Why resect the neck?

Compartment syndrome has been defined as “a condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space”.1 It is most commonly seen after injuries to the leg2-5 and forearm6-8 but may also occur in the arm,9 thigh,10 foot,11-13 buttock,14 hand15 and abdomen.16 It typically follows traumatic injury, but may also occur after ischaemic reperfusion injuries,17 burns,18 prolonged limb compression after drug overdose19 or poor positioning during surgery.20-24 Furthermore, subclinical compartment syndromes may explain the occurrence of a variety of postoperative disabilities which have been identified after the treatment of fractures of long bones using intramedullary nails.25 Approximately 40% of all acute compartment syndromes occur after fractures of the tibial shaft26 with an incidence in the range of 1% to 10%.26-30 A further 23% of compartment syndromes are caused by soft-tissue injuries with no fracture and fractures of the forearm account for 18%.26 Acute compartment syndrome is seen more commonly in younger patients, under 35 years of age31 and therefore leads to loss of function and long-term productivity in patients who would otherwise contribute to the country’s workforce for up to 40 years.

The Journal of Bone and Joint Surgery. British volumeVol. 72-B, No. 3 ArticlesFree AccessCup re-enforcement for recurrent dislocation after hip replacementT Gungor, G HallinT GungorSearch for more papers by this author, G HallinSearch for more papers by this authorPublished Online:1 May 1990https://doi.org/10.1302/0301-620X.72B3.2341467AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByAcetabular Lip Augmentation Devices for the Unstable Total Hip Replacement—A Systematic ReviewArthroplasty Today, Vol. 12Luxations et subluxations des prothèses totales de hancheAcetabular augmentation ring for recurrent dislocation of total hip arthroplasty: 60% stability rate after an average follow-up of 74 months19 October 2007 | International Orthopaedics, Vol. 33, No. 1The use of a posterior lip augmentation device for a revision of recurrent dislocation after primary cemented Charnley/Charnley Elite total hip replacementRESULTS AT A MEAN FOLLOW-UP OF SIX YEARS AND NINE MONTHSJ. McConway, S. O’Brien, E. Doran, P. Archbold, D. Beverland1 December 2007 | The Journal of Bone and Joint Surgery. British volume, Vol. 89-B, No. 12Minimal Surgical Approach for Recurrent Hip Dislocation Using the Posterior Lip Augmentation Device for the Charnley Hip ArthroplastyThe Journal of Arthroplasty, Vol. 21, No. 6Socket wall addition device in the treatment of recurrent hip prosthesis dislocation : Good outcome in 12 patients followed for 4.5 (1–9) years8 July 2009 | Acta Orthopaedica, Vol. 77, No. 1Acetabular Augmentation Ring for Recurrent Dislocations in Revision ArthroplastyClinical Orthopaedics and Related Research, Vol. &NA;, No. 436Recurrent hip arthroplasty dislocation: Good outcome after cup augmentation in 20 patients followed for 2 years8 July 2009 | Acta Orthopaedica Scandinavica, Vol. 73, No. 5Problems Seen after Olerud Acetabular Augmentation for Recurrent Dislocation of Total Hip Arthroplasty17 May 2019 | HIP International, Vol. 4, No. 2Trochanteric osteotomy for recurrent dislocation of total hip arthroplastyThe Journal of Arthroplasty, Vol. 8, No. 6 Vol. 72-B, No. 3 Metrics Downloaded 40 times History Published online 1 May 1990 Published in print 1 May 1990 InformationCopyright © 1990, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

The treatment of fractions of the shaft of the femur using nylon cerclage.

CORTICOSTEROID ARTHROPATHY AND TENDON RUPTURE

Use of acrylic prosthesis in the treatment of fracture of the head of the radius.

Dupuytren's disease.

Congenital aplasia and dysplasia of the tibia with intact fibula. Classification and management.

