DOCSLIB.ORG

Rhabdomyolysis: a Review, with Emphasis on the Pediatric Population

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Rhabdomyolysis: a Review, with Emphasis on the Pediatric Population Pediatr Nephrol (2010) 25:7–18 DOI 10.1007/s00467-009-1223-9 REVIEW Rhabdomyolysis: a review, with emphasis on the pediatric population Essam F. Elsayed & Robert F. Reilly Received: 9 March 2009 /Revised: 30 April 2009 /Accepted: 5 May 2009 /Published online: 16 June 2009 # IPNA 2009 Abstract Rhabdomyolysis is a common clinical syndrome Introduction and accounts for 7% of all cases of acute kidney injury (AKI) in the USA. It can result from a wide variety of Rhabdomyolysis is a common clinical syndrome, with disorders, such as trauma, exercise, medications and more than 25,000 cases reported annually in the USA, infection, but in the pediatric population, infection and where it accounts for 7% of all cases of acute kidney inherited disorders are the most common causes of injury (AKI) [1, 2]. It is due to injury to muscle tissue, rhabdomyolysis. Approximately half of patients with which may be caused by physical (e.g. crush injury), rhabdomyolysis present with the triad of myalgias, weak- chemical or biological factors. Striated muscle breakdown ness and dark urine. The clinical suspicion, especially in the (rhabdo-myo-lysis) leads to the release of breakdown setting of trauma or drugs, is supported by elevated products from damaged muscle cells into the bloodstream. creatinine kinase levels and confirmed by the measurement Some of these, such as myoglobin, are harmful to the of myoglobin levels in serum or urine. Muscle biopsy and kidney and may lead to AKI [3]. Although rhabdomyolysis genetic testing should be performed if rhabdomyolysis is may result from a wide variety of disorders that injure recurrent or metabolic myopathy is suspected. Early skeletal muscle, in this review we will focus on those recognition is important to prevent AKI through the use disorders that are prevalent in the pediatric population, of aggressive hydration. Prevention is important in patients especially those that result from inherited disease and with inherited forms, but novel therapies may be developed metabolic disorders. A variety of published reviews address with the better understanding of the pathophysiology and rhabdomyolysis secondary to trauma, infection and drugs in genetics of rhabdomyolysis. more detail [4–7]. Keywords Acute kidney injury. Genetic disorders . Myoglobin . Pediatric . Rhabdomyolysis Rhabdomyolysis in history The first historical mention of rhabdomyolysis is believed to be in the Old Testament among Jews after eating quail during their exodus from Egypt. The consumption of quail : E. F. Elsayed R. F. Reilly is linked to the development of myolysis caused by Department of Internal Medicine, Section of Nephrology, hemlock herbs consumed by the birds during their spring VA North Texas Health Care System, migration across the Mediterranean Sea [8]. A surgeon in The University of Texas Southwestern Medical Center at Dallas, ’ Dallas, TX, USA Napoleon s army in 1812 described limb gangrene from rhabdomyolysis in carbon monoxide victims. In more E. F. Elsayed (*) modern times, German military literature referred to Dallas VA Medical Center (111G1), rhabdomyolysis as crush syndrome, and the disease and 4500 S Lancaster Road, Dallas, TX 75216, USA its mechanisms were well described in World War II during e-mail: [email protected] the Blitz of London in 1941. Bywaters identified myoglo- 8 Pediatr Nephrol (2010) 25:7–18 binuria as the cause of renal failure in five patients from the syndrome from an increase in intracompartmental pressure, London Blitz [9]. as well as to hypovolemia. Injured muscles can sequester up to 12 liters of fluid in a few days [13]. Clinical picture Pathophysiology of kidney injury Damage to the cell membrane and the degradation of myofilaments lead to Approximately half of all patients with rhabdomyolysis the leakage of intracellular contents, including CK, myo- present with the triad of myalgias, weakness and dark (tea- globin, phosphate and potassium. The release of excessive colored) urine with a history of trauma or medication use. myoglobin into the plasma overwhelms the capacity of the Many patients presenting with calf pain or muscle swelling binding proteins (mainly haptoglobin). This results in have their diagnosis confounded by other conditions, such myoglobin then being filtered across the glomerulus, as deep venous thrombosis. A history of alcohol or illicit causing