614 Thigh Compartment Syndrome ACSM Burnham 2016 Boston скачать в хорошем качестве

614 Thigh Compartment Syndrome ACSM Burnham 2016 Boston

Intro by: Tom Best MD, PHD Presented by: Jeremy M. Burnham MD Professor Dept. of Orthopaedic Surgery and Sports Medicine University of Kentucky Lexington KY 0:00 Introduction 1:40 ACL Injuries & Rehabilitation in Women: Gender Specific Issues (Mary Ireland, MD) 2:20 HISTORY & PHYSICAL •CC: Thigh pain and swelling •History: 16 year old high school male football athlete presented to ER with 3 days of worsening thigh pain –Previous direct blow to thigh 1 week prior –Initially had minor pain and swelling that resolved the next day –Returned to play 4 days prior to presentation (actually played in football game and practice) –Woke up the next morning with thigh pain and swelling, which had progressively worsened over the last 3 days –He now said he couldn’t walk because of the intense pain 3:19 PHYSICAL EXAM •Swelling and palpable fullness of anterior thigh •Knee ROM 0-20 •1/5 Quad Strength, 5/5 Distally •Decreased subjective sensation over anteromedial thigh and knee •Extreme pain with passive stretch •2+ DP/PT pulses, symmetric with contralateral side 4:00 LABORATORY TESTS •Hemogram –WBC: 14.2 –Hemoglobin: 12.4 –Hematocrit: 37.3 •Coags: –PT/INR: 16.6/1.6 –PTT: 33 4:40 IMAGING 5:04 DISCUSSION 5:53 DIFFERENTIAL DIAGNOSIS •Simple contusion •Thigh hematoma •Quadriceps muscle strain •Anterior cruciate ligament injury •Femur fracture •Delayed onset compartment syndrome 7:40 TREATMENT •Decompressive Fasciotomy 7:46 INTRAOPERATIVE FINDINGS 8:41 LITERATURE •17 year old male, direct blow to thigh •24 hours later, exam in the ER demonstrated “tense, rock-hard anterior thigh” and “10-50 degrees of flexion” •Sensation decreased over anteromedial thigh •“Thigh compartment syndrome should be considered when any athlete suffers a direct blow to the anterior thigh with subsequent swelling, unrelenting pain, and loss of knee range of motion.” 9:17 COMPARTMENT SYNDROME •The “True Orthopaedic Emergency” •Intracompartmental pressure exceeds perfusion pressure •6 P’s of Compartment Syndrome –Pallor –Pain –Paresthesias –Paralysis –Poikilothermia –Pulselessness 10:00 COMPARTMENT SYNDROME IMAGES 10:50 LITERATURE •41% from MVC or MCC •49% had femur fractures •21% had coagulation deficiencies 11:11 FURTHER WORK-UP •Pediatric Heme-Onc Consulted –Coagulopathy Panel Ordered –vWF: Normal –Platelet Function: Normal –Factor IX: Normal –Factor VIII: Normal –INR: 1.6 –Thrombin Clot Time: 24.6 (Elevated) –Factor VII: 15% (Normal 67-143%) 11:49 CLOTTING CASCADE 12:05 COMMON BLEEDING DISORDERS 12:24 6 MONTH FOLLOW-UP •Walking normally •4+/5 Quad strength, everything else 5/5 •Normal sensation •No Pain •Wants to return to football next fall 12:38 KEY POINTS •“Thigh compartment syndrome should be considered when any athlete suffers a direct blow to the anterior thigh with subsequent swelling, unrelenting pain, and loss of knee range of motion.” Colosimo & Ireland 1992 •Return to contact sports? 13:05 DISCUSSION 15:05 PAY ATTENTION TO HEMOGLOBIN LEVELS IN CONTEXT 16:35 RETURN TO PLAY 19:10 WAS THERE MORE TO THE HISTORY? 21:00 COMPARTMENT SYNDROME 21:57 THANK YOU