Detaillierte Beitrags-Information
| Beitragstitel | Well leg compartment syndrome in trauma surgery – femoral shaft fracture treated by femoral intramedullary nailing in the hemilithotomy position: case series and review of the literature |
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| Beitragscode | P119 |
| Autoren | |
| Präsentationsform | Poster |
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| Abstract |
Introduction Well leg compartment syndrome (WLCS) is a rare complication, which can occur following orthopaedic interventions. During surgeries on a traction table, such as femoral nailing, the contralateral “well leg” is often placed in the hemilithotomy position, thus facilitating the use of fluoroscopy. This position (also named the Lloyd-Davis position) consists of hip flexion, abduction, external rotation and knee flexion. WLCS is associated with significant morbidity and mortality because delay in diagnosis and treatment can lead to loss of function and even life-threatening complications. We present the cases of two teenaged patients who underwent femoral nailing on a traction table and developed WLCS. We also present a review of the literature and developed the following guidelines. Methods We followed 2 cases of WLCS after a femur fracture treated with intramedullary nailing, well leg in hemilithotomy position. Both were under 20 years old, BMI < 26kg/m2. They respectively had an open Gustilo II AO 33 A3 left femur fracture and a closed right femoral fracture AO 32C1. Both developed WLCS 1 to 2 hours after surgery. One had intracompartmental pressure measurements, the other not because of clear diagnosis. Both underwent a four compartments fasciotomy with 2 incisions. Both fully recovered without any neurovascular or wound complication 4 to 5 months at the follow up. Results We have developed the following practical guidelines: • Every patient whose surgery lasts more than 2 hours must be considered at risk of developing WLCS. • Reduce the time in the hemilithotomy position to a mini¬mum. • Reduce and measure the flexion of the hip and knee in order to place the limb as close as possible to the level of the right atrium. • Mobilise the uninjured leg every 2 hours. • Avoid the Trendelenburg position. • Avoid hard supports and compressive bandages. Keep the ankle free. • Avoid hypovolemia before, during and after the intervention. • Avoid vasoconstrictors. • Inform nursing staff and junior colleagues of the rec¬ommendations and of the first signs of compartment syndrome. • Never delay a fasciotomy. Conclusion Orthopaedics surgeons need to be aware of the risk factors for WLCS and have high index of suspicion. |