Akut kompartman sendromu klinik yaklaşımları: Türkiye'de ortopedi ve travmatoloji doktorlarının uygulamalarının anket ile değerlendirilmesi
Abstract
Amaç: Çalışmanın amacı,
Türkiye’de halen çalışmakta olan ortopedi ve travmatoloji uzmanları ve
asistanlarının, kompartman sendromuna yönelik güncel yaklaşım ve algılarının
ortaya konmasıdır.
Gereç ve Yöntem: Çalışma icin tasarlanmış anket ile, bilinci açık veya kapalı hastada
tanı, kompartman sendromunun klinik bulguları, kompartman basıncı ölçümü, fasiyotomi
icin uygun müdahale süresi ve tekniği değerlendirildi.
Bulgular: Bu değerlendirmede, en önemli (%74) ve en erken (%82,2) oluşabilecek
semptomun ağrı olduğu görüşü hakimdir. Tanısal yaklaşımda, %59,6 aşırı ağrı ve
pasif germe ile aşırı ağrıyı tanı icin yeterli görmektedir. Bilinci kapalı
hastalarda, %22,6 kompartman basıncını her hastada ölçülmesi gerektiğini ve
birinci yüksek sonuçta acil fasiyotomi endikasyonunu uygun görmektedir. Öte
yandan, %59,6 kompartman basıncı ölçmeksizin klinik şüphenin acil fasiyotomi
icin yeterli bir endikasyon olduğu görüşündedir. %89,7 kompartman sendromu
şüphesinde basınç ölçmeye gerek duymamaktadır. %55,5 manuel kompartman ölçüm
düzeneğini hiç görmemiş ve %25,3 düzeneği kurabilecek bilgiye sahip olduğunu
ifade etmektedir.
Sonuç: Türkiye’de kompartman
sendromu yönetiminde tartışmalı yaklaşımlar olduğu gözlenmekle beraber, klinik
yaklaşım rehberlerinin hazırlanması, en uygun yaklaşımın oluşması, değişken
yaklaşımların ve komplikasyon insidanslarının azaltılması için fayda
sağlayacaktır.
References
- Matsen FA III, Krugmire RB Jr. Compartmental syndromes. Surg Gynecol Obstet 1978;147(6):943-9.
- McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg 2000;82(2):200-3.
- Elliott KGB, Johnstone AJ. Diagnosing acute compartment syndrome. J. Bone Joint Surg 2003;85(5):625-32.
- Via AG, Oliva F, Spoliti M, et al. Acute compartment syndrome. Muscles Ligaments Tendons J 2015;5(1):18-22.
- O’Toole RV, Whitney A, Merchant N, et al. Variation in diagnosis of compartment syndrome by surgeons treating tibial shaft fractures. J Trauma 2009;67(4):735-41.
- Raza H, Mahapatra A. Acute compartment syndrome in orthopedics: Causes, diagnosis, and management. Adv Orthop 2015;2015:543412.
- Hope MJ, McQueen MM. Acute compartment syndrome in the absence of fracture. J Orthop Trauma 2004;18(4):220-4.
- McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br 1996;78(1):99-104.
- Ulmer T. The clinical diagnosis of compartment syndrome of the lower leg: Are clinical findings predictive of the disorder? J Orthop Trauma 2002;16(8):572-7.
- von Keudell AG, Weaver MJ, Appleton PT, et al. Diagnosis and treatment of acute extremity compartment syndrome. Lancet 2015;386(10000):1299-310.
- Mar G, Barrington M, McGuirk B. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. Br J Anaesth 2009;102(1):3-11.
- Kalyani B, Fisher B, Roberts C, et al. Compartment syndrome of the forearm: A systematic review. J Hand Surg Am 2011;36(3):535-43.
- Frink M, Hildebrand F, Krettek C, et al. Compartment syndrome of the lower leg and foot. Clin Orthop Relat Res 2010;468(4):940- 50.