tubular damage. The pathophysiology of AKI in drug use, trauma, loss of consciousness and prolonged rhabdomyolysis is likely to be multifactorial, including immobilization should raise the suspicion of rhabdomyolysis. vasoconstriction, hypovolemia, direct myoglobin toxicity In a good percentage of patients, rhabdomyolysis can present and intraluminal cast formation [14]. Casts result from the with one or more of its complications, such as AKI, binding of myoglobin to Tamm–Horsfall protein, especially compartment syndrome and electrolytes abnormalities. in acidic urine. These pigmented casts are found in distal Acute kidney injury is one of the major complications of tubules and collecting ducts. Bywaters et al. reported that in rhabdomyolysis and occurs in about 24% of patients. The acidic urine, myoglobin dissociates into non-toxic (globin) risk of AKI in adults was estimated in one study to be 17– and toxic (ferrihemate) components. Ferrihemate will 35% [10]; in comparison the risk of AKI in children was increase the level of oxidative free radicals, resulting in estimated to be 42% in a small pediatric series and 5% in a further damage to the renal parenchyma [13]. Acidosis larger series [11]. Rhabdomyolysis has been reported to caused by etiological factors associated with rhabdomyol- account for about 5–20% of all cases of AKI. The mortality ysis or as a result of AKI and hypovolemia may further rate in patients with rhabdomyolysis, complicated by AKI, contribute to the formation of myoglobin casts. In addition may be as high as 80%, especially when creatine kinase to low urine pH, hyperuricemia may also be a risk factor for (CK) levels reach 100,000 U/L. Compartment syndrome AKI (similar to that seen in urate nephropathy) [15]. Also, may result from underlying etiology, as in the case of vasoactive agents, such as platelet activating factor, fractures of the lower extremities or during the course of endothelins and prostaglandin F2α, which may be in- treatment with fluid resuscitation, which can cause wors- creased in patients with rhabdomyolysis, cause the ening edema of the extremities [12]. vasoconstriction of renal arterioles. Pathophysiology Etiologies Pathophysiology of rhabdomyolysis All disorders causing rhabdomyolysis result in mechanical stress on the cell, Most of the literature on rhabdomyolysis came from adult which in turn leads to cellular membrane injury, cell studies with limited data from only a few pediatric case hypoxia and the release of degradative enzymes, such as series. Rhabdomyolysis can result from a wide variety of phospholipase A2, and, subsequently, to mitochondrial disorders, as shown in Fig. 1 and discussed below. While breakdown and ATP depletion. The ultimate result is a trauma and drugs are the most common causes of disruption of intracellular ion concentrations and Na/K rhabdomyolysis in adults (up to 80% of cases), infection ATPase, intracellular calcium influx, hyperactivity of and congenital disorders are the most common causes in the calcium-dependent proteolytic enzymes and the generation pediatric population [6, 10, 11]. of oxidative free radicals. The excessive calcium causes persistent contraction of the myofibers. Further damage Trauma occurs from a proinflammatory condition that arises from vasoconstriction, hypoxia and neutrophil aggregation, with Rhabdomyolysis was thought to be caused only by trauma the production of proteases and additional free radicals, until, less than half a century ago, other causes were which ultimately leads to cell death. The loss of cell volume described. Trauma is still the most common cause in adults. regulation and reperfusion injury contribute to muscle cell Rhabdomyolysis and its complications are major problems swelling along with an increase in blood flow. This may in people injured in disasters, such as earthquakes. It can subsequently lead to the development of compartment result from crush injury, compartment syndrome, electrical Pediatr Nephrol (2010) 25:7–18 9 Fig. 1 Causes of rhabdomyoly- sis. CMV Cytomegalovirus, HIV Hereditary Carnitine metabolism disorders human immunodeficiency virus, Illicit Drugs VLCAD EBV Epstein–Barr virus, McArdle disease Alcohol Low Potassium VLCAD very long chain acyl Malignanthy perthermia Cocaine (Severe) CoA deficiency Amphetamine Medications Causes Infections Statins Influenza, CMV, HIV, EBV Colchicine, Of Legionella, Salmonella Steroids Rhabdomyolysis Malaria Antipsychotic medications Others Food Sarcoid Quail Polymyositis Mushrooms Snake venom Trauma Licorice Crush injury Compartment syndrome Heat stroke, Exercise shock or heat stroke. In contrast to high-voltage injuries, sacroplasmic calcium, due to the gene mutation, leads to rhabdomyolysis is rare in lightning injuries. Rhabdomyol- persistent muscle rigidity and rhabdomyolysis. These ysis, with or without compartment syndrome, can occur patients develop skeletal muscle rigidity, hyperventilation after prolonged surgical procedures, such as bariatric and fever when exposed to general anesthesia, especially surgery [9, 16–23]. halothane. Non-anesthetic agents, such as decongestants and gasoline vapors, have also been reported to cause this
