Compartment Syndromes of the Upper Extremity*--John Gray Seiler III, MD Patrick J. Casey, MD Sandra Haas Binford, MAEd
The diagnosis and treatment of compartment syndrome is one of the most challenging problems in orthopaedic surgery. The myriad causes of compartment syndrome and the severe soft tissue findings that are associated with limb trauma make assessment of this condition difficult and the outcome from treatment variable. While the general findings that characterize compartment syndrome are agreed upon, the absolute diagnostic criteria remain controversial.
Prevalence of Negative- Pressure Pulmonary Edema at an Orthopaedic Hospital--W. Christopher Patton, MD Champ L. Baker, Jr., MD
Negative-pressure pulmonary edema (NPPE) occurs when a large, negative intrathoracic pressure is generated against an obstructed upper airway, causing fluid to shift into the lung interstitium. Young, healthy, athletic male patients appear to be at increased risk for this disorder, but the prevalence in orthopaedic surgery patients has been unknown. We retrospectively reviewed the charts of 14 patients (11 male, 3 female) with NPPE at our institution over a 15-year period. The patients had 11 different surgical procedures; 16,653 similar procedures were done during this time. The overall prevalence of NPPE (<0.1%) was not significantly different between male and female patients. Patients with NPPE were significantly younger than those without NPPE. If NPPE is recognized promptly and treated appropriately with intravenous diuretic and oxygen therapy, most patients respond well. Physicians should be vigilant to the potential for NPPE in young, otherwise healthy patients after general anesthesia.
Hip Arthroscopy in Staging Avascular Necrosis of the Femoral Head--Jon K. Sekiya, MD David S. Ruch, MD D. Monte Hunter, MD Thomas L. Pope, Jr., MD, L. Andrew Koman, MD, Gary G. Poehling, MD, Gregory B. Russell, MS
The purposes of this study were to evaluate how accurately current imaging modalities predict the quality of the articular surface in avascular necrosis (AVN) of the femoral head and to provide arthroscopic correlation to current staging modalities. An arthroscopic classification system, derived from the work of Marcus et al, was used to prospectively stage the articular surface in 23 hips with AVN using plain radiographs, magnetic resonance imaging (MRI), and arthroscopy. There was little correlation between all three diagnostic modalities. These findings were not statistically significant. Patients with stage IV disease had the widest variation in the appearance of the articular surface. This study shows poor correlation in the staging of AVN using current imaging techniques. Magnetic resonance imaging has been shown to be inadequate at assessing the articular cartilage. Therefore, either arthroscopy or direct visualization is required for accurate evaluation and staging, especially in stage IV disease.
Acromioplasty: Comparison of Outcome in Patients With and Without Workers’ Compensation--James G. Lopez, BS Michael D. Ernst, PhD Thomas W. Wright, MD
Acromioplasty was performed on 24 shoulders in 23 patients who had a diagnosis of impingement syndrome/rotator cuff tendinopathy. Ten patients were female and 13 were male; mean age was 52.3 years. Patients were divided into two groups, depending on whether they were receiving workers’ compensation benefits. Clinical outcomes were evaluated preoperatively and at follow-up postoperatively using the University of California Los Angeles (UCLA) Shoulder Rating Scale. All patients had bursectomy, anterior inferior acromioplasty, and coracoacromial ligament release. The two groups showed significantly different postoperative results in terms of pain, function, strength of forward flexion, and total score, with the workers’ compensation group consistently having a lower functional score. Pain did improve significantly for workers’ compensation patients over the course of treatment, but relief was not nearly as complete as in the noncompensated group. A positive response to a shoulder bursa steroid injection, even if temporary, was a good predictor of final outcome after an acromioplasty.