Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Dec 2007
Epidemiology, Etiology, Pathophysiology and Diagnosis of the Acute Compartment Syndrome of the Extremity.
Due to an insult that causes a pressure elevation in the compartment, which is the limited space surrounded by the unyielding bone and fascia, the circulation is compromised resulting in muscular and neural ischemia and eventually tissue necrosis. The diagnosis of the compartment syndrome has always been based on the clinical symptoms, however, multiple studies suggested that clinical examination alone is insufficient and may result in delayed diagnosis, delayed treatment and serious sequelae. ⋯ There is, however, no consensus about the indications for the compartment pressure monitoring, or about the threshold pressure that should be used for dermatofasciotomy. A diagnostic guideline is proposed.
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Compartment syndrome of the upper extremity is rare, but happens frequently. It most often affects the forearm, compartment syndromes of the upper arm and hand are seen much more seldom. Early diagnosis and efficient fasciotomy is of highest importance to achieve good outcome and prevent development of Volkmann's ischemic contracture.
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Distal forearm fractures are among the most common fractures in children. In the past few years the option of percutaneous pinning has gained more attention in the treatment of unstable fractures. However, it remains unclear in which cases a fracture or its reduction should be considered unstable. ⋯ Fully displaced fractures should always be reduced in a setting with pins immediately available. If anatomical reduction cannot be achieved, pinning is advocated. The AO proposal for pediatric long bone fracture classification could be a useful tool to render the diverse studies more comparable. However, the important feature of complete versus subtotal displacement is lacking.
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Eur J Trauma Emerg S · Dec 2007
Huge Extrapleural Hematoma After a Blunt Chest Trauma: An Unusual Presentation.
Massive extrapleural hematoma secondary to blunt chest trauma is exceedingly rare especially in nonanticoagulated patients. Significant amounts of blood can be sequestered between parietal pleura and the endothoracic facia leading to ventillatory and circulatory disturbances and even death. We report a case of a huge extrapleural hematoma in a non-anticoagulated 70-year-old patient secondary to blunt chest trauma. Etiology, surgical and treatment implications of this injury are briefly discussed.