High-Energy Trauma and Damage Control in the Lower Limb

The acute foot compartment syndrome is uncommon and occurs after high energy trauma. Your treatment is considered an orthopedic emergency and a fasciotomy becomes needed. However, after the inicial fase of damage control, the cover up of the incision is necessary. That can be done on the primary moment through parcial skin grafting or delayed primary, through the same technique or through direct suture. As an alternative, this case describes the use of polypropylene prosthesis, inicially described in musculoskeletal trauma of finger tips, as an adjunct to the healing process of foot fasciotomies. The main benefits of this technique are the achievement of one single surgical procedure and the absence of the typical morbidity that comes with skin grafting.

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The Effects of Early Rapid Control of Multiple Bowel Perforations after High-Energy Trauma to the Abdomen: Implications for Damage Control Surgery

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000221807.69844.63 ◽

2006 ◽

Vol 61 (1) ◽

pp. 185-191 ◽

Cited By ~ 10

Author(s):

Pia Olofsson ◽

Fikri M. Abu-Zidan ◽

Jianpu Wang ◽

Nico Nagelkerke ◽

Sten Lennquist ◽

...

Keyword(s):

Damage Control ◽

Damage Control Surgery ◽

High Energy ◽

High Energy Trauma ◽

Rapid Control

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Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-200986 ◽

2021 ◽

pp. 1-9

Author(s):

Lucas Sousa Macedo ◽

Renato Polese Rusig ◽

Gustavo Bersani Silva ◽

Alvaro Baik Cho ◽

Teng Hsiang Wei ◽

...

Keyword(s):

Computed Tomography ◽

Upper Limb ◽

Computed Tomography Angiography ◽

Lower Limb ◽

High Energy ◽

Lower Limbs ◽

Added Value ◽

Vascular Lesions ◽

Limb Injuries ◽

Significant Difference

BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.

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Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre

Emergency Medicine Journal ◽

10.1136/emermed-2014-204083 ◽

2014 ◽

Vol 32 (7) ◽

pp. 535-538 ◽

Cited By ~ 2

Author(s):

Shahram Paydar ◽

Armin Ahmadi ◽

Behnam Dalfardi ◽

Alireza Shakibafard ◽

Hamidreza Abbasi ◽

...

Keyword(s):

High Energy ◽

Trauma Centre ◽

Economic Effects ◽

Trauma Patients ◽

Radiological Evaluation ◽

High Energy Trauma ◽

Level 1

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Angiography in patients with pelvic fractures and contrast extravasation on CT following high-energy trauma

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01628-w ◽

2021 ◽

Author(s):

Jonathan Hammerschlag ◽

Yehuda Hershkovitz ◽

Itamar Ashkenazi ◽

Zahar Shapira ◽

Igor Jeroukhimov

Keyword(s):

High Energy ◽

Pelvic Fractures ◽

Contrast Extravasation ◽

High Energy Trauma

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Changing presentation of knee dislocation and vascular injury from high-energy trauma to low-energy falls in the morbidly obese

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.11.067 ◽

2013 ◽

Vol 57 (5) ◽

pp. 1196-1203 ◽

Cited By ~ 40

Author(s):

Andrew G. Georgiadis ◽

Farah H. Mohammad ◽

Kristin T. Mizerik ◽

Timothy J. Nypaver ◽

Alexander D. Shepard

Keyword(s):

Vascular Injury ◽

Knee Dislocation ◽

High Energy ◽

Low Energy ◽

Morbidly Obese ◽

High Energy Trauma

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Scapulothoracic dissociation

British Journal of Radiology ◽

10.1259/bjr.20190090 ◽

2019 ◽

Vol 92 (1101) ◽

pp. 20190090

Author(s):

Kimia Khalatbari Kani ◽

Felix S Chew

Keyword(s):

Differential Diagnosis ◽

Shoulder Girdle ◽

High Energy ◽

Imaging Evaluation ◽

Acute Setting ◽

High Energy Trauma ◽

Diagnosis And Management ◽

Life Threatening ◽

Spectrum Imaging ◽

Scapulothoracic Dissociation

Scapulothoracic dissociation is a rare and potentially limb- and life-threatening injury, that results from high-energy trauma. Scapulothoracic dissociation has the potential to be overlooked in the acute setting, especially in the setting of polytrauma. Therefore, a careful search for this condition should be performed in all patients with high-energy shoulder girdle injuries. The goals of this article are to review the anatomy of the scapulothoracic articulation as well as the spectrum, imaging evaluation, differential diagnosis and management of scapulothoracic dissociations.

