfully treated utilizing a closed fasciotomy with a rapid return to sport.

OBJETIVO: Describir las manifestaciones características del dolor en la pierna que presentan los atletas, y discutir las opciones de diagnósticos y tratamiento quirúrgico del síndrome compartimental de la pierna en este grupo de pacientes. MÉTODOS: Los datos de una serie de atletas con dolor en la pierna debido al esfuerzo excesivo en los ejercicios, fueron analizados y categorizados según la etiología. RESULTADOS: Sesenta y seis atletas con dolor de piernas debido al esfuerzo excesivo en 102 miembros fueron analizados. Dieciséis pacientes en un primer grupo de 20 pacientes con un diagnóstico provisional de síndrome compartimental anterior de la pierna por esfuerzo experimentaron fasciotomía cerrada con resolución completa de los síntomas. Un segundo grupo de 42 pacientes fueron diagnosticados con síndrome de estrés medial de la tibia, y a un tercer grupo de cuatro pacientes se le confirmó fractura por estrés o sobrecarga de la tibia. CONCLUSIÓN: El dolor de la pierna por esfuerzo en los ejercicios es una queja común con las que los acuden a los médicos y fisioterapeutas de la medicina deportiva. Un análisis cuidadoso puede conducir a un diagnóstico preciso y al comienzo de un tratamiento eficaz. El síndrome compartimental anterior por esfuerzo puede tratarse con éxito utilizando una fasciotomía cerrada que permita un rápido retorno a la actividad deportiva.

Amputación por accidente botrópico grave: reporte de un caso / Amputation bothropic serious accident: a case report

RESUMEN:Se denomina accidente bothrópico al cuadro clínico producido por el veneno inoculado por ofidios del género Bothrops(Yarará). Este se caracteriza por ser proteolítico, coagulante y hemorragíparo, y ocasiona en las víctimasefectos locales y sistémicos.Las complicaciones incluyen: tendinitis, fascitis, infección bacteriana, abscesos y síndrome compartimental. Esteúltimo tiene una incidencia inferior...

SUMMARY:Clinical simptoms produced by venom of Bothrops (Yarará) are called ophidism. The poison of these snakes hasproteolitic, coagulant action and causes hemorrage. It causes local and systemic effects.Complications include: tendinitis, fasciitis, bacterial infection, abscesses and compartment syndrome...

Chama-se acidente botrï ao quadro clínico produzidos pelo veneno de Bothrops ophidia. Recaracteriza por ser proteolítica,coagulante e hemorragiparo e causas das vítimas em efeitos locais e sistêmicos. No sítio da inoculação ocorreum dano tecidual imediatamente com mionecrose, hemorragia e edema.Complicações incluem: tendinite, fasciíte plantar, infecção bacteriana, abscesso, e síndrome compartimental...

Síndrome compartimental em perna após reconstrução de ligamento cruzado anterior: relato de caso / Leg's compartment syndrome after reconstruction of the anterior cruciate ligament: case report

Os autores apresentam o relato de caso de um paciente que foi submetido à cirurgia de reconstrução de ligamento cruzado anterior e reparo de ligamento colateral medial de joelho esquerdo e que evoluiu com síndrome de compartimento de perna.

The authors report a case of a patient that was submitted to a surgery of reconstruction of anterior cruciate ligament and collateral medial ligament repair of the left knee that complicated to a compartment syndrome.

Tendinopatia do compartimento anterior do tornozelo / Tendinopathy of the anterior compartment of the ankle

OBJETIVO: Análise retrospectiva da etiopatogenia, diagnóstico e opções de tratamento nos casos de tendinopatias do compartimento anterior do tornozelo (TCAT). MÉTODO: No período de setembro de 1998 a fevereiro de 2009, 13 pacientes foram operados por tendinopatia do compartimento anterior do tornozelo. A casuística constou de 10 pacientes do sexo masculino e três do feminino. O lado direito foi acometido em 12 pés e um do esquerdo. A média de idade foi de 35 anos (15-67). A etiologia foi traumática em oito pacientes e em cinco, degenerativa (atraumática). O tempo médio do diagnóstico ao tratamento foi de 19 meses (1-60) e o seguimento foi de 34 meses (4-127). O diagnóstico foi feito através da história e exame clínico. A ressonância magnética foi realizada em nove pacientes para estadiamento e planejamento. O tratamento cirúrgico foi personalizado para cada caso (sinovectomia, ressecção de ventre muscular, solidarização com o tendão adjacente e enxerto livre de tendão semitendíneo). Para a avaliação dos resultados foram utilizadas as escalas: 1) graduação subjetiva de satisfação, 2) AOFAS e 3) Maryland. RESULTADO: Em relação à escala de graduação subjetiva de satisfação, 12 pacientes satisfeitos e um paciente insatisfeito. A média da escala AOFAS foi de 80 pontos, a média da escala Maryland foi de 86 pontos. CONCLUSÃO: O tratamento cirúrgico é eficaz para recuperação funcional. As técnicas cirúrgicas devem ser personalizadas. A opção do enxerto livre de tendão semitendíneo é eficiente nas falhas maiores que cinco centímetros.

