- Email: [email protected]
Distal radius fracture and compartment syndrome
Injury, Int. J. Care Injured (2006) 37, 1026—1031
www.elsevier.com/locate/injury
LETTER TO THE EDITOR Distal radius fracture and compartment syndrome Sir, We read the article ‘Acute compartment syndrome in the forearm following closed reduction and Kwiring of wrist fracture’ by Maru et al.2 with great interest. It is interesting to know that compartment syndrome can occur after such a common procedure. However, we have some queries for authors on this article. 1. The authors have not mentioned what the diastolic blood pressure was when compartment pressures were checked? It is an accepted practice to do fasciotomy when compartment pressures are within 30 mmHg of diastolic blood pressure.3 The authors have not mentioned whether diagnosis was confirmed at surgery by observing muscles bulging out of the compartment at surgery. This is said to confirm the diagnosis clinically.3 2. The authors have not mentioned whether the wounds were closed primarily after fasciotomy. Delayed wound closure on the third or fourth day is an accepted and safe practice after fasciotomy.1 It is normally not possible to close a fasciotomy wound primarily due to muscles bulging out of the wound. 3. Why was the limb elevated high in the postoperative period after fasciotomy? Elevation above heart level has been shown to reduce perfusion of muscles and so is not generally advised in compartment syndrome.4
References [1] Dente CJ, Feliciano DV, Rozycki GS, Cava RA, Ingram WL, Salomone JP, et al. A review of upper extremity fasciotomies in a level I trauma centre. Am Surg 2004 Dec;70(12): 1088—93.
§
The authors were invited to reply but have not responded.
[2] Maru M, Varma S, Gill P. Acute compartment syndrome in the forearm following closed reduction and K-wiring of wrist fracture. Injury 2005;36(10):1257—9. [3] McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg Br 2000;82(2): 200—3. [4] Zhang Q, Styf J, Lindberg LG. effects of limb elevation and increased intramuscular pressure on human tibialis anterior muscle blood flow. Eur J Appl Physiol 2001;85(6): 561—71.
Harish V. Kurup* Sameer Batra Department of Orthopaedics, Ysbyty Gwynedd, Bangor, North Wales LL57 2PW, United Kingdom Preethy Nath Department of Medicine, Ysbyty Gwynedd, Bangor, North Wales LL57 2PW, United Kingdom *Corresponding author. Tel.: +44 7984706456 E-mail address: [email protected] doi:10.1016/j.injury.2006.03.026
LETTER TO THE EDITOR Re: Mouhsine E, Garofalo R, Borens O, Wettstein M, Blanc CH, Fischer JF, Moretti B, Leyvraz PF. Percutaneous retrograde screwing for stabilisation of acetabular fractures [Injury 2005;36(11): 1330—6] Dear Sir, I read with some interest and slight nervousness this Paper from Switzerland. The seven (!) authors must be congratulated on an interesting Paper and the illustrations on technique are excellent. The results are also impressive. The Swiss seem very lucky that they are able to get their acetabular fractures to
0020–1383/$ — see front matter # 2006 Elsevier Ltd. All rights reserved.
www.elsevier.com/locate/injury
LETTER TO THE EDITOR Distal radius fracture and compartment syndrome Sir, We read the article ‘Acute compartment syndrome in the forearm following closed reduction and Kwiring of wrist fracture’ by Maru et al.2 with great interest. It is interesting to know that compartment syndrome can occur after such a common procedure. However, we have some queries for authors on this article. 1. The authors have not mentioned what the diastolic blood pressure was when compartment pressures were checked? It is an accepted practice to do fasciotomy when compartment pressures are within 30 mmHg of diastolic blood pressure.3 The authors have not mentioned whether diagnosis was confirmed at surgery by observing muscles bulging out of the compartment at surgery. This is said to confirm the diagnosis clinically.3 2. The authors have not mentioned whether the wounds were closed primarily after fasciotomy. Delayed wound closure on the third or fourth day is an accepted and safe practice after fasciotomy.1 It is normally not possible to close a fasciotomy wound primarily due to muscles bulging out of the wound. 3. Why was the limb elevated high in the postoperative period after fasciotomy? Elevation above heart level has been shown to reduce perfusion of muscles and so is not generally advised in compartment syndrome.4
References [1] Dente CJ, Feliciano DV, Rozycki GS, Cava RA, Ingram WL, Salomone JP, et al. A review of upper extremity fasciotomies in a level I trauma centre. Am Surg 2004 Dec;70(12): 1088—93.
§
The authors were invited to reply but have not responded.
[2] Maru M, Varma S, Gill P. Acute compartment syndrome in the forearm following closed reduction and K-wiring of wrist fracture. Injury 2005;36(10):1257—9. [3] McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg Br 2000;82(2): 200—3. [4] Zhang Q, Styf J, Lindberg LG. effects of limb elevation and increased intramuscular pressure on human tibialis anterior muscle blood flow. Eur J Appl Physiol 2001;85(6): 561—71.
Harish V. Kurup* Sameer Batra Department of Orthopaedics, Ysbyty Gwynedd, Bangor, North Wales LL57 2PW, United Kingdom Preethy Nath Department of Medicine, Ysbyty Gwynedd, Bangor, North Wales LL57 2PW, United Kingdom *Corresponding author. Tel.: +44 7984706456 E-mail address: [email protected] doi:10.1016/j.injury.2006.03.026
LETTER TO THE EDITOR Re: Mouhsine E, Garofalo R, Borens O, Wettstein M, Blanc CH, Fischer JF, Moretti B, Leyvraz PF. Percutaneous retrograde screwing for stabilisation of acetabular fractures [Injury 2005;36(11): 1330—6] Dear Sir, I read with some interest and slight nervousness this Paper from Switzerland. The seven (!) authors must be congratulated on an interesting Paper and the illustrations on technique are excellent. The results are also impressive. The Swiss seem very lucky that they are able to get their acetabular fractures to
0020–1383/$ — see front matter # 2006 Elsevier Ltd. All rights reserved.