The Journal of Bone and Joint Surgery. British volumeVol. 64-B, No. 2 ArticlesFree AccessThe inheritance of slipped upper femoral epiphysisAM RennieAM RennieSearch for more papers by this authorPublished Online:1 Apr 1982https://doi.org/10.1302/0301-620X.64B2.7068737AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByThe Genetic Epidemiology of Joint Shape and the Development of Osteoarthritis11 May 2020 | Calcified Tissue International, Vol. 109, No. 3Epidemiology of Slipped Capital Femoral Epiphysis in Ontario, CanadaJournal of Pediatric Orthopaedics, Vol. 39, No. 3Outcomes following subcapital osteotomy for severe slipped upper femoral epiphysisI. S. Vanhegan, J. P. Cashman, P. Buddhdev, A. Hashemi-Nejad1 December 2015 | The Bone & Joint Journal, Vol. 97-B, No. 12The hereditary predisposition to hip osteoarthritis and its association with abnormal joint morphologyOsteoarthritis and Cartilage, Vol. 21, No. 2Slipped Capital Femoral Epiphysis18 May 2011Genetic influences in the aetiology of femoroacetabular impingementA SIBLING STUDYT. C. B. Pollard, R. N. Villar, M. R. Norton, E. D. Fern, M. R. Williams, D. W. Murray, A. J. Carr1 February 2010 | The Journal of Bone and Joint Surgery. British volume, Vol. 92-B, No. 2Slipped Capital Femoral Epiphysis14 November 2009Demographics and clinical presentation of slipped capital femoral epiphysis in Singapore: comparing the East with the WestJournal of Pediatric Orthopaedics B, Vol. 17, No. 6Changing incidence of slipped capital femoral epiphysisA RELATIONSHIP WITH OBESITY?A. W. Murray, N. I. L. Wilson1 January 2008 | The Journal of Bone and Joint Surgery. British volume, Vol. 90-B, No. 1Slipped upper femoral epiphysisCurrent Orthopaedics, Vol. 21, No. 3The Epidemiology of Slipped Capital Femoral EpiphysisJournal of Pediatric Orthopaedics, Vol. 26, No. 3Épiphysiolyse fémorale supérieureEMC - Appareil locomoteur, Vol. 1, No. 1Epifisiólisis femoral superiorEMC - Aparato Locomotor, Vol. 39, No. 2Slipped Capital Femoral Epiphysis in Down SyndromeJournal of Pediatric OrthopaedicsSlipped Capital Femoral Epiphysis in Down SyndromeJournal of Pediatric Orthopaedics, Vol. 24, No. 5Slipped Capital Femoral Epiphysis*†The Journal of Bone and Joint Surgery-American Volume, Vol. 82, No. 8Wiberg's Center-Edge Angle in Patients with Slipped Capital Femoral EpiphysisJournal of Pediatric Orthopaedics, Vol. 19, No. 1Journal of Pediatric Orthopedics, Vol. 19, No. 1SLIPPED CAPITAL FEMORAL EPIPHYSIS IN IDENTICAL TWINS: HLA PREDISPOSITIONOrthopedics, Vol. 21, No. 12FAMILIAL SLIPPED CAPITAL FEMORAL EPIPHYSIS: A REPORT AND CONSIDERATIONS IN MANAGEMENTANZ Journal of Surgery, Vol. 68, No. 9The HLA Phenotype in Slipped Capital Femoral EpiphysisJournal of Pediatric Orthopaedics, Vol. 17, No. 5The HLA Phenotype in Slipped Capital Femoral EpiphysisJournal of Pediatric Orthopaedics, Vol. 17, No. 5The Demographics of Slipped Capital Femoral Epiphysis An International Multicenter StudyClinical Orthopaedics and Related Research, Vol. 322Natural History of Untreated Chronic Slipped Capital Femoral EpiphysisClinical Orthopaedics and Related Research, Vol. 322Cuneiform Osteotomy of the Femoral Neck in Severe Slipped Capital Femoral EpiphysisClinical Orthopaedics and Related Research, Vol. 322Slipped capital femoral epiphysis in 6 of 8 first-degree relatives8 July 2009 | Acta Orthopaedica Scandinavica, Vol. 66, No. 6Slipped capital femoral epiphysis associated with Rubinstein-Taybi syndrome23 April 2008 | Clinical Genetics, Vol. 44, No. 2The Lower LimbSlipped Capital Femoral EpiphysisOrthopedic Clinics of North America, Vol. 18, No. 4Growth of children with physiolysis of the hip8 July 2009 | Acta Orthopaedica Scandinavica, Vol. 58, No. 2Slipped capital femoral epiphysis in southern Sweden 1910-19828 July 2009 | Acta Orthopaedica Scandinavica, Vol. 58, No. sup226Slipped capital femoral epiphysis in three generations8 July 2009 | Acta Orthopaedica Scandinavica, Vol. 57, No. 3Familial slipped capital femoral epiphysis8 July 2009 | Acta Orthopaedica Scandinavica, Vol. 57, No. 6 Vol. 64-B, No. 2 Metrics Downloaded 30 times History Published online 1 April 1982 Published in print 1 April 1982 InformationCopyright © 1982, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