- Christenson J, Wulff K. Compartment pressure following leg injury: The effect of diuretic treatment. Injury 1985;16(9):591-4.
- Cohen M, Garfin S, Hargens A, Mubarak S. Acute compartment syndrome. Effect of dermotomy on fascial decompression in the leg. Jof Bone Joint Surg Br 1991;73(2):287-90.
- Busch T, Sîrbu H, Zenker D, et al. Vascular complications related to intraaortic balloon counterpulsation: An analysis of ten years experience. Thorac Cardiovasc Surg 1997;45(2):55-9.
- Wiger P, Styf JR. Effects of limb elevation on abnormally increased intramuscular pressure, blood perfusion pressure, and foot sensation: An experimental study in humans. J Orthop Trauma 1998;12(5):343-7.
- Matsen FA, Wyss CR, Krugmire RB, et al. The effects of limb elevation and dependency on local arteriovenous gradients in normal human limbs with particular reference to limbs with increased tissue pressure. Clin Orthop Relat Res 1980;(150):187-95.
- Wall CJ, Lynch J, Harris IA, et al. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma. ANZ J Surg 2010;80(3):151-6.
- O’Sullivan MJ, Rice J, McGuinness AJ. Compartment syndrome without pain! Ir Med J 2002;95(1):22.
- Uliasz A, Ishida JT, Fleming JK, et al. Comparing the methods of measuring compartment pressures in acute compartment syndrome. Am J Emerg Med 2003;21(2):143-5.
- Whitesides TE, Haney TC, Morimoto K, et al. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res 1975;(113):43-51.
- Williams PR, Russell ID, Mintowt-Czyz WJ. Compartment pressure monitoring -- current UK orthopaedic practice. Injury 1998;29(3):229-32.
- Wall CJ, Richardson MD, Lowe AJ, et al. Survey of management of acute, traumatic compartment syndrome of the leg in Australia. ANZ J Surg 2007;77(9):733-7.
- Bhattacharyya T, Vrahas MS. The medical-legal aspects of compartment syndrome. J Bone Joint Surg Am 2004;86-A(4):864-8.
- Shadgan B, Menon M, Sanders D, et al. Current thinking about acute compartment syndrome of the lower extremity. Can J Surg 2010;53(5):329-34.
Management of acute limb compartment syndrome: A survey of clinical practice among orthopedics and traumatology surgeons in Turkey
Abstract
Aim: The
aim is to conduct a survey of currently practising orthopedics and traumatology
surgeons and residents in Turkey regarding their current practice and
perceptions on compartment syndrome management.
Materials and Methods: A structured survey was developed for the study. Diagnosis in alert and
unconscious patients, clinical signs of the condition, compartment pressure
measurement, optimal time frame and technique for performing a fasciotomy, and
preventive measures in patients with limb injuries were assessed.
Results: Due to the evaluation, most
significant and earliest symptom thought to be pain in 74% and 82.2%
respectively. In diagnostic approach of conscious patients, 59.6% find intense
pain and intense pain with passive stretching sufficient for diagnosis. In
unconscious patients, 22.6% measure intracompartment pressure in every patient
and if high in first measurement, indicates emergent fasciotomy, whereas 59.5%
apply emergent fasciotomy in clinical suspicion without measuring
intracompartment pressure. 89.7% don’t use pressure gauge in case of a
compartment syndrome suspicion. 55.5% have not seen manually constructed
mechanism before. 25.3% participants have sufficient knowledge to construct the
mechanism.
Conclusion: There are controversies in the management of compartment syndrome in
Turkey, development of clinical practice guidelines may encourage best
practice, reduce variations and reduce the incidence of complications.
References
- Matsen FA III, Krugmire RB Jr. Compartmental syndromes. Surg Gynecol Obstet 1978;147(6):943-9.
- McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg 2000;82(2):200-3.
- Elliott KGB, Johnstone AJ. Diagnosing acute compartment syndrome. J. Bone Joint Surg 2003;85(5):625-32.
