INTRODUCTION: The publishing of our case report on an idiopathic compartment syndrome of both upper limbs after icing a contusion trauma was motivated by another article on the acute spontaneous compartment syndrome of upper limb published in Rozhledy v chirurgii 8/2021. CASE REPORT: We present the case of a 43-year-old man admitted in the evening for painful massive swelling of both upper extremities. The swelling developed immediately after icing his bruises suffered due to a probable fall on the previous day in a state of inebriety. Compartment syndrome of the left hand and right forearm was diagnosed; subsequently, adequate dermatofasciectomy resulted in normalization of the condition in both upper limbs. The patients condition was cured to a full extent without any disorders of perfusion, mobility or sensation in both upper extremities. CONCLUSION: Only few reports on the atraumatic compartment syndrome of upper extremity can be found in the literature and it is an acute condition encountered quite rarely at outpatient offices of surgery. Nevertheless, we need to be able to recognize this nosological unit and provide proper treatment in time, otherwise the patient may suffer serious permanent damage.

• Klíčová slova
• atraumatic acute compartment syndrome, bradykinin system, intrafascial pressure measurement, urgent dermatofasciectomy,
• MeSH
• akutní nemoc MeSH
• dospělí MeSH
• kompartment syndrom * diagnóza   etiologie   chirurgie   MeSH
• lidé MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

INTRODUCTION: Compartment syndrome (CS) is exceedingly rare in ankle fractures. However, the risk of CS development seems to be increased in the presence of a Bosworth fracture-dislocation (BF), a rare variant of locked dislocation of the fibula behind the tibia. MATERIALS AND METHODS: Here, we report the case of a 39-year old man with delayed diagnosis of CS after having sustained a BF and failed attempts on closed reduction. The patient developed a flexion contracture of the hallux necessitating secondary fusion. RESULTS: At 3 years after the injury, the patient was capable of running, but had 10 degrees limitation of ankle dorsiflexion, persisting decreased sensation on the plantar surface and clawing of the lesser toes. A thorough review of the literature revealed nine cases of CS after 167 reported BF resulting in a calculated prevalence of 5.4%. CONCLUSIONS: Given the extreme paucity of CS in malleolar fractures, CS in BF has a relatively high prevalence. Risk factors include severe dislocations, repeated attempts on closed reduction, and a long interval to definite surgery. A high index of suspicion is required because delayed diagnosis leads to lasting functional restrictions.

• Klíčová slova
• Ankle, Compartment syndrome, Fasciotomy, Fracture, Locked dislocation,
• MeSH
• dislokace kloubu * chirurgie   MeSH
• dislokovaná fraktura * komplikace   diagnostické zobrazování   chirurgie   MeSH
• dospělí MeSH
• fibula chirurgie   MeSH
• fraktury kotníku * chirurgie   MeSH
• kompartment syndrom * diagnóza   etiologie   chirurgie   MeSH
• lidé MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH

INTRODUCTION: Acute compartment syndrome is a serious complication of trauma and pathological disorders. Non-traumatic acute compartment syndrome is very rare and has no coherence with trauma. The case report demonstrates diagnostics difficulties and the treatment strategy. CASE REPORT: We present a 36-year-old man with acute onset of pain after manual labor with a shovel. He had been treated with anticoagulation therapy due to a heart valve replacement. Blood clotting test showed prolongation of prothrombin time of more than four times due to iatrogenic bleeding disorder. Symptoms were considered consistent with the diagnosis of tendovaginitis, however the worsening of the symptoms was underestimated. Four days after the onset of the first symptoms, the acute compartment syndrome developed and urgent fasciotomy of the forearm and hand was performed. The convalescence lasted 10 months with restoration of the function and range of motion of the hand. The patient was able to fully self-service and manually work with a light load. The permanent consequence remained a limitation of the hand grip strength and paresthesia and neuropathic pain due to median nerve impairment. CONCLUSION: Spontaneous compartment syndrome of the upper extremity is a rare but very dangerous entity requiring thorough understanding. It should be considered in the case of non-traumatic limb pain that does not respond to analgesics in patients receiving systemic anticoagulation. Only early diagnosis and immediate fasciotomy can prevent catastrophic permanent consequences.