The Journal of Bone and Joint Surgery. British volumeVol. 77-B, No. 2 ArticlesFree AccessOsteochondritis dissecans of the talus in identical twinsK Woods, I HarrisK WoodsSearch for more papers by this author, I HarrisSearch for more papers by this authorPublished Online:1 Mar 1995https://doi.org/10.1302/0301-620X.77B2.7706361AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByAnkle Osteochondral Pathologies and Treatment4 November 2021Proposition d’une nouvelle classification arthroscannographique des lésions ostéochondrales du talusRevue de Chirurgie Orthopédique et Traumatologique, Vol. 107, No. 6Proposal of a new CT arthrographic classification system of osteochondral lesions of the talusOrthopaedics & Traumatology: Surgery & Research, Vol. 107, No. 6Osteochondritis Dissecans29 March 2021 | Journal of Bone and Joint Surgery, Vol. 103, No. 12Athletic Performance in the National Basketball Association After Arthroscopic Debridement of Osteochondral Lesions of the Talus6 January 2021 | Orthopaedic Journal of Sports Medicine, Vol. 9, No. 1Concurrent Pathology and Ankle Instability29 April 2021Osteochondral Defects of the Talar Dome3 March 2020Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study14 May 2019 | The American Journal of Sports Medicine, Vol. 47, No. 7Osteochondral Lesions of the Talus13 April 2019Emerging Concepts in Treating Cartilage, Osteochondral Defects, and Osteoarthritis of the Knee and Ankle8 May 2018Surgical Treatment Paradigms of Ankle Lateral Instability, Osteochondral Defects and Impingement8 May 2018Candidate Loci are Revealed by an Initial Genome-wide Association Study of Juvenile Osteochondritis DissecansJournal of Pediatric Orthopaedics, Vol. 37, No. 1Pediatric Knee Osteochondritis Dissecans LesionsOrthopedic Clinics of North America, Vol. 47, No. 4Retrograde Percutaneous Drilling for Osteochondritis Dissecans of the Head of the Talus: Case Report and Review of the LiteratureThe Journal of Foot and Ankle Surgery, Vol. 55, No. 2A suspected genetic form of bilateral osteochondritis dissecans of the knee in a Dutch familyThe Knee, Vol. 22, No. 6Juvenile osteochondritis dissecans of the talus: predictors of conservative treatment failure13 August 2015 | Archives of Orthopaedic and Trauma Surgery, Vol. 135, No. 10Mosaicplasty of Osteochondral Lesions of the AnkleTreatment of osteochondral defects of the talus in children18 September 2013 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 22, No. 9Nontraumatic Osteochondral Lesion of the Talar Head: A Case Report and Description of Operative Technique for Arthroscopic Debridement1 January 2014 | Journal of Foot and Ankle Surgery (Asia Pacific), Vol. 1, No. 1Osteochondritis Dissecans of the TalusClinics in Sports Medicine, Vol. 33, No. 2Osteochondral Defects in the Ankle Joint19 March 2014Osteochondral Lesions8 February 2014Articular osteochondrosis: a comparison of naturally-occurring human and animal diseaseOsteoarthritis and Cartilage, Vol. 21, No. 11Evaluation of Joint Position Sense Measured by Inversion Angle Replication Error in Patients with an Osteochondral Lesion of the TalusThe Journal of Foot and Ankle Surgery, Vol. 52, No. 3Talus Osteochondral Bruises and DefectsFoot and Ankle Clinics, Vol. 18, No. 1Managing the Cystic Osteochondral DefectFoot and Ankle Clinics, Vol. 18, No. 1Autologous Matrix-induced Chondrogenesis in Osteochondral Lesions of the TalusFoot and Ankle Clinics, Vol. 18, No. 1Reconstruction of Osteochondral Lesions of the Talus With Autologous Spongiosa Grafts and Autologous Matrix-Induced Chondrogenesis7 February 2013 | The American Journal of Sports Medicine, Vol. 41, No. 3Sports Injuries of the AnkleOsteochondrosis dissecans tali14 December 2012 | Der Unfallchirurg, Vol. 115, No. 12Conservative Treatment for Juvenile Osteochondritis Dissecans of the Talus1 August 2012 | Journal of Orthopaedic Surgery, Vol. 20, No. 2Ätiologie und Pathophysiologie der osteochondralen Läsion des TalusFuß & Sprunggelenk, Vol. 10, No. 2Osteochondral Injuries of the Talus22 June 2011Osteochondral lesion of the talus in homozygous twins—The question of heredityFoot and Ankle Surgery, Vol. 16, No. 3Osteochondral defects in the ankle: why painful?12 February 2010 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 18, No. 5The basic science of the subchondral bone30 January 2010 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 18, No. 4Case Report: Osteochondritis Dissecans in Twins: Treatment with Fresh Osteochondral Grafts7 August 2009 | Clinical Orthopaedics and Related Research®, Vol. 468, No. 3A Review of Osteochondral Lesions of the TalusClinics in Podiatric Medicine and Surgery, Vol. 26, No. 2Treatment of osteochondral defects of the talusRevue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, Vol. 94, No. 8Osteochondritis Dissecans of the Capitellum in Fraternal Twins: Case ReportThe Journal of Hand Surgery, Vol. 33, No. 8Ankle InjuriesNew Advances in the Foot and AnkleLower Extremity InjuriesCurrent Concepts: Treatment of Osteochondral Ankle DefectsFoot and Ankle Clinics, Vol. 11, No. 2Osteochondral Ankle DefectsOsteochondritis Dissecans of the Talus in ChildrenJournal of Pediatric OrthopaedicsOsteochondritis Dissecans of the Talus in ChildrenJournal of Pediatric Orthopaedics, Vol. 23, No. 5Osteochondral lesions of the talusFoot and Ankle Clinics, Vol. 8, No. 1A medieval Italian child with osteochondritis dissecans of the cuboidThe Foot, Vol. 10, No. 4RADIOLOGIC CASE STUDYOrthopedics, Vol. 21, No. 3 Vol. 77-B, No. 2 Metrics Downloaded 117 times History Published online 1 March 1995 Published in print 1 March 1995 InformationCopyright © 1995, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

