Síndrome de embolia grasa y el cirujano de ortopedia y traumatología: lecciones aprendidas y recomendaciones clínicas

http://www.traumaysiniestros.com.mx/traumatologia/sindrome-de-embolia-grasa-y-el-cirujano-de-ortopedia-y-traumatologia-lecciones-aprendidas-y-recomendaciones-clinicas/

Fat emboli syndrome and the orthopaedic trauma surgeon: lessons learned and clinical recommendations

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28555248

https://link.springer.com/article/10.1007%2Fs00264-017-3507-1

De:

Dunn RH1,Jackson T1,Burlew CC2,Pieracci FM2,Fox C2,Cohen M2,

Campion EM2,Lawless R2,Mauffrey C3.

Int Orthop.

2017 May 30. doi: 10.1007/s00264-017-3507-1. [Epub ahead of print]

Todos los derechos reservados para:

Copyright information

© SICOT aisbl 2017

Abstract

PURPOSE:

Fat emboli syndrome is a rare but well-described complication of long-bone fractures classically characterised by a triad of respiratory failure, mental status changes and petechial rash. In this paper, we present the case of a patient who sustained bilateral femoral fractures and subsequently developed FES. Our aim was to review and summarise the current literature regarding the pathophysiology and management of fat emboli syndrome (FES) and propose an algorithm for treating patients with bilateral femoral fractures to reduce the risk of FES.

CONCLUSIONS:

Our algorithm for managing bilateral femoral fractures prioritises early stabilisation with external fixation, staged intramedullary nailing and conversion to plate fixation if FES develops. This protocol is meant to be the basis of future investigations of optimal treatment strategies.

KEYWORDS:

Bilateral femur fractures; Complication; Damage control orthopaedics; Fat emboli syndrome; Femur shaft fracture

Resumen

PROPÓSITO:
El síndrome de embolia grasa es una complicación rara pero bien descrita de fracturas de hueso largo caracterizadas clásicamente por una tríada de insuficiencia respiratoria, cambios en el estado mental y erupción petequial. En este artículo presentamos el caso de un paciente que sostuvo fracturas femorales bilaterales y posteriormente desarrolló FES. Nuestro objetivo fue revisar y resumir la literatura actual sobre fisiopatología y manejo del síndrome de embolia grasa (FES) y proponer un algoritmo para el tratamiento de pacientes con fracturas femorales bilaterales para reducir el riesgo de FES.

CONCLUSIONES:
Nuestro algoritmo para el manejo de fracturas femorales bilaterales prioriza la estabilización temprana con fijación externa, clavado intramedular escalonado y conversión a fijación de placa si FES se desarrolla. Este protocolo está destinado a ser la base de futuras investigaciones de estrategias de tratamiento óptimo.
PALABRAS CLAVE:
Fracturas bilaterales del fémur; Complicación; control de daños en ortopedia; Síndrome de embolia grasa; Fractura del fémur

PMID:  28555248   DOI:  

10.1007/s00264-017-3507-1

#Fracturas bilaterales del fémur#control de daños en ortopedia#Síndrome de embolia grasa#fémur#fracturas

El papel del control de daños en politraumas: un caso de disyunción pélvica asociado con dislocación de cadera con lesión vascular

http://www.traumaysiniestros.com.mx/siniestros/el-papel-del-control-de-danos-en-politraumas-un-caso-de-disyuncion-pelvica-asociado-con-dislocacion-de-cadera-con-lesion-vascular/

Role of Trauma Damage Control Orthopaedic in polytraumas: a case of pelvic disjunction associated with hip dislocation with vascular injury

Fuente

Este artículo es publicado originalmente en:

https://www.ncbi.nlm.nih.gov/pubmed/28904652

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567943/

http://www.panafrican-med-journal.com/content/article/27/122/full/

De:

Madani T1,El Alouani EM1,Mhammdi Y1,Kharmaz M1,El Ouadghiri M1,

Lahlou A1,Omar LM1,El Bardouni A1,Mahfoud M1,Berrada MS1.

Pan Afr Med J.

2017 Jun 15;27:122. doi: 10.11604/pamj.2017.27.122.8699. eCollection 2017.

Todos los derechos reservados para:

Copyright and License information ▼

Reçu 2015 déc. 22; Accepté 2016 avr. 3.