Load more

Recommended publications
  • Treatment of Established Volkmann's Contracture*
    ~hop. Acta Treatment of Established Volkmann’sContracture* BY KENYA TSUGE, M.D.’J’, HIROSHIMA, JAPAN ldon, From the Department of Orthopaedic Surgery, Hiroshima Universi~.’ 1-76, School of Medicine, Hiroshima 38. The disease first described by Volkmann in 1881 is the extent of the disease: mild, moderate, and severe. In generally considered to result from spasm of the main ar- the mild type, also called the localized type, there was de- ~ts of teries of the forearm, and their branches as a consequence generation of part of the flexor digitorum profundus mus- Acta of trauma to the elbow or forearm. The severe and pro- cle, causing contractures in only two or three fingers. longed but incomplete interruption of arterial blood sup- There were hardly any neurological signs, and when pres- ~. (in ply, together with venostasis, produces acute ischemic ent they were minimum. In the moderate type, the muscle z and necrosis of the flexor muscles. The most marked ischemia degeneration involved all or nearly all of the flexor digito- occurs in the deeply situated muscles such as the flexor rum profundus and flexor pollicis longus, with partial pollicis longus and flexor digitorum profundus, but severe degeneration of the superficial muscles as well. The neu- ischemia is evident in the pronator teres and flexor rological signs were invariably present and generally -484, digitorum superficialis muscles, and comparatively mild the median nerve was more severely affected than the :rtag, ischemia occurs in the superficially located muscles such ulnar nerve. In the severe type, there was degeneration as the wrist flexors. The muscle degeneration which fol- of all the flexor muscles with necrosis in the center ).
    [Show full text]
  • Crush Injuries Pathophysiology and Current Treatment Michael Sahjian, RN, BSN, CFRN, CCRN, NREMT-P; Michael Frakes, APRN, CCNS, CCRN, CFRN, NREMT-P
    LWW/AENJ LWWJ331-02 April 23, 2007 13:50 Char Count= 0 Advanced Emergency Nursing Journal Vol. 29, No. 2, pp. 145–150 Copyright c 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins Crush Injuries Pathophysiology and Current Treatment Michael Sahjian, RN, BSN, CFRN, CCRN, NREMT-P; Michael Frakes, APRN, CCNS, CCRN, CFRN, NREMT-P Abstract Crush syndrome, or traumatic rhabdomyolysis, is an uncommon traumatic injury that can lead to mismanagement or delayed treatment. Although rhabdomyolysis can result from many causes, this article reviews the risk factors, symptoms, and best practice treatments to optimize patient outcomes, as they relate to crush injuries. Key words: crush syndrome, traumatic rhabdomyolysis RUSH SYNDROME, also known as ology, pathophysiology, diagnosis, and early traumatic rhabdomyolysis, was first re- management of crush syndrome. Cported in 1910 by German authors who described symptoms including muscle EPIDEMIOLOGY pain, weakness, and brown-colored urine in soldiers rescued after being buried in struc- Crush injuries may result in permanent dis- tural debris (Gonzalez, 2005). Crush syn- ability or death; therefore, early recognition drome was not well defined until the 1940s and aggressive treatment are necessary to when nephrologists Bywaters and Beal pro- improve outcomes. There are many known vided descriptions of victims trapped by mechanisms inducing rhabdomyolysis includ- their extremities during the London Blitz ing crush injuries, electrocution, burns, com- who presented with shock, swollen extrem- partment syndrome, and any other pathology ities, tea-colored urine, and subsequent re- that results in muscle damage. Victims of nat- nal failure (Better & Stein, 1990; Fernan- ural disasters, including earthquakes, are re- dez, Hung, Bruno, Galea, & Chiang, 2005; ported as having up to a 20% incidence of Gonzalez, 2005; Malinoski, Slater, & Mullins, crush injuries, as do 40% of those surviving to 2004).