We studied the effect of total knee replacement on venous flow in 110 patients. Resting venous blood flow was measured using straingauge plethysmography before operation, after surgery and after discharge from hospital. There was a significant reduction in mean venous capacitance (p < 0.001) and mean venous outflow (p < 0.004) affecting only the operated leg. Both improved significantly after mobilisation in the early postoperative period, returning to preoperative levels by six days after surgery and before discharge from hospital.

The Journal of Bone and Joint Surgery. British volumeVol. 76-B, No. 6 ArticlesFree AccessA new operation for reconstruction of the femoral neckWG Li, YJ Li, H YunWG LiSearch for more papers by this author, YJ LiSearch for more papers by this author, H YunSearch for more papers by this authorPublished Online:1 Nov 1994https://doi.org/10.1302/0301-620X.76B6.7983136AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byQuadratus femoris muscle pedicle bone flap transplantation in the treatment of femoral neck fracture for Chinese young and middle-aged patients: A systematic review and meta-analysisChinese Journal of Traumatology, Vol. 20, No. 6The management of ununited fractures of the femoral neck using internal fixation and muscle pedicle periosteal graftingA. Gupta1 November 2007 | The Journal of Bone and Joint Surgery. British volume, Vol. 89-B, No. 11 Vol. 76-B, No. 6 Metrics History Published online 1 November 1994 Published in print 1 November 1994 InformationCopyright © 1994, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Rupture of the collateral ligament of the metacarpo-phalangeal joint of the thumb.