Droit d’auteur

© Tarik Madani et al.The Pan African Medical Journal – ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The knowledge of the pathophysiology of patients with severe trauma and the hemodynamic and inflammatory consequences of initial surgical management has led many surgeons to change their approach to the treatment of patients with severe polytraumas associated with lesions of the pelvis or of limbs by integrating the principles of sequential treatment or Trauma Damage Control Orthopaedic (TDCO). We report the case of a patient involved in a public road accident, admitted to hospital in a state of shock with pelvic disjunction and hip dislocation complicated by vascular injury in the same limb. Our approach was based on TDCO concepts by favoring external fixation of the pelvis after hip dislocation reduction. The timeliness of our apprach allowed early limb revascularization while avoiding the hemodynamic and inflammatory complications of open surgery.

KEYWORDS:

TDCO; pelvis; polytrauma

Resumen

El conocimiento de la fisiopatología de los pacientes con trauma severo y las consecuencias hemodinámicas e inflamatorias del manejo quirúrgico inicial ha llevado a muchos cirujanos a cambiar su enfoque al tratamiento de pacientes con politraumas severos asociados con lesiones de la pelvis o miembros integrando los principios de tratamiento secuencial o Control de daños en ortopedia y traumatología (CDOT). Presentamos el caso de un paciente involucrado en un accidente de tráfico público, ingresado en un hospital en estado de choque con disyunción pélvica y dislocación de cadera complicada por lesión vascular en la misma extremidad. Nuestro enfoque se basó en los conceptos CDOT, favoreciendo la fijación externa de la pelvis después de la reducción de la dislocación de la cadera. La puntualidad de nuestro estudio permitió la revascularización de las extremidades tempranas evitando las complicaciones hemodinámicas e inflamatorias de la cirugía abierta.

PALABRAS CLAVE:
control de daños; pelvis; politrauma

PMID:  28904652   PMCID:  

PMC5567943  

DOI:  

10.11604/pamj.2017.27.122.8699

[Indexed for MEDLINE]