    [Show full text]
  • Rotator Cuff Tear Arthropathy: Pathophysiology, Diagnosis And
    yst ar S em ul : C c u s r u r e M n t & R Orthopedic & Muscular System: c e Aydin, et al., Orthopedic Muscul Syst 2014, 3:2 i s d e e a p ISSN: 2161-0533r o c DOI: 10.4172/2161-0533-3-1000159 h h t r O Current Research Review Article Open Access Rotator Cuff Tear Arthropathy: Pathophysiology, Diagnosis and Treatment Nuri Aydin*, Okan Tok and Bariş Görgün Istanbul University Cerrahpaşa, School of Medicine, Istanbul, Turkey *Corresponding author: Nuri Aydin, Istanbul University Cerrahpaşa, School of Medicine, Orthopaedics and Traumatology, Istanbul, Turkey, Tel: +905325986232; E- mail: [email protected] Rec Date: Jan 25, 2014, Acc Date: Mar 22, 2014, Pub Date: Mar 28, 2014 Copyright: © 2014 Aydin N, et al. 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 author and source are credited. Abstract The term rotator cuff tear arthropathy is a broad spectrum pathology but it involves common characteristic features as rotator cuff tear, leading to glenohumeral joint arthritis and superior migration of the humeral head. Although there are several factors described causing rotator cuff tear arthropathy, the exact mechanism is still unknown because the rotator cuff tear arthropathy develops in only a group of patients with chronic rotator cuff tear. The aim of this article is to review pathophysiology of rotator cuff tear arthropathy, to explain the diagnostic features and to discuss the management of the disease. Keywords: Arthropathy; Glenohumeral joint; Articular fluid Rotator cuff tear not only plays a role at the beginning of the disease, but also a developed rotator cuff tear is a result of the inflammatory Introduction process.
    [Show full text]
  • Don't-Miss Diagnoses
    Nine Don’t-Miss Diagnoses iYin Young Ad Adltults James R. Jacobs, MD, PhD, FACEP Director – Student Health Services The Ohio State University Office of Student Life Wilce Student Health Center 9 Diagnoses Disproportionate Easy to miss Immediate Sudden death impact on young or threat to life or in young adults misdiagnose organ adults Rhabdomyolysis • • Necrotizing •• Fasciitis Hodgkin •• Lymphoma Ectopic • Pregnancy WPW • • • Pulmonary ••• Embolism Peritonsillar •• Abscess Hypertrophic •• • Cardiomyopathy Testicular ••• Torsion 1 Don’t Miss Rhabdomyolysis in Young Adults Don’t Miss Rhabdomyolysis in Young Adults • Definition – Syndrome resulting from acute necrosis of skeletal muscle fibers and consequent leakage of muscle constituents into the circulation – Characterized by limb weakness , myalgia, swelling, and, commonly, gross pigmenturia without hematuria • Can include low-grade fever, nausea, vomiting, malaise, and delirium 2 Don’t Miss Rhabdomyolysis in Young Adults Etiologies Examples Crush injury, lightning or electrical injury, prolonged Trauma immobilization, burns Excessive muscle Strenuous exercise, status epilepticus, status asthmaticus activity Increased body Heat stroke, malignant hyperthermia, neuroleptic malignant temperature syndrome Ethanol, cocaine, amphetamines, PCP, LSD, carbon monoxide, benzodiazepines, barbiturates, statins, fibrates, Toxins and drugs neuroleptics, envenomation (e.g., snake, black widow, bees), quail ingestion Many viral and bacterial infections (including influenza, Infection Legionella, TSS);
    [Show full text]
  • Table of Contents 1
    GENERAL THORACIC SURGERY DATABASE v.2.3 TRAINING MANUAL August 2017 Table of Contents 1. Demographics ................................................................................................................................................................. 2 2. Follow Up ........................................................................................................................................................................ 9 3. Admission ..................................................................................................................................................................... 10 4. Pre-Operative Evaluation ............................................................................................................................................. 14 5. Diagnosis (Category of Disease) ................................................................................................................................... 48 6. Procedure ..................................................................................................................................................................... 70 7. Post-Operative Events ................................................................................................................................................ 111 8. Discharge .................................................................................................................................................................... 135 9. Quality Measures ......................................................................................................................................................
    [Show full text]
  • Bilateral Atraumatic Compartment Syndrome of the Legs Leading to Rhabdomyolysis and Acute Renal Failure Following Prolonged Kneeling in a Heroin Addict
    PAJT 10.5005/jp-journals-10030-1075 CASE REPORTBilateral Atraumatic Compartment Syndrome of the Legs Leading to Rhabdomyolysis and Acute Renal Failure Bilateral Atraumatic Compartment Syndrome of the Legs Leading to Rhabdomyolysis and Acute Renal Failure Following Prolonged Kneeling in a Heroin Addict. A Case Report and Review of Relevant Literature Saptarshi Biswas, Ramya S Rao, April Duckworth, Ravi Kothuru, Lucio Flores, Sunil Abrol ABSTRACT cerrado, que interfiere con la circulación de los componentes mioneurales del compartimento. Síndrome compartimental Introduction: Compartment syndrome is defined as a symptom bilateral de las piernas es una presentación raro que requiere complex caused by increased pressure of tissue fluid in a closed una intervención quirúrgica urgente. En un reporte reciente osseofascial compartment which interferes with circulation (Khan et al 2012), ha habido reportados solo 8 casos de to the myoneural components of the compartment. Bilateral síndrome compartimental bilateral. compartment syndrome of the legs is a rare presentation Se sabe que el abuso de heroína puede causar el síndrome requiring emergent surgical intervention. In a recent case report compartimental y rabdomiólisis traumática y atraumática. El (Khan et al 2012) there have been only eight reported cases hipotiroidismo también puede presentarse independiente con cited with bilateral compartment syndrome. rabdomiólisis. Heroin abuse is known to cause compartment syndrome, traumatic and atraumatic rhabdomyolysis. Hypothyroidism can Presentación del caso: Presentamos un caso de una mujer also independently present with rhabdomyolysis. de 22 años quien presentó con tumefacción bilateral de las piernas asociado con la perdida de la sensación, después Case presentation: We present a case of a 22 years old female de pasar dos días arrodillado contra una pared después de who presented with bilateral swelling of the legs with associated usar heroína intravenosa.