- Via AG, Oliva F, Spoliti M, et al. Acute compartment syndrome. Muscles Ligaments Tendons J 2015;5(1):18-22.
- O’Toole RV, Whitney A, Merchant N, et al. Variation in diagnosis of compartment syndrome by surgeons treating tibial shaft fractures. J Trauma 2009;67(4):735-41.
- Raza H, Mahapatra A. Acute compartment syndrome in orthopedics: Causes, diagnosis, and management. Adv Orthop 2015;2015:543412.
- Hope MJ, McQueen MM. Acute compartment syndrome in the absence of fracture. J Orthop Trauma 2004;18(4):220-4.
- McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br 1996;78(1):99-104.
- Ulmer T. The clinical diagnosis of compartment syndrome of the lower leg: Are clinical findings predictive of the disorder? J Orthop Trauma 2002;16(8):572-7.
- von Keudell AG, Weaver MJ, Appleton PT, et al. Diagnosis and treatment of acute extremity compartment syndrome. Lancet 2015;386(10000):1299-310.
- Mar G, Barrington M, McGuirk B. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. Br J Anaesth 2009;102(1):3-11.
- Kalyani B, Fisher B, Roberts C, et al. Compartment syndrome of the forearm: A systematic review. J Hand Surg Am 2011;36(3):535-43.
- Frink M, Hildebrand F, Krettek C, et al. Compartment syndrome of the lower leg and foot. Clin Orthop Relat Res 2010;468(4):940- 50.
- Christenson J, Wulff K. Compartment pressure following leg injury: The effect of diuretic treatment. Injury 1985;16(9):591-4.
- Cohen M, Garfin S, Hargens A, Mubarak S. Acute compartment syndrome. Effect of dermotomy on fascial decompression in the leg. Jof Bone Joint Surg Br 1991;73(2):287-90.
- Busch T, Sîrbu H, Zenker D, et al. Vascular complications related to intraaortic balloon counterpulsation: An analysis of ten years experience. Thorac Cardiovasc Surg 1997;45(2):55-9.
- Wiger P, Styf JR. Effects of limb elevation on abnormally increased intramuscular pressure, blood perfusion pressure, and foot sensation: An experimental study in humans. J Orthop Trauma 1998;12(5):343-7.
- Matsen FA, Wyss CR, Krugmire RB, et al. The effects of limb elevation and dependency on local arteriovenous gradients in normal human limbs with particular reference to limbs with increased tissue pressure. Clin Orthop Relat Res 1980;(150):187-95.
- Wall CJ, Lynch J, Harris IA, et al. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma. ANZ J Surg 2010;80(3):151-6.
- O’Sullivan MJ, Rice J, McGuinness AJ. Compartment syndrome without pain! Ir Med J 2002;95(1):22.
- Uliasz A, Ishida JT, Fleming JK, et al. Comparing the methods of measuring compartment pressures in acute compartment syndrome. Am J Emerg Med 2003;21(2):143-5.
- Whitesides TE, Haney TC, Morimoto K, et al. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res 1975;(113):43-51.
- Williams PR, Russell ID, Mintowt-Czyz WJ. Compartment pressure monitoring -- current UK orthopaedic practice. Injury 1998;29(3):229-32.
- Wall CJ, Richardson MD, Lowe AJ, et al. Survey of management of acute, traumatic compartment syndrome of the leg in Australia. ANZ J Surg 2007;77(9):733-7.
- Bhattacharyya T, Vrahas MS. The medical-legal aspects of compartment syndrome. J Bone Joint Surg Am 2004;86-A(4):864-8.
- Shadgan B, Menon M, Sanders D, et al. Current thinking about acute compartment syndrome of the lower extremity. Can J Surg 2010;53(5):329-34.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 14, 2019 |
| Submission Date | September 25, 2018 |
| Published in Issue | Year 2019Volume: 58 Issue: 1 |
