[ ISSN : 2576-5442 ]
Acute compartment syndrome; Ulnar artery; Injury
A case of acute compartment syndrome is described in an old woman following branch stuck to her forearm. She just displayed a little wound with no fractures. The ulnar artery was punctured by a branch and caused a large forearm hematoma and eventually lead to an acute forearm compartment syndrome. Prompt diagnosis and surgical management bring a successful consequence. The written informed consent was obtained from the patient to publicate this case, including the following pictures.
Acute compartment syndrome is defined as an increase in intra compartmental pressure cause by a decrease of perfusion pressure. Although this disorder has been describing about 130 years, it is still a challenge to diagnose and treat effectively [1]. To our knowledge, an acute forearm compartment syndrome which without fracture or crush injury is a rare but disastrous clinical condition [2]. Here, we report an acute compartment syndrome caused by a little branch.
A sixty-three-year-old woman was admitted to our hospital. Her left forearm was punctured by a little branch. There was only a 0.5-centimeter tear in the skin of her medial forearm, and only a small amount of blood oozed from the wound (Figure 1A). She complained the pain in her swelling left forearm. The patient was otherwise fit and well, taking no medications and with no known allergies. Radiographs showed no fracture. Her left forearm became more and more swollen and painful in the following half hour. Just two hours later, the patient’s left forearm became extremely swelling, the patient cried with pain. The distal ulnar and radial pulses were intact. Active and passive movements were resisted by the patient due to severe pain. On the basis of these examinations, an urgent upper limb fasciotomy was performed at once. Compartment decompression was performed through an anterior fasciotomy incision. A large hematoma was found in the process of the operation. To our surprise, we found an incomplete rupture of the ulnar artery which may be the result of acute compartment syndrome (Figure 1B). The ulnar artery was sutured and hematoma was completely debrided. The fasciotomy wound was treated with Vacuum Sealing Drainage (VSD). The patient recovered well postoperatively with no motor or neurovascular deficit. The wound was closed after five days.
Figure 1: A - a 0.5-centimeter tear in the skin of medial forearm, B- an incomplete rupture of the ulnar artery.
Acute limb compartment syndrome is a limb threatening and occasionally a life-threatening emergency for which timely diagnosis and treatment is essential. Consequences can range from muscle necrosis, limb amputation to renal failure and death [1]. However, there is a few reports about acute compartment syndrome of forearm, particularly in the absence of a forearm fracture [3]. To the best of our knowledge, rupture of the ulnar artery without a fracture or crush injury which lead to a compartment syndrome has not been reported previously. Although this condition was rarely, early diagnosis and prompt surgical management can obviate the potentially devastating and irreversible consequences of a missed compartment syndrome.
2. Kim JY, Schierle CF, Subramanian VS, Birman MV, Kloeters O, Forte AJ, et al. A prognostic model for the risk of development of upper extremity compartment syndrome in the setting of brachial artery injury. Ann Plast Surg 2009; 62: 22-27.
3. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg Br 2000; 82: 200-203.
Liang Y, Zhang P, Chen P, Hu Y, He J and Wang J. Acute Compartment Syndrome of the Forearm Following Ulnar Artery Puncture in a Patient Stuck by Branch. SM Musculoskelet Disord. 2017; 2(2): 1017.
Occlusion is biologically defined as the coordinated functional interaction between the various cell populations forming the masticatory system as they differentiate, model, remodel, fail and repair
Talia Becker*
Achilles tendon is a common site of foot and ankle discomfort but its rupture is not frequent. It’s a superficial tendon and this lends it to excellent evaluation by sonography instead of magnetic resonance imaging. Recently ultrasonography has been widely used in musculoskeletal practice. We present a case of Achilles tendon ruptures diagnosed based on fundamental sonographic findings.
Arash Babaei-Ghazani¹,², Safoora Ebadi¹,², Bijan Forogh¹,³, and Bina Eftekharsadat⁴*
Osteoarthritis (OA), one of the most common skeletal disorders characterized by cartilage degradation and osteophyte formation in joints, is induced by accumulated mechanical stress; however, little is known about the underlying molecular mechanism. Several experimental OA models in mice by producing instability in the knee joints have been developed to apply approaches from mouse genetics. Although proteinases like matrix metalloproteases and aggrecanases have now been proven to be the principal initiators of OA progression, clinical trials of proteinase inhibitors have not been successful for the treatment, turning the interest of researchers to the upstream signals of proteinase induction. These signals include under graded and fragmented matrix proteins like type II collagen or fibronection that affects chondrocytes through distinct receptors. Another signal is pro inflammatory factors that are produced by chondrocytes and synovial cells; however, recent studies that used mouse OA models in knockout mice did not support that these factors have a role in the central contribution to OA development. Our mouse genetic approaches found that the induction of a transcriptional activator Runx2 in chondrocytes under mechanical stress contributes to the pathogenesis of OA through chondrocyte hypertrophy. In addition, chondrocyte apoptosis has recently been identified as being involved in OA progression. We hereby propose that these endochondral ossification signals may be important for the OA progression, suggesting that the related molecules can clinically be therapeutic targets of this disease.
