Onur BAŞCI, Ahmet Emrah ACAN, Mehmet ERDURAN

Management of acute limb compartment syndrome: A survey of clinical practice among orthopedics and traumatology surgeons in Turkey

Aim: The aim is to conduct a survey of currently practising orthopedics and traumatology surgeons and residents in Turkey regarding their current practice and perceptions on compartment syndrome management. Materials and Methods: A structured survey was developed for the study. Diagnosis in alert and unconscious patients, clinical signs of the condition, compartment pressure measurement, optimal time frame and technique for performing a fasciotomy, and preventive measures in patients with limb injuries were assessed. Results: Due to the evaluation, most significant and earliest symptom thought to be pain in 74% and 82.2% respectively. In diagnostic approach of conscious patients, 59.6% find intense pain and intense pain with passive stretching sufficient for diagnosis. In unconscious patients, 22.6% measure intracompartment pressure in every patient and if high in first measurement, indicates emergent fasciotomy, whereas 59.5% apply emergent fasciotomy in clinical suspicion without measuring intracompartment pressure. 89.7% don’t use pressure gauge in case of a compartment syndrome suspicion. 55.5% have not seen manually constructed mechanism before. 25.3% participants have sufficient knowledge to construct the mechanism. Conclusion: There are controversies in the management of compartment syndrome in Turkey, development of clinical practice guidelines may encourage best practice, reduce variations and reduce the incidence of complications.

Akut kompartman sendromu klinik yaklaşımları: Türkiye'deki ortopedi ve travmatoloji doktorlarının uygulamalarının anket ile değerlendirilmesi

Amaç: Çalışmanın amacı, Türkiye’de halen çalışmakta olan ortopedi ve travmatoloji uzmanları ve asistanlarının, kompartman sendromuna yönelik güncel yaklaşım ve algılarının ortaya konmasıdır. Gereç ve Yöntem: Çalışma icin tasarlanmış anket ile, bilinci açık veya kapalı hastada tanı, kompartman sendromunun klinik bulguları, kompartman basıncı ölçümü, fasiyotomi icin uygun müdahale süresi ve tekniği değerlendirildi. Bulgular: Bu değerlendirmede, en önemli (%74) ve en erken (%82,2) oluşabilecek semptomun ağrı olduğu görüşü hakimdir. Tanısal yaklaşımda, %59,6 aşırı ağrı ve pasif germe ile aşırı ağrıyı tanı icin yeterli görmektedir. Bilinci kapalı hastalarda, %22,6 kompartman basıncını her hastada ölçülmesi gerektiğini ve birinci yüksek sonuçta acil fasiyotomi endikasyonunu uygun görmektedir. Öte yandan, %59,6 kompartman basıncı ölçmeksizin klinik şüphenin acil fasiyotomi icin yeterli bir endikasyon olduğu görüşündedir. %89,7 kompartman sendromu şüphesinde basınç ölçmeye gerek duymamaktadır. %55,5 manuel kompartman ölçüm düzeneğini hiç görmemiş ve %25,3 düzeneği kurabilecek bilgiye sahip olduğunu ifade etmektedir. Sonuç: Türkiye’de kompartman sendromu yönetiminde tartışmalı yaklaşımlar olduğu gözlenmekle beraber, klinik yaklaşım rehberlerinin hazırlanması, en uygun yaklaşımın oluşması, değişken yaklaşımların ve komplikasyon insidanslarının azaltılması için fayda sağlayacaktır.

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