Compartment syndrome causes systemic inflammation in a rat.

AIMS: Compartment syndrome results from increased intra-compartmental pressure (ICP) causing local tissue ischaemia and cell death, but the systemic effects are not well described. We hypothesised that compartment syndrome would have a profound effect not only on the affected limb, but also on remote organs. METHODS: Using a rat model of compartment syndrome, its systemic effects on the viability of hepatocytes and on inflammation and circulation were directly visualised using intravital video microscopy. RESULTS: We found that hepatocellular injury was significantly higher in the compartment syndrome group (192 PI-labelled cells/10(-1) mm(3), standard error of the mean (sem) 51) compared with controls (30 PI-labelled cells/10(-1) mm(3), sem 12, p < 0.01). The number of adherent venular white blood cells was significantly higher for the compartment syndrome group (5 leukocytes/30s/10 000 µm(2), sem 1) than controls (0.2 leukocytes/30 s/10 000 µm(2), sem 0.2, p < 0.01). Volumetric blood flow was not significantly different between the two groups, although there was an increase in the heterogeneity of perfusion. CONCLUSIONS: Compartment syndrome can be accompanied by severe systemic inflammation and end organ damage. This study provides evidence of the relationship between compartment syndrome in a limb and systemic inflammation and dysfunction in a remote organ. Cite this article: Bone Joint J 2016; 98-B:1132-7.

Contribution of inflammation to cellular injury in compartment syndrome in an experimental rodent model.

Compartment syndrome, a devastating consequence of limb trauma, is characterised by severe tissue injury and microvascular perfusion deficits. We hypothesised that leucopenia might provide significant protection against microvascular dysfunction and preserve tissue viability. Using our clinically relevant rat model of compartment syndrome, microvascular perfusion and tissue injury were directly visualised by intravital video microscopy in leucopenic animals. We found that while the tissue perfusion was similar in both groups (38.8% (standard error of the mean (sem) 7.1), 36.4% (sem 5.7), 32.0% (sem 1.7), and 30.5% (sem 5.35) continuously-perfused capillaries at 45, 90, 120 and 180 minutes compartment syndrome, respectively versus 39.2% (sem 8.6), 43.5% (sem 8.5), 36.6% (sem 1.4) and 50.8% (sem 4.8) at 45, 90, 120 and 180 minutes compartment syndrome, respectively in leucopenia), compartment syndrome-associated muscle injury was significantly decreased in leucopenic animals (7.0% (sem 2.0), 7.0%, (sem 1.0), 9.0% (sem 1.0) and 5.0% (sem 2.0) at 45, 90, 120 and 180 minutes of compartment syndrome, respectively in leucopenia group versus 18.0% (sem 4.0), 23.0% (sem 4.0), 32.0% (sem 7.0), and 20.0% (sem 5.0) at 45, 90, 120 and 180 minutes of compartment syndrome in control, p = 0.0005). This study demonstrates that the inflammatory process should be considered central to the understanding of the pathogenesis of cellular injury in compartment syndrome.

The effect of flexor tendon repair bulk on tendon gliding during simulated active motion: an in vitro comparison of two-strand and six-strand techniques.

The gliding function of 2-strand (Tajima) and 6-strand (Savage) techniques of flexor tendon repair were compared in an in vitro biomechanical model. Stainless steel beads were inserted directly into the metacarpals, phalanges, and flexor digitorum profundus tendons of 22 human cadaver specimens. The FDP tendons were loaded from 5 to 25 N using a pneumatic actuator. The angular rotation and tendon excursion of the cadaver specimens were measured radiographically. The gliding function of the repairs was compared with core suture only, core suture plus epitenon repair, and sheath repair. There was no significant difference in angular rotation or linear excursion between the 2-strand and 6-strand techniques of flexor tendon repair. The addition of the epitendinous suture to the core suture improved the angular rotation and linear excursion for the 2-strand technique. Although the 6-strand repair tended to increase the repair site bulk more than the conventional 2-strand technique, the gliding function of the repair techniques was equivalent.

Conservative management of hepatic duct injury after blunt trauma: a case report.

