Acute Compartment Syndrome (ACS) is an orthopaedic emergency that can develop after a wide array of etiologies. In this pilot study the MY01 device was used to assess its ease of use and its ability to continuously reflect the intracompartmental pressure (ICP) and transmit this data to a mobile device in real time. This preliminary data is from the lead site which is presently expanding data collection to five other sites as part of a multi-center study. Patients with long bone trauma of the lower or upper extremity posing a possibility of developing compartment syndrome were enrolled in the study. Informed consent was obtained from the patients. A Health Canada licensed continuous compartmental pressure monitor (MY01) was used to measure ICP. The device was inserted in the compartment that was deemed most likely to develop ACS and ICP was continuously measured for up to 18 hours. Fractures were classified according to the AO/OTA classification. Patient clinical signs and pain levels were recorded by healthcare staff during routine in-patient monitoring and were compared to the ICP from the device. Important treatment information was pulled from the patient's chart to help correlate all of the patient's data and symptoms. The study period was conducted from November 2020 through December 2021. Twenty-six patients were enrolled. There were 17 males, and nine females. The mean age was 38 years (range, 17–76). Seventeen patients received the device post-operatively and nine received it pre-operatively. Preliminary results show that post-operative ICPs tend to be significantly higher than pre-operative ICPs but tend to trend downwards very quickly. The trend in this measurement appears to be more significant than absolute numbers which is a real change from the previous literature. One patient pre-operatively illustrated a steep trend upwards with minimal clinical symptoms but required compartment release at the time of surgery that exhibited no muscle necrosis. The trend in this patient was very steep and, as predicted, predated the clinical findings of compartment syndrome. This trend allows an early warning signal of the absolute pressure, to come, in the compartment that is being assessed by the device. Preliminary results suggest that this device is reliable and relatively easy to use within our institutions. In addition it suggests that intracompartmental pressures can be higher immediately post-op but lower rapidly when the patient does not develop ACS. These results are in line with current literature of the difference between pre and post-operative baselines and thresholds of ICP, but are much more striking, as continuous measurements have not been part of the data set in most of past studies. Further elucidation of the pressure thresholds and profiles are currently being studied in the ongoing larger multicenter study and will add to our understanding of the critical values. This data, plus the added value of continuous trends in the pressure, upwards or downwards, will aid in preventing muscle necrosis during our management of these difficult long bone fractures

Aim. Duration of perioperative antimicrobial prophylaxis (PAP) remains controversial in prevention of fracture-related infection (FRI) – with rates up to 30% - in open fracture (OF) management. Objectives were to investigate the impact of the PAP duration exclusively in or related to long bone OF trauma patients and the influence of augmented renal clearance (ARC), a known phenomenon in trauma patients, as PAP consists of predominantly renally eliminated antibiotics. Method. Trauma patients with operatively treated OF, admitted between January 2003 and January 2017 at the University Hospitals Leuven, were retrospectively evaluated. FRI was defined following the criteria of the consensus definition of FRI. A logistic regression model was conducted with FRI as outcome. Results were considered statistically significant when p< 0.05. Results. Forty (8%) from the 502 patients developed a FRI, with 20% FRIs in Gustilo-Anderson (GA) III OFs. Higher GA grade and polytrauma were independently associated with the occurrence of FRI. The heterogeneity in OF management, especially with regard to the applied PAP regimens and duration, was striking and consequently hampering the investigation on the impact of PAP duration. To overcome this issue, a subgroup analysis was performed in patients treated with the two PAP regimens as defined in the hospitals' guidelines – i.e. cefazolin, with metronidazole and tobramycine when extensive contamination was present -, revealing flap coverage and relative duration of augmented renal ARC as independently associated factors. Conclusions. For the first time, a definition based on diagnostic criteria was used to objectively include patients with a FRI. In order to support clinicians in establishing strategies to prevent FRI in long bone OFs, further prospective large randomized controlled trials with clearly predefined PAP regimens are needed to provide reliable recommendations regarding the impact of duration of PAP and ARC

Introduction. Long bone surgery and marrow instrumentation represent significant surgical insults, and may cause severe local and systemic sequelae following both planned and emergent surgery. Preconditioning is a highly conserved evolutionary endogenous protective mechanism, but finding a clinically safe and acceptable method of induction has proven difficult. Glutamine, a known inducer of the heat shock protein (HSP) response, offers pharmacological modulation of injury through clinically acceptable preconditioning. This effect has not been previously demonstrated in an orthopaedic model. Aims. The aim of the study was to test the hypothesis that glutamine preconditioning protects against the local and systemic effects of long bone trauma in a rodent model. Methods. Thirty two adult male Sprague-Dawley rats were randomised into four groups:. Control group which received trauma without preconditioning,. Normal Saline preconditioning 1 hour before trauma,. Glutamine preconditioning 1 hour before trauma, and. Glutamine preconditioning 24 hours prior to trauma. Trauma consisted of bilateral femoral fracture following intramedullary instrumentation. Blood samples were taken just prior to the insult, and at an interval four hours following this. The animals were then sacrificed, bronchioalveolar lavage (BAL) performed and skeletal muscle and lung harvested for evaluation. Results. Glutamine pretreated rats had lower CK levels at 4 hours than those treated with normal saline. Renal dysfunction was less in pre-treated animal, and there was a significant reduction in neutrophil infiltration into BAL fluid. Finally glutamine pre-treated rats showed less muscle and lung oedema. This effect was more pronounced for the group which received glutamine 24 hours before trauma than the group receiving glutamine one hour before trauma. Conclusion. This data suggests that preconditioning with a single bolus of intravenous glutamine prior to planned orthopaedic intervention may afford local and end-organ protection

Standard imaging of complex intra-articular distal radius fractures consists of posterior-anterior, lateral and oblique x-rays. Recently the liberal use of CT scan in this area became widely accepted as an additional imaging tool in pre-operative evaluation. The aim of this study was to evaluate whether CT scanning of complex distal radius fractures changed the management of these fractures compared to plain films. A series of 20 closed distal radius complex intra-articular fractures AO 12-C which had both plain PA, lateral and oblique films and CT scans were selected from our long bone trauma database. The plain films were blindly reviewed by five observers. A management plan was then formulated. Options provided were: closed manipulation, closed manipulation with percutaneous K wire fixation, open reduction and internal fixation, external fixature or bone graft/substitute. The same patients' CT scans (in randomised order) were blindly reviewed at the one week interval by the same clinicians with the same management options decided upon. Kappa statistic was used to measure the intra-individual agreement between x-ray and CT, as well as inter-individual agreement within each imagining modality. The agreement between individual observer's management decisions, based on the x-rays and on the CT scan was poor; with an average Kappa score of 0.038 (range 0.006 to 0.19). A regression model with management as a graded 5 level variable ranging from least invasive to most invasive and imaging modality as the predictor gave an estimated coefficient of 0.163, (p=-0.267); this indicates a trend towards a slightly higher level of invasiveness when the management decision was based on the CT compared to the plain x-rays. The agreement on management decisions between the observers based on x-ray alone was higher than that based on CT alone (kapa=0.174 vs 0.03). This study indicates a very poor level of agreement between decision-making, based on x-ray and on CT. Even within individual's ‘interindividual’ agreement appears higher with x-ray than CT. This study also raises the possibility that the use of CT scans increases the level of invasiveness in the surgical management of complex distal radius fractures