OBJECTIVE: To carry out a retrospective analysis of the etiopathogeny, diagnosis and therapeutic options in cases of tendinopathies of the anterior compartment of the ankle. METHOD: 13 patients underwent surgery between September 1998 and February 2009; ten men and three women. The right side was involved in twelve patients and the left in one. The averaging age was 35 years of age (15-67). The etiology was traumatic in eight patients and degenerative (non-traumatic) in five. The average time to diagnosis was 19 months (1 - 60) and the average follow-up time was 34 months (4 - 127). The diagnosis was made by anamnesis and clinical findings. Magnetic resonance imaging was performed in nine patients, for staging and planning. The surgical treatment was personalized in each case (debridement, resection of the muscle, grafting with the adjacent tendon, and free graft of the semitendinosus tendon). The following scales were used for the evaluation: 1) subjunctive satisfaction scale, 2) AOFAS and 3) Maryland. RESULTS: In relation to the subjective satisfaction scale, 12 patients were satisfied and one was dissatisfied. The average AOFAS scale was 80 points, and the average Maryland scale was 86 points. CONCLUSION: Surgical treatment is effective for restoring function. The surgical techniques must also be personalized. The free graft of the semitendinosus tendon option is effective for gaps larger than five centimeters.

Congenital anterior tibiofemoral subluxation

Congenital anterior tibiofemoral subluxation is an extremely rare disorder. All reported cases accompanied by other abnormalities and syndromes. A 16-year-old high school girl referred to us with bilateral anterior tibiofemoral subluxation as the knees were extended and reduced at more than 30 degrees flexion. Deformities were due to tightness of the iliotibial band and biceps femuris muscles and corrected by surgical release. Associated disorders included bilateral anterior shoulders dislocation, short metacarpals and metatarsals, and right calcaneuvalgus deformity

Regeneração do músculo tibial anterior em diferentes períodos após lesão por estimulação elétrica neuromuscular / Regeneration of the tibialis anterior muscle at different times following injury induced by neuromuscular electrical stimulation

CONTEXTUALIZAÇÃO: Lesões no musculoesquelético podem ser causadas pela própria contração muscular. OBJETIVO: Analisar em diferentes períodos a lesão do músculo tibial anterior (TA) induzida pela eletroestimulação. MATERIAL E MÉTODO: ratos Wistar macho (298,2 ± 16,0g) foram divididos nos grupos: eletroestimulado (EE) e analisado após 3 e 5 dias (n= 20) e controle (C), 3 e 5 dias (n = 14). O TA, mantido em alongamento, foi lesado por eletroestimulação neuromuscular (90 min, 30Hz, 1m/s, Ton/Toff 4s e 4mA). Após 3 e 5 dias, os animais foram sacrificados e os músculos retirados, sendo os cortes histológicos (10 μm) obtidos em criostato e corados com Azul de Toluidina. Os pesos corporal e muscular foram analisados estatisticamente pelo teste T-Student (p < 0,05). RESULTADO: Aumento do peso corporal final quando comparado com inicial em C3 e C5 (288,5 ± 18,3g x 308,5 ± 24,3g; 288,4 ± 15,0g x 305,5 ± 20,7g, respectivamente) e diminuição em EE3 e EE5 (305,0 ± 13,0g x 285,6 ± 13,2g; 306,1 ± 12,4g x 278,4 ± 20,9g, respectivamente). Peso muscular relativo do EE5 foi menor quando comparado com o C5 (0,20 ± 0,001 por cento x0,22 ± 0,01 por cento, respectivamente). Análise histológica mostrou variabilidade na extensão e nos sinais de fibras lesadas e/ou em regeneração e a região distal foi a mais lesada. Grupo EE3 apresentou predominância de infiltrado celular e hipercontração dos miofilamentos, e no grupo EE5 houve predominância de infiltrado celular, basofilia e fibrose. CONCLUSÃO: O período de 2 dias após eletroestimlação foi suficiente para observar diferença no processo de regeneração com maior susceptibilidade à lesão na região distal do músculo tibial anterior.

BACKGROUND: Skeletal muscle injuries may be caused by contraction of the muscle concerned. OBJECTIVE: To analyze the tibialis anterior muscle at different times following injury induced by electrical stimulation. METHOD: Male Wistar rats (298.2 ± 16.0g) were divided into two electrically stimulated groups evaluated after three and five days (n= 20) and two control groups, also evaluated after three and five days (n= 14). While stretched, the tibialis anterior muscle was injured by neuromuscular electrical stimulation (90 minutes, 30 Hz, 1 m/s, Ton/Toff 4 s and 4 mA). Three and five days afterwards, the animals were sacrificed and the muscles were removed. Histological sections were cut (10 μm) using a cryostat and were stained with toluidine blue. The body and muscle weights were statistically analyzed using Student's t test (p < 0.05). RESULTS: The final body weight was higher than the initial weight for the 3-day control group (288.5 ± 18.3g vs. 308.5 ± 24.3g) and 5-day control group (288.4 ± 15.0g vs. 305.5 ± 20.7g) and lower for the 3-day stimulated group (305.0 ± 13.0g vs. 285.6 ± 13.2g) and 5-day stimulated group (306.1 ± 12.4g vs. 278.4 ± 20.9g). The relative muscle weight in the 5-day stimulated group was lower than in the 5-day control group (0.20 ± 0.001 percent vs. 0.22 ± 0.01 percent, respectively). The histological analysis showed variance between the animals regarding the extent and signs of fiber damage and/or regeneration, and the distal region was the most injured. The 3-day stimulated group presented predominance of cell infiltrate and myofilament hypercontraction, while the 5-day stimulated group presented predominance of cell infiltrate, basophils and fibrosis. CONCLUSION: A period of two days following electrical stimulation was sufficient for showing a difference in the regeneration process. The distal region of the tibialis anterior muscle was more susceptible to injury.