Free PMC Article

#control de daños#pelvis#politrauma

MÉXICO ESTÁ DE PIE

Septiembre 21, 2017. No. 2818

Los huracanes y los terremotos han golpeado a México de una manera cruel. La devastación, la muerte y mil desgracias son el tema actual, y nosotros los Mexicanos nos hemos unido en gran apoyo a aquellos que han sido afectados por la Madre Naturaleza. Hurricanes and earthquakes have hit México in a crude way. Devastation, death and a thousand misfortunes are the current theme, and we Mexicans have united in great support for those who have been affected by Mother Nature.  Furacões e terremotos atingiram o México de uma maneira grosseira. A devastação, a morte e mil desgraças são o tema atual, e nós, os mexicanos, nos unimos em grande apoio para aqueles que foram afetados pela Mãe Natureza. Enlaces para donar / Links to donate International Community Foundation(ICF) https://donate.icfdn.org/npo/international-disaster-relief-fund Global Giving https://www.globalgiving.org/projects/mexico-earthquake-and-hurricane-relief-fund/   Red Cross Méxicohttps://www.cruzrojamexicana.org.mx Unicef México https://www.unicef.org/mexico/spanish/ Provisión de anestesia en desastres y conflictos armados. Anesthesia Provision in Disasters and Armed Conflicts. Trelles Centurion M1, Van Den Bergh R2, Gray H3. Author information Abstract Curr Anesthesiol Rep. 2017;7(1):1-7. doi: 10.1007/s40140-017-0190-0. Epub 2017 Feb 16. Local, spinal and general intravenous (mainly with Ketamine) anesthetics seem to be the most widely accepted. Inhalation anesthesia has constraints; regional is underused and epidural is not recommended. Standard operative procedures should be in place, and an informed consent from the patient must be granted. PDF Anestesia regional para lesiones dolorosas después de desastres (RAPID): protocolo de estudio para un ensayo controlado aleatorio. Regional Anesthesia for Painful Injuries after Disasters (RAPID): study protocol for a randomized controlled trial. Levine AC1, Teicher C2, Aluisio AR3, Wiskel T3, Valles P4, Trelles M4, Glavis-Bloom J3, Grais RF2. Author information Trials. 2016 Nov 14;17(1):542. Abstract BACKGROUND: Lower extremity trauma during earthquakes accounts for the largest burden of disaster-related injuries. Insufficient pain management is common in resource-limited disaster settings, and regional anesthesia (RA) may reduce pain in injured patients beyond current standards of care. To date, no controlled trials have been conducted to evaluate the use of RA for pain management in a disaster setting. METHODS/DESIGN: The Regional Anesthesia for Painful Injuries after Disasters (RAPID) study aims to evaluate whether regional anesthesia (RA), either with or without ultrasound (US) guidance, can reduce pain from earthquake-related lower limb injuries in a disaster setting. The proposed study is a blinded, randomized controlled equivalence trial among earthquake victims with serious lower extremity injuries in a resource-limited setting. After obtaining informed consent, study participants will be randomized in a 1:1:1 allocation to either: standard care (parenteral morphine at 0.1 mg/kg); standard care plus a landmark-guided fascia iliaca compartment block (FICB); or standard care plus an US-guided femoral nerve block. General practice humanitarian response providers who have undergone a focused training in RA will perform nerve blocks with 20 ml 0.5 % levobupivacaine. US sham activities will be used in the standard care and FICB arms and a normal saline injection will be given to the control group to blind both participants and nonresearch team providers. The primary outcome measure will be the summed pain intensity difference calculated using a standard 11-point Numerical Rating Scale reported by patients over 24 h of follow-up. Secondary outcome measures will include overall analgesic requirements, adverse events, and participant satisfaction. DISCUSSION: Given the high burden of lower extremity injuries in the aftermath of earthquakes and the currently limited treatment options, research into adjuvant interventions for pain management of these injuries is necessary. While anecdotal reports on the use of RA for patients injured during earthquakes exist, no controlled studies have been undertaken. If demonstrated to be effective in a disaster setting, RA has the potential to significantly assist in reducing both acute suffering and long-term complications for survivors of earthquake trauma. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02698228 ), registered on 16 February 2016. KEYWORDS: Earthquake; Humanitarian response; Natural disaster; Pain management; Randomized controlled trial; Regional anesthesia PDF ¿Una cuestión de vida o de miembro? Una revisión de los patrones de lesiones traumáticas y técnicas de anestesia para el alivio de desastres después de terremotos de gran magnitud. A matter of life or limb? A review of traumatic injury patterns and anesthesia techniques for disaster relief after major earthquakes. Missair A1, Pretto EA, Visan A, Lobo L, Paula F, Castillo-Pedraza C, Cooper L, Gebhard RE. Author information Anesth Analg. 2013 Oct;117(4):934-41. doi: 10.1213/ANE.0b013e3182a0d7a7. Epub 2013 Aug 19. Abstract BACKGROUND: All modalities of anesthetic care, including conscious sedation, general, and regional anesthesia, have been used to manage earthquake survivors who require urgent surgical intervention during the acute phase of medical relief. Consequently, we felt that a review of epidemiologic data from major earthquakes in the context of urgent intraoperative management was warranted to optimize anesthesia disaster preparedness for future medical relief operations. The primary outcome measure of this study was to identify the predominant preoperative injury pattern (anatomic location and pathology) of survivors presenting for surgical care immediately after major earthquakes during the acute phase of medical relief (0-15 days after disaster). The injury pattern is of significant relevance because it closely relates to the anesthetic techniques available for patient management. We discuss our findings in the context of evidence-based strategies for anesthetic management during the acute phase of medical relief after major earthquakes and the associated obstacles of devastated medical infrastructure. METHODS: To identify reports on acute medical care in the aftermath of natural disasters, a query was conducted using MEDLINE/PubMed, Embase, CINAHL, as well as an online search engine (Google Scholar). The search terms were "disaster" and "earthquake" in combination with "injury," "trauma," "surgery," "anesthesia," and "wounds." Our investigation focused only on studies of acute traumatic injury that specified surgical intervention among survivors in the acute phase of medical relief. RESULTS: A total of 31 articles reporting on 15 major earthquakes (between 1980 and 2010) and the treatment of more than 33,410 patients met our specific inclusion criteria. The mean incidence of traumatic limb injury per major earthquake was 68.0%. The global incidence of traumatic limb injury was 54.3% (18,144/33,410 patients). The pooled estimate of the proportion of limb injuries was calculated to be 67.95%, with a 95% confidence interval of 62.32% to 73.58%. CONCLUSIONS: Based on this analysis, early disaster surgical intervention will focus on surviving patients with limb injury. All anesthetic techniques have been safely used for medical relief. While regional anesthesia may be an intuitive choice based on these findings, in the context of collapsed medical infrastructure, provider experience may dictate the available anesthetic techniques for earthquake survivors requiring urgent surgery. PDF Los Siete Pasos a la Seguridad contra Terremotos html

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org