The Journal of Bone and Joint Surgery. British volumeVol. 64-B, No. 2 ArticlesFree AccessSupracondylar femoral osteotomy for knee flexion contracture resulting from poliomyelitisJC Leong, CO Alade, D FangJC LeongSearch for more papers by this author, CO AladeSearch for more papers by this author, D FangSearch for more papers by this authorPublished Online:1 Apr 1982https://doi.org/10.1302/0301-620X.64B2.7068740AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByIntraoperative neuromonitoring during distal femoral extension osteotomy in children with cerebral palsy28 May 2021 | Journal of Pediatric Orthopaedics B, Vol. 31, No. 2Usage of External Fixation in the Treatment of Adult Patients with Knee Joint Stiffness: Review2 April 2021 | Traumatology and Orthopedics of Russia, Vol. 27, No. 1Role of Ilizarov external fixator in the treatment of long-standing knee flexion deformity in adults: A prospective cohort study1 March 2020 | Current Orthopaedic Practice, Vol. 31, No. 2Management of severe congenital flexion deformity of the knee using Ilizarov methodJournal of Pediatric Orthopaedics B, Vol. 29, No. 1Common Pediatric Orthopaedic Diseases24 November 2020Unusual entrapment of deep peroneal nerve after femoral distal extension osteotomyJournal of Pediatric Orthopaedics B, Vol. 24, No. 5Osteotomie des distalen Femurs18 June 2015 | Operative Orthopädie und Traumatologie, Vol. 27, No. 3Neurological Complications After Supracondylar Femoral Osteotomy in Cerebral PalsyJournal of Pediatric Orthopaedics, Vol. 35, No. 3Differential Diagnosis of Limb Length Discrepancy in a 19th Century Burial from Southwest Mississippi17 March 2012 | International Journal of Osteoarchaeology, Vol. 24, No. 4Knee Stiffness in Children22 April 2014Paralytic DisordersDistal Femoral Osteotomy Using the LCP Pediatric Condylar 90-Degree Plate in Patients With Neuromuscular DisordersJournal of Pediatric Orthopaedics, Vol. 32, No. 3Supracondylar femoral extension osteotomy and patellar tendon advancement in the management of persistent crouch gait in cerebral palsyIndian Journal of Orthopaedics, Vol. 46, No. 2Poliomyelitis8 June 2011Poliomyelitis14 November 2009Managing Flexion Knee Deformity Using a Circular FrameClinical Orthopaedics & Related Research, Vol. 466, No. 12Paralytic DisordersPoliomyelitisJoint Distraction and Reconstruction in Complex Knee ContracturesJournal of Pediatric Orthopaedics, Vol. 27, No. 4Effectiveness of Serial Stretch Casting for Resistant or Recurrent Knee Flexion Contractures Following Hamstring Lengthening in Children With Cerebral PalsyJournal of Pediatric Orthopaedics, Vol. 26, No. 1The Ilizarov method around the kneeCurrent Opinion in Orthopedics, Vol. 10, No. 1Operative Kontrakturlösung an den unteren Gliedmaßen bei PoliomyelitisSoft tissue contractures of the knee or ankle treated by the llizarov technique: High recurrence rate in 26 patients followed for 3-6 years8 July 2009 | Acta Orthopaedica Scandinavica, Vol. 67, No. 5Les possibilités de verticalisation et de marche chez l'enfant dans les séquelles de poliomyélite en milieu africain1 June 1992 | International Orthopaedics, Vol. 16, No. 2Pressure erosion of the femoral trochlea, patella baja, and altered patellar surfacesAmerican Journal of Physical Anthropology, Vol. 85, No. 3Modified Posterior Soft Tissue Release for Management of Severe Knee Flexion ContractureOrthopedics, Vol. 12, No. 5 Vol. 64-B, No. 2 Metrics Downloaded 219 times History Published online 1 April 1982 Published in print 1 April 1982 InformationCopyright © 1982, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