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Features of surgical treatment of intra- and periarticular fractures of the lower third of the femur in patients with polytrauma

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17116/vto201902114 ◽

2019 ◽

Vol 26 (2) ◽

pp. 14-18

Author(s):

E. I Solod ◽

N. V Zagorodni ◽

A. F Lazarev ◽

M. A Abdulkhabirov ◽

Ya. M Alsmadi ◽

...

Keyword(s):

Distal Part ◽

Distal Femur ◽

Traumatic Shock ◽

High Energy ◽

Optimal Time ◽

Prospective Analysis ◽

Severity Scale ◽

Duration Of Treatment ◽

High Energy Trauma ◽

Results Of Treatment

Treatment of patients with fractures of femur has a particular relevance in modern traumatology, especially in patients with polytrauma. The treatment of such fractures is complicated by the fact that it depends not only on the nature of the fracture, but also on the general condition of the patient. These fractures are caused by high-energy trauma, they have the tendency to be splintered or fragmented, and often accompanied by neurovascular complications, especially in the distal part. Such fractures are often accompanied by soft tissue damage. Purpose: improving the results of treatment of intra-and periarticular fractures of the distal femur in patients with polytrauma. Material and methods. In the present study, a prospective analysis of using conversion osteosynthesis in the treatment of 72 patients with intra-and periarticular fractures of the lower third of the femur patients with polytrauma, according to the ISS severity scale (ISS 17-40) was performed in a multidisciplinary hospital. Results. The most optimal time for conversion osteosynthesis to patients with polytrauma was 5-7 days, which prevented the occurrence of traumatic shock and prevented the occurrence of inflammatory complications in the postoperative period. Conclusion. The study confirmed the feasibility of conversion osteosynthesis in the treatment of patients with intra-and periarticular fractures of the lower third of the femur. The use of the technique of transferring the fixation of fragments by the external fixation to the internal osteosynthesis (conversion) contributed to a reduction in the duration of treatment of patients in the hospital with fractures of the long bones.

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Factors Influencing Functional Outcomes of Subtalar Fusion for Posttraumatic Arthritis After Calcaneal Fracture

Foot & Ankle International ◽

10.1177/1071100718777492 ◽

2018 ◽

Vol 39 (9) ◽

pp. 1062-1069 ◽

Cited By ~ 8

Author(s):

Quirine M.J. van der Vliet ◽

Falco Hietbrink ◽

Fabio Casari ◽

Luke P.H. Leenen ◽

Marilyn Heng

Keyword(s):

Quality Of Life ◽

Functional Outcomes ◽

Calcaneal Fracture ◽

High Energy ◽

Posttraumatic Arthritis ◽

High Energy Trauma ◽

Subtalar Arthrodesis ◽

Subtalar Fusion ◽

Subtalar Arthritis

Background: Subtalar arthrodesis is a common salvage operation for posttraumatic subtalar arthritis. This study aimed to identify factors associated with functional outcomes and quality of life after subtalar fusion for posttraumatic subtalar arthritis after calcaneal fracture. Methods: This is a retrospective study with follow-up by questionnaire in two level 1 trauma centers. Patients who underwent subtalar arthrodesis for posttraumatic arthritis after a calcaneal fracture between 2001 and 2016 were identified and contacted for completion of a survey consisting of the Foot and Ankle Ability Measure (FAAM), Maryland Foot Score (MFS), Patient-Reported Outcomes Measurement System Physical Function (PROMIS PF, Short Form 10a) questionnaire, EuroQol 5-dimensional (EQ-5D) questionnaire, and EuroQol visual analog scale (EQ-VAS). Exclusion criteria were initial subtalar arthrodesis at an outside facility, primary arthrodesis for fracture, initial arthrodesis earlier than 2001, amputation of the fused foot or leg, younger than 18 years at time of fusion, and inability to communicate in English. A total of 159 patients met our inclusion criteria. Eighty-four patients completed the questionnaires, resulting in a response rate of 59%. Results: Median FAAM score was 79 (interquartile range [IQR], 48-90), median MFS was 74 (IQR, 56-86), and median PROMIS PF was 45 (IQR, 38-51). Quality of life was significantly lower when compared to a reference population ( P = .001). Smoking was independently associated with worse outcomes. Complications after fusion (such as nonunion, implant failure, and infectious complications), high-energy trauma, and ipsilateral injury were also predictors for poorer outcomes. Conclusion: Acceptable functional outcomes and quality of life were observed after subtalar fusion. Smoking, complications after subtalar fusion, high-energy trauma, and presence of ipsilateral injuries were independently associated with worse functionality and quality of life. Level of Evidence: Prognostic level III, comparative series.

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