Hiroshi Kawaguchi
Estimating the Knee Functional Axis (KFA) is crucial to both correctly implanting the prosthesis and accessing the joint kinematics. Researchers have mainly reported KFA by manual management of flexion extension movements, which are passively performed without any voluntary movements. Active touch and movement refers to what is ordinarily called as touching, which is defined as variations in skin stimulation caused by variations in a person’s motor activity.
The difference is very important for the individual. However, it has not been emphasized in the biomechanical literatures. This study aims to confirm the distinction between touching and being touched. We are particularly interested in measuring the Instantaneous Axes of the Knee (IAK) during locomotion. This geometrical “pattern” of the IAK is altered along with the touch pattern by the mechanical necessities of terrestrial movement.
Wangdo Kim¹, Young Choi², and Hong-Gi Lee³*
Although fractures of the epiphyseal cartilage injuries are common in childhood, epiphyseal fractures involving the proximal tibia entities are very rare and are usually caused by high-energy trauma, with an incidence ranging between 0.5 and 3.1% of patients; peak incidence between the ages 12-14 years in male patients. The aim of this report is describe a case of fracture of the epiphyseal cartilage of a 13 year old boy, a victim of sports trauma showing lateral tibial plateau fracture and epiphyseal cartilage fracture at the same side, not compatible with the classifications of fractures in children.
Omar Ferreira Miguel
In the last few years, clinical applications of regenerative medicine have been increasing their way in medical practice.
Valerio Di Nicola¹,² and Mauro Di Pietrantonio³*
The twentieth century epidemic of low back pain has continued unabated into the 21st century. Up to 20% of the Australian population will experience low back pain at some stage of their lives
J Saunders¹, M Cusi¹,³ and H Van der Wall¹,²*
Music is the most essential ingredient of any entertainment. In order to create successful entertaining event musicians plays an imperative role. Musicians are wizards who spread the fragrance of joy by absorbing woes, in the form of Playing Related Musculoskeletal Disorders (PRMDs), for themselves. Like other occupations, musicians also suffer from work related musculoskeletal disorders which are often disabling
Wricha Mishra
Dupuytren’s Contracture (DC) is a fibro-proliferative tumor according to ICD 10 - fascial fibromatosis of unknown etiology (M 720), accompanied by a stable bending contracture of fingers. In CD in the postoperative period extremely high rate of surgical complications is observed: intraoperative (injury of blood vessels, nerves, tendons), general postoperative (hematoma, necrosis, odema, stiffness, etc.), late postoperative (recurrence, spread, progression). In the last case according to the data of different authors, complications frequency is depend upon the degree (from partial up to the total) and the accuracy of excision of the affected aponeurosis ?almaris. One of the problems in choosing the type of operation and technology is the complexity of the cutoff determination boundaries of the affected CD. Up to now there is no suitable for use in the practical CD surgery algorithm of the affected aponeurosis ?almaris spread non invasive visualization in a particular patient. The most appropriate method for the solution of this problem is a method of MRI. The technology of identifying the boundaries of surgery of the affected aponeurosis palmaris in Dupuytren’s contracture by means of MRI has been elaborated. It has been shown that MRI is a highly informative method in the assessment of topographic anatomy of aponeurosis palmaris in normal and CD states. PD, T1, T2 - weighed images allow objectively to visualize the border areas of the affected aponeurosis in I - III stages of CD. PD fsat (fat tissues signal saturation) MRI mode is not recommended for use.
Baikeev RF¹, Mikusev GI², Osmonaliyev IZh², Zakirov RH² and Afletonov EN²*
Metallosis is an aseptic fibrosis, local necrosis, inflammation, or loosening of an implant device secondary to metallic corrosion and release of wear debris. The condition has been highlighted recent years due to the clinical complications caused by metal-on-metal (MoM) hip replacement. Although some major types of MoM hip prostheses have been recalled from the market, metallosis is far from over as not only there are still a million implanted MoM hip prosthetic cases worldwide, but also it has been found in non-MoM hip prostheses and other metal implants. This mini review aims to provide recent findings of implants related metallosisin skeletal tissue.
Zhidao Xia