• Klíčová slova
• acute compartment syndrome − spontaneous compartment syndrome − upper extremity,
• MeSH
• dospělí MeSH
• fasciotomie MeSH
• kompartment syndrom * diagnóza   etiologie   chirurgie   MeSH
• lidé MeSH
• předloktí * MeSH
• síla ruky MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Acute compartment syndrome occurs most frequently in connection with injuries, terminal or chemical damage of tissues, ischemia, the activity of toxins or in patients with tissue ischemia or muscle necrosis. Clinical findings have found pronounced pain, followed by paresthesias, pallor, and paresis. Decreased pulsation of arteries has also been a frequent finding. In severe forms decompressive fasciotomy has been indicated within the first 12-24 hours after diagnosis. In the following paper, the authors present the case report of a 68-year woman who swallowed 1500 mg of trazodone as an attempt at suicide. After 12 hours her husband found her lying on the carpet with compression of the left arm under the trunk. The patient was treated conservatively and followed clinically, examined by ultrasonography, EMG and finally MRI.

• Klíčová slova
• compartment syndrome, electromyography, magnetic resonance imaging, trazodone intoxication, ultrasonography,
• MeSH
• antidepresiva druhé generace otrava   MeSH
• CT angiografie metody   MeSH
• kompartment syndrom * diagnóza   etiologie   patofyziologie   terapie   MeSH
• konzervativní terapie metody   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• neurologické vyšetření metody   MeSH
• paréza diagnóza   etiologie   MeSH
• pokus o sebevraždu MeSH
• předloktí diagnostické zobrazování   MeSH
• senioři MeSH
• trazodon otrava   MeSH
• ultrasonografie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• antidepresiva druhé generace MeSH
• trazodon MeSH

Acute compartment syndrome (ACS) is a potential orthopaedic/traumatology emergency. Without prompt, precise diagnosis and immediate treatment with surgical decompressive fasciotomy it can lead to neurological dysfunction and disability. The role of regional anaesthesia (RA) in patients at risk for ACS/ and in those with developed ACS is controversial. The aim of this critical review was to answer the question, whether regional anaesthesia can delay the diagnosis. The authors use an evidence-based approach to discuss these high risk patients in considering RA as a method of choice for effective analgesia. To the date of data collection, there was no single case report identified where RA alone led to delay in ACS diagnosis and surgical treatment. In four clinical cases, epidural analgesia can be associated with delayed ACS diagnosis. Frequent clinical evaluation and breakthrough pain despite a functional RA in combination with intracompartment pressure measurement remains the keystone of recommended management for patients at risk of ACS.

• Klíčová slova
• compartment syndrome, peripheral nerve block/blockade, regional anaesthesia,
• MeSH
• čas zasáhnout při rozvinutí nemoci * MeSH
• chirurgická dekomprese metody   MeSH
• epidurální anestezie * škodlivé účinky   MeSH
• fasciotomie metody   MeSH
• kompartment syndrom diagnóza   chirurgie   MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• monitorování fyziologických funkcí MeSH
• opožděná diagnóza škodlivé účinky   MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: The possibility of predicting severe compartment syndrome using simple biochemical parameters was evaluated in a single-center study of 55 patients who presented with acute femoral embolism and who were treated with open surgical embolectomy. METHODS: Parameters related to tissue damage and oxidative metabolism (i.e., lactate, bilirubin, myoglobin, uric acid, glucose, and fibrinogen) were monitored in ipsilateral femoral vein blood. RESULTS: Several statistically significant predictors of relevant compartment syndrome after surgical reperfusion were found, including lactate, uric acid, transcutaneous oxygen pressure, bilirubin, intrafascial pressure, and serum myoglobin. Glycemia and serum albumin did not significantly change over time. CONCLUSIONS: The lactate concentration in femoral vein blood sampled during surgical embolectomy can be used for the stratification of additional postoperative risk of clinically significant compartment syndrome complicating reperfusion after acute embolism of the femoral artery.

