ABSTRACT
Acute Peripheral Ischemia (API) is the most severe acute complication after both open and closed fractures, as ischemia compromises not only the vitality of the affected limb, but also the patient's life, because metabolic anaerobic changes following ischemia have serious local and general consequences. These explain why early diagnosis of API is very important for the prognosis of the traumatized limb.The authors analyse cases when API was not diagnosed immediately after trauma, but some time after the first examination, due to either low systolic BP or to late onset of API. The patients were analysed concerning the type of the fracture, the reason for delayed diagnosis of API, the moment of API diagnosis and the arterial injury. In all those cases, surgery was performed immediately after API diagnosis, in order to identify and treat the complex injuries(bone and vascular).
Subject(s)
Fractures, Bone/complications , Fractures, Bone/diagnosis , Ischemia/diagnosis , Ischemia/etiology , Lower Extremity/blood supply , Upper Extremity/blood supply , Vascular System Injuries/complications , Vascular System Injuries/diagnosis , Adult , Delayed Diagnosis , Female , Femoral Fractures/complications , Femoral Fractures/diagnosis , Fracture Fixation, Internal/adverse effects , Fractures, Bone/surgery , Fractures, Closed/complications , Fractures, Closed/diagnosis , Fractures, Open/complications , Fractures, Open/diagnosis , Humans , Humeral Fractures/complications , Humeral Fractures/diagnosis , Ischemia/surgery , Male , Middle Aged , Prognosis , Quality of Life , Tibial Fractures/complications , Tibial Fractures/diagnosis , Treatment Outcome , Vascular System Injuries/surgeryABSTRACT
Compartment Syndrome (CS) is characterised by an imbalance produced by increased pressure in an inextensible space (called "the Compartment"). Without being specific for orthopaedics, CS has increasing frequency in modern traumatology. Microcirculation disturbances generate the syndrome's self-augmenting physiopathological character. The pathognomonic feature of the clinical panel in CS of the lower limbs is increased consistency of the muscular groups, while peripheral pulse maintainance does not exclude CS. Although positive diagnosis is based on measuring the intra-compartmental pressure, (ICP) clinical suspicion is crucial. The correct treatment is surgical, consisting in early and large decompressive fasciotomy. Without proper treatment, CS endangers not only the vitality of the limb (due to Acute Peripheral Ischemia with onset in microcirculation and centripetal extension), but also the patient's life, thus becoming a life-threatening disorder. The authors underline the importance of correct clinical evaluation and early treatment in order to prevent the serious local and general complications of the CS.
