Recent advances in mechanism and treatment of fracture-related tension blister / 中华创伤杂志

The presence of tension blister often predicts severe soft tissue damage，which not only increases the risk of wound complications but also prolongs the surgical treatment time. However，the developed tension blister has been proposed as a potential decompressive approach for it may relieve the pressure of osteofascial compartment and improve the likelihood of relieving clinical symptoms，as well as avoid unnecessary surgery in cases of suspected osteofascial compartment syndrome. Recently，the osteofascial system has been increasingly recognized that associations were found between the tension blister and osteofascial self-release processing. Thus，the timing of blister occurrence and regression substantially influences physicians′ clinical decisions，making blister management as part of the treatment of fractures. In this review，the authors give an overview of the characteristics，mechanism，stress reduction effect，prevention，current treatment status and complications of the fracture-related tension blister，hoping to help orthopedic physicians understand and treat the tensile blister.

Myofascial self-release law / 中华创伤杂志

Osteofascial compartment syndrome (OFCS) is clinically common and is well known to orthopedic surgeons.Clinicians attach great importance to OFCS because of its severe clinical consequences,and decompression of fascial compartment is often performed in emergency treatment.This article reviews the literature on the threshold of fascial compartment decompression proposed by many scholars in the past and discusses the problems in the clinical diagnosis of acute compartment syndrome,especially the inconsistent pressure thresholds as the indication for emergency decompression surgery.By observing calf fractures patients with tension blister,we found that the pressure of fascia decreased sharply upon the appearance of blisters.Meanwhile,the swelling gradually subsided as well as the clinical manifestations of pain and parasthsia.In view of the uncertainty of various thresholds of fascial decompression and self-decompression,the concepts of myofascial self-release law and muscle-swelling syndrome were first proposed.The author believes that when intracompartmental pressure rises to a point,some unknown mechanisms of fascia can achieve self-decompression.Therefore,no compartment syndrome will take place.We also emphasize that the ' muscle-swelling syndrome'should be strictly distinguished from the soft tissue necrosis caused by crush syndrome and acute limb vascular injury,so as to provide more precise treatment.We believe that without external restrictions such as casts,splints and compression bandages,the muscle-swelling syndrome can achieve self decompression by releasing the pressure in the compartment through tension blisters,and there is no need for fasciotomy.