• MeSH
• akutní nemoc MeSH
• biologické markery krev   MeSH
• časové faktory MeSH
• embolektomie škodlivé účinky   MeSH
• embolie diagnóza   chirurgie   MeSH
• ischemie diagnóza   chirurgie   MeSH
• kompartment syndrom krev   diagnóza   etiologie   chirurgie   MeSH
• kyselina mléčná krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• vena femoralis MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• biologické markery MeSH
• kyselina mléčná MeSH

PURPOSE OF THE STUDY: In this prospective randomised study, the short-term results of arthroscopic transcapsular iliopsoas tenotomy approached from the peripheral versus the central compartment for internal snapping hip syndrome are presented. MATERIAL AND METHODS: A group of 19 patients (15 women and four men; mean age, 24.3 years) who underwent arthroscopic transcapsular iliopsoas tenotomy for internal snapping hip syndrome in the period between September 2010 and December 2011 were prospectively evaluated. No injury, hip surgery or feeling of hip instability was recorded in their personal histories. Radiographs did not show any dysplasia, retroversion of the acetabulum or cam lesions. The patients were allocated to two groups using sealed envelope randomisation: Group 1 patients (n=10) were treated by tenotomy from the peripheral compartment and group 2 patients (n=9) underwent tenotomy from the central compartment during traction of the lower extremity. The evaluation included pre-operative 3T MRI findings, arthroscopically detected intra-articular lesions, duration of traction and post-operative complications. The pre-operative WOMAC scores were compared with those at one-year follow-up. In comparison of the two groups, the Mann-Whitney exact test was used for WOMAC scores and Fisher's exact test for post-operative complications. Statistical significance was set at a 0.05 level. RESULTS: In comparing post-operative complications, a significant difference (p=0.0468) between the groups was found only for genital paresthesia, which did not occur in group 1. The other differences were not statistically significant. The pre-operative WOMAC scores did not differ significantly between the groups (p=0.79). The post-operative WOMAC scores were significantly higher in group 1 (p=0.02). In each group the change in WOMAC scores was different and was statistically significant in group 1 (p=0.0014). Associated intra-articular hip pathologies, most frequently synovitis of the peripheral compartment, acetabular chondropathy, or labral lesions, were diagnosed in 90% of group 1 patients and in 66.7% of group 2 patients. DISCUSSION: Most of the authors comparing the results of two different ilioproas tenotomy techniques at one-year follow-up did not report any statistically significant differences in WOMAC scores between them. In accordance with the data reported, an increase in the post-operative WOMAC score, i.e., improvement of clinical outcome, was achieved in all our patients and, in group 1, it was significantly higher (p=0.0015), as compared with a similar study by Ilizaliturri. However, further follow-up of the patients and evaluation of long-term results will be necessary. CONCLUSIONS: The technique of arthroscopic ilioproas tenotomy approached from the peripheral compartment resulted in significantly fewer cases of genital paresthesia and provided significantly better clinical outcomes in comparison with tenotomy from the central compartment.

• MeSH
• artroskopie metody   MeSH
• bederní svaly chirurgie   MeSH
• dospělí MeSH
• kompartment syndrom diagnóza   chirurgie   MeSH
• kyčel chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mladý dospělý MeSH
• nemoci kloubů diagnóza   chirurgie   MeSH
• prospektivní studie MeSH
• šlachy chirurgie   MeSH
• syndrom MeSH
• tenotomie metody   MeSH
• úžinový syndrom chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