The Journal of Bone and Joint Surgery. British volumeVol. 52-B, No. 2 Clinical StudiesFree AccessDELAYED PRIMARY SUTURE OF FLEXOR TENDONS CUT IN THE DIGITAL SHEATHErin MadsenErin MadsenSearch for more papers by this authorPublished Online:1 May 1970https://doi.org/10.1302/0301-620X.52B2.264AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByPrimary Care of Flexor Tendon InjuriesLong-term functional results of primary reconstruction of severe forearm injuriesJournal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 60, No. 4The Scientific Basis for Advances in Flexor Tendon SurgeryJournal of Hand Therapy, Vol. 18, No. 2Development of flexor tendon surgery: Twenty-five years of progressThe Journal of Hand Surgery, Vol. 25, No. 2Surgical Treatment of the Divided Flexor Digitorum Profundus Tendon in Zone 2, Delayed More than 6 Weeks, by Tendon Grafting in 50 Cases29 August 2016 | Journal of Hand Surgery, Vol. 21, No. 1Flexor sheath closure during delayed primary tendon repairThe Journal of Hand Surgery, Vol. 19, No. 4Acute Flexor Tendon InjuriesOrthopedic Clinics of North America, Vol. 23, No. 1Long-term follow-up of primary flexor pollicis longus tenorrhaphiesThe Journal of Hand Surgery, Vol. 16, No. 4Zone II flexor tendon repair: Effects of vitamins A, E, β-caroteneJournal of Surgical Research, Vol. 49, No. 1Primary Care of Flexor Tendon InjuriesHand Clinics, Vol. 5, No. 3Early Mobilisation after Flexor Tendon Repair17 January 2017 | Journal of Hand Surgery, Vol. 14, No. 4Flexor Tendon Surgery17 January 2017 | Journal of Hand Surgery, Vol. 14, No. 4Flexor Tendon InjuriesHand Clinics, Vol. 2, No. 1Flexor Tendon RepairHand Clinics, Vol. 1, No. 1Management of Acute Flexor Tendon InjuriesOrthopedic Clinics of North America, Vol. 14, No. 4Unterarm, Handgelenk und HandDigital function following flexor tendon repair in Zone II: A comparison of immobilization and controlled passive motion techniquesThe Journal of Hand Surgery, Vol. 5, No. 6Delayed Primary Suture of Flexor Tendons Cut in the Digital Theca4 December 2016 | Hand, Vol. os-12, No. 2Flexor Tendon Repair in No Man's Land8 July 2009 | Scandinavian Journal of Plastic and Reconstructive Surgery, Vol. 14, No. 3Flexor Tendon Repair in No Man's Land8 July 2009 | Scandinavian Journal of Plastic and Reconstructive Surgery, Vol. 14, No. 3Primary Repair Of Flexor Tendons Within The Digital Theca Of The Hand18 July 2017 | Hand, Vol. os-10, No. 2Delayed flexor tendon repair in no man's landThe Journal of Hand Surgery, Vol. 2, No. 6Tendon HealingClinics in Plastic Surgery, Vol. 4, No. 3Vascular changes in flexor tendons after injury and repair: an experimental studyInjury, Vol. 8, No. 3Assessment of the influence of the timing of repair on flexor tendon injuries in chickensBritish Journal of Plastic Surgery, Vol. 29, No. 1Diagnosis and Management of the Severed Flexor Tendon of the HandSurgical Clinics of North America, Vol. 54, No. 4Surgery of the HandNew England Journal of Medicine, Vol. 287, No. 23Delayed Primary Suture in Flexor Tendon Division6 December 2016 | Hand, Vol. 3, No. 2 Vol. 52-B, No. 2 Metrics Downloaded 32 times History Published online 1 May 1970 Published in print 1 May 1970 InformationCopyright © 1970, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Compartment syndrome is a serious complication of fractures of the tibial shaft and its clinical presentation and evaluation have been well documented (Holden 1975; Kikuchi, Hasue and Watanabe 1978). The most important diagnostic feature is the presence of inappropriate pain even after stabilisation of the fracture by a cast or by external or internal fixation. Pain is made worse by passive stretching of the muscles involved and there is an associated sensory disturbance. The prognosis is directly related to the speed at which the diagnosis is made and treatment begun. It has been shown that muscle can tolerate only four hours of ischaemia without injury (Heppenstall et al 1988; Heckman et al 1993). We describe a patient with a fracture of the tibial shaft in whom the diagnosis of compartment syndrome was delayed because of the use of a local nerve block given in the operating theatre after intramedullary nailing. Case report. A 28-year-old man presented after a football injury with a closed fracture of the tibial shaft (42-A2.2 according to the AO classification (Muller et al 1990)). Before operation there were no signs of neurovascular compromise or of a compartment syndrome. The fracture was initially stabilised in a plaster back slab and closed, unreamed locked intramedullary nailing then performed. At the end of the operation, the patient was given a triple nerve block (femoral, obturator, lateral cutaneous nerve of thigh) using bupivacaine 0.5% for pain control. After operation, he was entirely free from pain, although he did complain of areas of altered sensation in his foot and leg, but these varied in site and were initially thought to be a result of the nerve block rather than a symptom of a developing compartment syndrome. Pressure measurements were made 48 hours after operation because symptoms persisted and there was inability actively to extend the big toe. They showed a pressure of 108 mmHg in the anterior compartment. We performed fasciotomy urgently but all the muscles in the anterior compartment were dead. No other compartment was involved. The whole of the anterior tibial compartment was debrided 48 hours later as there was no sign of recovery. The patient now walks with an orthosis. Discussion. The treatment of postoperative pain in patients whose tibial fractures have been stabilised is usually by elevation of the injured leg and the use of oral or intramuscular analgesics, especially non-steroidal anti-inflammatory agents. Local anaesthetic nerve blocks are now also commonly given to patients with fractures of the lower limb; they are effective and especially useful after fracture of the femoral shaft. A nerve block using bupivacaine persists for about eight hours (Macrae and Davies 1993), but recovery from the block may be patchy and erratic over a period of several hours. The diagnosis of compartment syndrome is essentially