Acute compartment syndrome of the thigh following minor trauma in a patient on dual anti-platelet therapy.

Acute compartment syndrome of the thigh is a rare surgical emergency. It is usually associated with high energy trauma and concomitant femoral fracture. We present the case of a 54 year old man who developed acute compartment syndrome of the thigh following a low energy traumatic hamstring tear. Background anti-platelet therapy and hospital prescribed anticoagulants were likely contributors to this pathology. We describe these factors and discuss the issues associated with assessment of minor trauma in the anti-coagulated patient.

Pre-operative platelet-bound CD40 ligand is probably associated with peri-operative cardiac events in hip and knee arthroplasty.

BACKGROUND: Peri-operative cardiac events are common and associated with significant morbidity. A predictive biomarker would assist in pre-operative risk stratification of surgical patients. This study explored the utility of pre-operative measurements of platelet-bound CD40 ligand and other biomarkers for predicting peri-operative cardiac events in total hip or knee arthroplasty. METHODS: Blood samples were collected from 62 patients prior to surgery and tested for the biomarkers platelet CD40 ligand, platelet factor V/Va, platelet P-selectin, high-sensitivity C-reactive protein, B-type natriuretic peptide and soluble CD40 ligand. The Revised Cardiac Risk Index was also calculated. Patients were then followed up prospectively and screened for peri-operative cardiac events by means of ECG, serial troponin I, a cardiologist's review and an interview at 6 weeks post operation. RESULTS: Six of 62 (9.7%) patients had a cardiac event. Patients who experienced a cardiac event had higher pre-operative platelet CD40 ligand levels as measured by flow cytometry [median 0.55% vs. 0.29% (P = 0.02)]. In this sized sample, platelet CD40L was the only biomarker independently associated with cardiac events (P = 0.02), the area under the receiver-operator characteristic curve being 0.79. CONCLUSION: In a study of this number of patients, of the six biomarkers tested, only platelet CD40 ligand was found to have a probable association with peri-operative cardiac events in hip and knee arthroplasty.