Iatrogenic injuries to blood vessels in joint replacement surgery are rare events that occur as few per thousand. However, their sequelae are serious. The patient may either bleed to death, because vascular injury is not obvious and therefore difficult to diagnose, or lose the limb due to ischaemia. The highest risk of vascular injury is associated with repeat surgery and loosening of the acetabular component. We distinguish sharp and blunt force injuries. The former are caused by implants, sharp instruments, bone fragments or bone cement debris. The latter arise from stretching over a part of implanted material. Bleeding can be inapparent or apparent. Inapparent bleeding is difficult to diagnose and is recognized from the dynamics of blood losses. Haemodynamic instability or, in a worse case, even hypovolaemic shock may be the only signs of bleeding. Occlusion of an artery is manifested by limb ischaemia. The seriousness and progression of ischaemia depends on the rate of arterial occlusion, potential pathways for collateral circulation and the degree of atherosclerotic vascular disease. The patient with conduction anaesthesia does not feel pain and therefore the diagnosis must primarily be based on arterial pulsation in the limb and its skin colour. A pseudoaneurysm can develop due to a partially weakened vascular wall and its rupture is a life-threatening complication. Its presence is recognized as a pulsating mass in the groin. An arterio- venous fistula which arises from traumatic communication between the two vessels may lead to cardiac failure. The diagnosis is based on examination by sonography and digital subtraction angiography. The results of CT angiography and MR angiography are difficult to evaluate because of the presence of metal implants. In apparent bleeding it is sometimes difficult to locate the source. It is recommended to perform digital compression and gain access to the vessels from the extraperitoneal approach. When an expanding haematoma or ischaemia is present, the artery can be treated by surgical exploration or percutaneous transluminal angioplasty. A possibility of vascular injury should be taken into account particularly in revision arthroplasty. To check blood flow in the limb before surgery is advisable. If the procedure entails a significant risk of post-operative complications, a vascular surgeon should be available. In the case of acute intra-operative bleeding, the source should be localised as soon as possible, the site compressed and an expert assistance called in. When the source is not obvious, it should not be attempted to apply vascular clamps or clips at random; this may do even more damage to the vessel.

• MeSH
• arteriovenózní píštěl diagnóza   etiologie   terapie   MeSH
• bérec krevní zásobení   MeSH
• hematom etiologie   terapie   MeSH
• ischemie diagnóza   etiologie   terapie   MeSH
• kompartment syndrom diagnóza   etiologie   terapie   MeSH
• krvácení diagnóza   etiologie   terapie   MeSH
• lidé MeSH
• náhrada kyčelního kloubu škodlivé účinky   MeSH
• nepravé aneurysma diagnóza   etiologie   terapie   MeSH
• poranění cév diagnóza   etiologie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

Intraabdominal hypertension is frequently observed both in surgical and non-surgical patients hospitalised at intensive care units. This clinical syndrome of multifactorial etiology is characterised by increased intraabdominal tension with subsequent development of organ dysfunctions. It is reflected in impaired cardiovascular, pulmonary, renal, splanchnic and neurological functions which improve after the abdominal decompression. Patients with intraabdominal hypertension can be relatively easily identified by measuring tension in the bladder the primary purpose of which is early detection of clinically less severe stages and also the detection of the most sever forms of abdominal compartment syndrome. The objective of subsequent surgical or conservative treatment is to prevent organ dysfunction and subsequent multi-organ failure.

• MeSH
• břicho patofyziologie   MeSH
• jednotky intenzivní péče MeSH
• kompartment syndrom diagnóza   patofyziologie   terapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

The authors analyze a group of 7 patients transferred to their hospital for instable fractures of the pelvic circle and lumbar spine. The pelvic compartment was manifested 24-48 hours after injury. Early diagnostics are based on the use of new imaging techniques, spiral CT examination is preferred, and angiography in stabilized patients. Early surgical intervention is aimed at evacuation of haematomas, revision of vessels, release of the ureters and temporary nephrostomy.

• MeSH
• fraktury kostí komplikace   MeSH
• kompartment syndrom diagnóza   etiologie   chirurgie   MeSH
• lidé MeSH
• pánev * MeSH
• pánevní kosti zranění   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH