Assessment and diagnosis of acute limb compartment syndrome: A literature review

Background: Compartment syndrome is a collection of symptoms that signal increased pressure in the muscle compartment and results in compromised tissue perfusion. Failure to diagnose and treat the condition can result in permanent neurovascular deficit, tissue ischaemia, limb amputation and rhabdomyolysis. Aims: The aim of the review was to determine the strength of the evidence regarding risk reduction and early detection of ALCS and to identify the gaps in the evidence. Methods: Following a systematic search, literature about patient risk, risk reduction, clinical observation and compartment monitoring was identified and the methodological quality of studies was considered. Findings: Diaphyseal fractures of the tibia are the most significant risk factor for compartment syndrome followed by fracture of the distal radius. The anterior compartment of the leg and the flexor compartment of the forearm are most affected. Other factors include calcaneal fractures, male gender, age <35 years, high energy trauma, soft tissue injuries (especially in patients with bleeding disorders), open fracture, limb compression due to traction, padding and casts and surgical management of fractures. Males aged below 35 years who sustain a fracture of the lower leg or forearm should be monitored most carefully. Clinical observations, together with compartment pressure monitoring, in patients at risk appears to be the best method of diagnosing the condition. Pain out of proportion to the injury and pain on passive muscle stretch are the most effective clinical observation in conscious patients. Paresis/paralysis, parasthesia and pallor may help in diagnosis but are late signs. The sensitivity and specificity of these symptoms in diagnosing ALCS is unclear and the approach to pain assessment is not considered in detail

The pains and pleasures of using Orthopaedic Patient Reported Outcome Measures (PROMS) in clinical assessment and evaluation

Aim This paper aims to explore the usefulness of PROMS in the clinical assessment and evaluation of patients undergoing orthopaedic interventions such as total hip and knee arthroplasty. Also to discuss some of the challenges in the use of PROMS with patients with multiple comorbidities or learning/ communication difficulties. Abstract Health care globally requires the measurement of outcome before and following procedures such as total hip and knee replacement to demonstrate the intervention has resulted in an improvement in the patient’s condition and/or functional status (Jester, Santy & Rogers 2011). Outcome can be assessed from the clinician perspective in a number of ways including: measures of function, clinical investigations such as x-ray or MRI scan and direct observation such as gait analysis. However this does not capture the patient’s perspective of the impact of the disease and subsequent effectiveness of an intervention/s. Patient Reported Outcome Measures (PROMS) have become increasingly used in Orthopaedics to capture the patient’s perspective. One of the most frequently used PROMS used with patients undergoing THR and TKR are the Oxford Hip and Knee Scores. These scores are frequently included in initial clinical assessment to ascertain how patients perceive the severity of their symptoms and the impact on various activities. Subsequently the tools are administered at regular intervals following THR/TKR and compared to the baseline scores to assess improvement in symptoms and function. Oxford hip and knee scores have been used extensively over the last 20 years in the UK and internationally and form part of the data collected for a number of national joint registers. They have been tested extensively to demonstrate their reliability, validity and sensitivity and are minimally influenced by patient co-morbidity (Murray et al, 2007). However there is very little research on the patient’s experience and satisfaction with these scores (Wylde et al, 2005). This presentation will discuss the difficulties patients with co-morbidities, multiple joint involvement and learning or communication difficulties have in completing these scores and the impact this may have during clinical assessment and evaluation of outcome

The early benefits of a problem-based approach to teaching social inclusion using an online virtual town

This article describes the delivery of a core pre-registration nursing and midwifery module centred on social inclusion. The module was previously delivered using a classroom-based problem-based learning approach. Difficulties with this approach led to changes to the module and its delivery. Logistic issues encouraged the module team to implement a blended learning approach using a virtual town to facilitate online learning and discussion activities. The paper describes and discusses the use of online learning technology to support student nurses and midwives. It highlights the benefits of this approach and outlines some of the experiences of the students including their evaluation of the virtual town. There is also an examination of some of the practical and theoretical issues related to both problem-based learning, online working and using a virtual town to support learning. This article outlines the approach taken and its implications