Compartment syndrome of the forearm: a systematic review.

In this systematic review, we examined the available evidence regarding compartment syndrome of the forearm. Applying our inclusion criteria, we found 12 articles for a total of 84 cases using the MEDLINE (Ovid) database. All were retrospective studies (level IV evidence). In this study, papers were analyzed for causes, diagnosis, treatment, methods of wound closure, functional outcome, and complications. The most common cause of compartment syndrome of the forearm in children was a supracondylar fracture, while in adults the most common cause was a fracture of the distal radius. The diagnostic criterion used was clinical assessment alone in 48%, and in 52%, a combination of measurement of intracompartmental pressure and clinical assessment was used. The intracompartmental pressure was measured using various techniques including a wick catheter, slit catheter, the Whitesides technique, and the Stryker compartment pressure measuring device. Fasciotomy was the preferred method of treatment (73%). In cases reporting wound management, postfasciotomy skin grafting was needed in 61% of the cases, whereas secondary closure was performed in 39% of the cases. Neurological deficit was the most common complication (21%).

Low molecular weight heparin: current evidence for its application in orthopaedic surgery.

Low molecular weight heparin (LMWH) is used in orthopaedic surgery largely for prophylaxis of venous thromboembolism (VTE). The purpose of this study was to review the available evidence to better define its role. The most recent American College of Chest Physicians Evidence-Based Practice guidelines for the most current recommendations for the application of LMWH to orthopaedic surgery are reviewed. A systematic review of the literature was undertaken using MEDLINE database and manual searches, the terms low molecular weight heparin, orthopaedic procedures, venous thromboembolism, and thromboprophylaxis were used as keywords. A total of 34 studies were identified, including prospective, randomized controlled clinical studies comparing LMWH with other treatment methods in orthopaedic surgery patients, meta-analysis and health economic related studies. There is clear supporting evidence for the application of LMWH for DVT prophylaxis in orthopaedic surgery. Although newer agents such as oral thrombin inhibitors are being developed for DVT prophylaxis, it will take some time to adequately assess the clinical efficacy, safety, and cost-effectiveness of these newer agents. Whether these agents will ultimately supplant the widespread application of LMWH to orthopaedic surgery remains to be seen.