Nonoperative management of solid organ injury in children with blunt abdominal trauma represents the standard of care. In rare cases, a major duct injury with persistent bile leakage may result from blunt trauma to the liver. This injury is of concern in patients treated nonoperatively because it generally must be treated with major abdominal surgery. The authors describe a case of hepatic duct injury from blunt trauma in which healing occurred without surgical repair or resection.

Cyclic testing of flexor tendon repairs: an in vitro biomechanical study.

Forty cadaveric flexor digitorum profundus tendons were repaired using the Tajima, Halsted, Silfverskiold, or Savage techniques. The tendons were cyclically loaded in sets of 4,000 cycles beginning at 25 N and increasing by 10-N increments until failure occurred. Gap formation was continuously monitored with an extensiometer. Only the Savage repair group consistently withstood 4,000 cycles of 25-N loading, with respect to 2-mm gap formation and repair rupture. Tendon repairs subjected to cyclic loading demonstrated gap formation and repair rupture at lower loads than with static testing. Of the methods of flexor tendon repair tested, only the Savage technique could withstand simulated early active motion.

In-vitro strength of flexor-tendon repairs.

OBJECTIVE: To compare the standard Tajima technique for flexor-tendon repair of the hand with three new techniques with respect to strength and technical ease of the repair and bulk at the repair site. DESIGN: A randomized analysis of human cadaver flexor digitorum superficialis tendon repairs. SETTING: A musculoskeletal research laboratory at a university-affiliated health centre. MATERIAL: Thirty-nine fresh-frozen cadaveric flexor digitorum superficialis tendons from index, long and ring fingers harvested and divided transversely. The tendons were randomly allocated for repair by the current standard technique or one of three new techniques. INTERVENTIONS: The standard Tajima (modified Kessler) technique, and the Halsted, Savage or Silfverskiold technique. MAIN OUTCOME MEASURES: The time to perform each repair, the cross-sectional dimension and the load to failure of the tendon repairs. RESULTS: The Savage repair tolerated the highest loads, followed by the Halsted, Silfverskiold and Tajima repairs. The Silfverskiold technique was the least time-consuming to perform, followed by the Tajima, Halsted and Savage repairs. All of the techniques increased the cross-sectional dimensions of the tendon: the Silfverskiold repair by at least 50% and the Savage repair by over 100%. Although none of the techniques tested performed ideally, all three new techniques provided greater initial static strength than the standard Tajima method. CONCLUSION: Further in-vitro and in-vivo studies of these new techniques of flexor-tendon repair of the hand are necessary to optimize the treatment of these injuries.

Favorable outcome in children with Beckwith-Wiedemann syndrome and intraabdominal malignant tumors.

Children with Beckwith-Wiedemann syndrome (BWS) have an increased risk of developing Wilms' tumors, hepatoblastomas, and adrenal tumors. This study evaluates disease-free survival in children with BWS and intraabdominal tumors. Sixteen tumors occurred in 13 children with BWS (8 boys, 5 girls). Diagnoses included Wilms' tumor (10) (2 bilateral, 20%), hepatoblastoma (2), bladder rhabdomyosarcoma (1), and adrenal cortical tumor (1). In the 10 children with Wilms' tumor, the average age at diagnosis was 3.5 years (range, 7 months to 5 years). Nine of 10 had initial tumor resection, chemotherapy, and radiation therapy (when indicated). One child with bilateral disease had tumor biopsy, chemotherapy, and partial nephrectomy. Tumors were classified as stage I (5), stage II (2), stage IV (1) and stage V (2), all with favorable histology. Disease-free survival rate was 100% with median follow-up of 9 years (range, 4 to 22 years). One patient had a left adrenal tumor detected during screening sonography 11 years after Wilms' tumor resection. Two infants with advanced-stage hepatoblastoma responded to chemotherapy, allowing subsequent complete hepatic resection. Both tumors had unfavorable histology. Both completed postoperative chemotherapy and have no evidence of disease (NED) with normal alpha-fetoprotein levels at 21 and 12 months, respectively, after tumor detection. One patient with stage III (group 3) bladder rhabdomyosarcoma underwent partial cystectomy following chemoradiation and is alive (NED) after 20 months. Children with BWS should be screened at regular intervals (every 3 to 6 months) for renal, adrenal, and hepatic tumors. The exact duration of screening is not yet determined.(ABSTRACT TRUNCATED AT 250 WORDS)