The natural course of chronic exertional compartment syndrome of the lower leg.

PURPOSE: The aim of this study was to investigate the natural course of chronic exertional compartment syndrome (CECS) in the lower leg. METHODS: Twelve military men [mean age 30 (SD 4)] diagnosed with CECS after intracompartmental pressure (ICP) measurements immediately post-exercise in 21 legs, who did not undergo a fasciotomy, were reviewed and participated in a repeat pressure measurement after a mean time of 50 months (SD 15). RESULTS: Sixteen of 21 legs still showed an ICP of 35 mm Hg or more (the cut-off point) at the second visit. All twelve patients still had typical complaints. Mean ICP at index measurement was 58 (SD 15) mm Hg. At the second visit, it was 51 (SD 15) mm Hg. Six patients chose to undergo a subcutaneous fasciotomy, and these six patients all benefited in the short term. CONCLUSION: The natural course of CECS seems to be persistent symptoms over time. LEVEL OF EVIDENCE: Case series with no comparative group, Level IV.

A clinical decision model identifies patients at risk for delayed diagnosed injuries after high-energy trauma.

OBJECTIVE: Tertiary trauma survey is widely implemented in trauma care to identify all injuries in trauma patients. However, various studies consistently show that some trauma patients have missed injuries. In this study, we developed a clinical decision model to identify patients who are at risk for delayed diagnosed injuries. METHODS: During a period of 18 months, we collected the medical records of all the adult patients who presented after a high-energy trauma at the emergency department of a Dutch trauma centre. The type of trauma, patient characteristics, the radiology studies performed, Glasgow Coma Scale, Revised Trauma Score, and Injury Severity Score (ISS) were registered. We thoroughly screened all medical records for delayed diagnosed injuries. Stepwise logistic regression analysis was used to identify the variables associated with the outcome delayed diagnosed injuries and to develop a clinical prediction model. RESULTS: We included 475 patients. Thirteen (2.7%) patients with delayed diagnosed injuries were identified. Stepwise logistic regression analysis revealed several models with the ISS, ICU admittance, and CT-head as predictive variables. The model we proposed with the ISS could identify patients who are at a risk for delayed diagnosed injuries with a sensitivity of 92.3% and a specificity of 86.4%. CONCLUSION: Our newly developed clinical decision model can identify patients who are at a risk for delayed diagnosed injuries and who should undergo an intensified search for potential unidentified injuries.

[Waveboard-related injuries. Greater protection is advised]. / Letsels bij 'waveboarden'. Aanbeveling om meer bescherming te dragen.

OBJECTIVE: Waveboarding, a type of skateboarding, is a new craze among children. The aim of this study is to describe how many children visit the emergency department as a consequence of waveboarding and the types of injury they have. DESIGN: Retrospective, descriptive. METHOD: All records of children aged 5 to 15 years who had visited the emergency department of the Medical Center Alkmaar in the period March to May 2010 were examined. If a case of waveboard-related injury was found then the type of injury was noted. For all of the injuries a phone call was made to try to find out if protective gear had been worn. RESULTS: A total of 1418 records from 2010 were investigated. In 132 cases, a waveboard-related injury was found. Contusion was found in 31% of cases and a fracture in 64% of cases. The 2 most frequently occurring sites of injury were the forearm and wrist (53%) and the elbow (14%). In 3% of the waveboard-related injuries the child concerned had worn any protective gear. CONCLUSION: Children who visited the emergency department due to waveboard-related injuries mainly had injuries to the wrists, forearm and elbow. Only 3% of the children wore protective gear when waveboarding. As effective protection against accident-related injuries exists for skaters, the wearing of protective gear during waveboarding can be expected to lead to a reduced number of injuries.

Reliability of near-infrared spectroscopy in people with dark skin pigmentation.

OBJECTIVE: Near-infrared spectroscopy (NIRS) is a promising non-invasive technique for the continuous monitoring of tissue oxygen delivery. NIRS detects light absorbance of haemoglobin chromophores to determine tissue oxygen saturation (StO2). As skin colour is also determined by the presence of chromophores, it is plausible that NIRS signal quality may be affected by dark skin pigmentation. METHODS: Tissue saturation in the anterior compartment of the lower leg during isometric contraction was measured using NIRS in 17 volunteers with dark skin pigmentation. Measurements were continued until StO2 was zero percent or until the signal disappeared. RESULTS: The NIRS device failed to register tissue saturation values at some point in nine of seventeen volunteers. This occurred more often in individuals with darker skin. CONCLUSIONS: In patients with a dark pigmented skin, NIRS StO2 measurements should be interpreted with caution, as melanin clearly interferes with the quality of the reflected NIRS signal.