Mini-invasive distraction technique for treatment of severe ankle and foot deformities secondary to ischemic contracture of the leg / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the Ilizarov mini-invasive distraction technique for the treatment of severer ankle and foot deformities secondary to ischemic contracture of the leg.</p><p><b>METHODS</b>Based on the tension-stress low of Ilizarov, a serial of adjustable three dimensions external distractive instrument was developed in our department. From April 2002 to March 2004, 8 patients with ankle and foot deformities secondary to ischemic contracture of the leg induced by trauma and fracture were treated with the distractive instrument. Of them, 4 patient were male and 4 female, aged from 13 to 31 years with an average of 23 years. Five affected legs were in the left and 3 in the right. Preoperative abnormal style included talipes equines in 6 feet and equinovarus in 2 feet, with extensive scar contracture in the legs. Five patients suffered from failure of soft tissue release before, two patients with severe bony deformity of the feet were underwent limited foot triple osteotomy in this department before the distractive correction. The distraction was begun from 7 d after operation and distractive time from 29 to 60 d with an average 46 d.</p><p><b>RESULTS</b>All of the 8 patients were followed up from 10 months to 29 months, with an average of 13 months. All of deformities in the feet were corrected satisfactorily, full feet contacted with the ground in stand or walking and achieved with good function. No complication, such as pin tract infection, skin necrosis and neurovascular injury was occurred in this group.</p><p><b>CONCLUSIONS</b>Mini-invasive distraction technique for treatment of severe ankle and foot deformity secondary to ischemic contracture of the leg is safe and mini-injury, it is also an effective approach for the treatment of various kinds of rigid foot anomaly.</p>

Anterior Compartment Syndrome after Surgery of Bosworth Fracture-Dislocation of the Ankle: A Case Report / 대한족부족관절학회지

Bosworth fracture-dislocation of ankle is very rare, occurred by eversion and external rotation force. It is known as irreducible fracture by closed method. Also, compartment syndrome after ankle fracture are exceedingly rare. There are only a few reported cases of compartment syndrome after ankle fracture and compartment syndrome are involved commonly deep posterior compartment. We present a case in which a patient had a Bosworth fracturedislocation of the ankle underwent open reduction with internal fixation and subsequently occurred an anterior compartment syndrome of the leg.

¿Es la extremidad superior más tolerante al síndrome compartimental? / ¿Is the upper extremity more tolerant to the compartment syndrome?

El trauma vascular es causa comun de consulta en los grandes centros de trauma del mundo y la lesión vascular es la razón más frecuente de sindrome compartimental que tratan los cirujanos. Durante muchos años la fasciotomía ha sido la herramienta terapéutica mas aceptada para el manejo del sindrome compartimental y en múltiples esutdios se han demostrado sus bondades. No obstante su utilidad se convierte en la puerta de entrada para la infección en áreas musculares previamene afectadas por la isquemia. Mucho se ha escrito acerca de la fasciotomia como una herramienta terapéutica en cualquier extremidad, pero se acepta que esta muestra sus mejores resultados en la extremidad superior, teóricamente con base en la mayor tolerancia de la extremidad superior a los efectos del síndrome compartimental; las series muestran desproporción en el porcentaje de fasciotomías en pacientes con trauma vascular de las extremidades superiores en comparación con las inferiores. Esta mejor tolerancia a la isquemia determinaria una mejor evolución clínica de las extremidades superiores que han requerido fasciotomía, con respecto a las extremidades inferiores. El objetivo del presente trabajo fue comparar las características clínicas y complicaciones de los pacientes con trauma vascular de las extremidades superiores que requirieron fasciotomía con respecto a las infereiores, para detectar si existe diferencia en el pronóstico e identificar qué factores pueden explicar esta diferencia.

Sindrome compartimental agudo post-ejercicio / Compartment syndrome sharp post-exercise

RESUMEN: El síndrome compartimental (SC) de los miembros inferiores es una complicación temible de múltiples situaciones clínicas, especialmente fracturas. Presentamos aqui un caso relacionado a la práctica deportiva del squash. Se destacan además de la descripción de la fisiopatología y clínica general del SC dos aspectos de este caso: primero que en nuestro conocimiento solo hay dos citas bibliográficas en los últimos 10 años que se relacionen SC con el squash y segundo y más importante que la demora diagnóstica y terapéutica tine consecuencias irreversibles e invalidantes para el paciente.