    [Show full text]
  • Page 1 of 4 COPYRIGHT © by the JOURNAL of BONE and JOINT SURGERY, INCORPORATED LAMPLOT ET AL
    COPYRIGHT © BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED LAMPLOT ET AL. RISK OF SUBSEQUENT JOINT ARTHROPLASTY IN CONTRALATERAL OR DIFFERENT JOINT AFTER INDEX SHOULDER, HIP, OR KNEE ARTHROPLASTY http://dx.doi.org/10.2106/JBJS.17.00948 Page 1 Appendix TABLE E-1 Included Alternative Primary Diagnoses ICD-9-CM Code Diagnosis* 716.91 Arthropathy NOS, shoulder 716.95 Arthropathy NOS, pelvis 716.96 Arthropathy NOS, lower leg 719.45 Joint pain, pelvis 719.91 Joint disease NOS, shoulder *NOS = not otherwise specified. Page 1 of 4 COPYRIGHT © BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED LAMPLOT ET AL. RISK OF SUBSEQUENT JOINT ARTHROPLASTY IN CONTRALATERAL OR DIFFERENT JOINT AFTER INDEX SHOULDER, HIP, OR KNEE ARTHROPLASTY http://dx.doi.org/10.2106/JBJS.17.00948 Page 2 TABLE E-2 Excluded Diagnoses* ICD-9- ICD-9- ICD-9- ICD-9- CM Code Diagnosis CM Code Diagnosis CM Code Diagnosis CM Code Diagnosis 274 Gouty arthropathy NOS 696 Psoriatic 711.03 Pyogen 711.38 Dysenter arthropathy arthritis- arthritis NEC forearm 274.01 Acute gouty arthropathy 696.1 Other psoriasis 711.04 Pyogen 711.4 Bact arthritis- arthritis-hand unspec 274.02 Chr gouty arthropathy 696.2 Parapsoriasis 711.05 Pyogen 711.46 Bact arthritis- w/o tophi arthritis-pelvis l/leg 274.03 Chr gouty arthropathy w 696.3 Pityriasis rosea 711.06 Pyogen 711.5 Viral arthritis- tophi arthritis-l/leg unspec 274.1 Gouty nephropathy NOS 696.4 Pityriasis rubra 711.07 Pyogen 711.55 Viral arthritis- pilaris arthritis-ankle pelvis 274.11 Uric acid nephrolithiasis 696.5 Pityriasis NEC & 711.08
    [Show full text]
  • A Systematic Review of Rhabdomyolysis for Clinical Practice Luis O
    Chavez et al. Critical Care (2016) 20:135 DOI 10.1186/s13054-016-1314-5 REVIEW Open Access Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice Luis O. Chavez1, Monica Leon2, Sharon Einav3,4 and Joseph Varon5* Abstract Background: Rhabdomyolysis is a clinical syndrome that comprises destruction of skeletal muscle with outflow of intracellular muscle content into the bloodstream. There is a great heterogeneity in the literature regarding definition, epidemiology, and treatment. The aim of this systematic literature review was to summarize the current state of knowledge regarding the epidemiologic data, definition, and management of rhabdomyolysis. Methods: A systematic search was conducted using the keywords “rhabdomyolysis” and “crush syndrome” covering all articles from January 2006 to December 2015 in three databases (MEDLINE, SCOPUS, and ScienceDirect). The search was divided into two steps: first, all articles that included data regarding definition, pathophysiology, and diagnosis were identified, excluding only case reports; then articles of original research with humans that reported epidemiological data (e.g., risk factors, common etiologies, and mortality) or treatment of rhabdomyolysis were identified. Information was summarized and organized based on these topics. Results: The search generated 5632 articles. After screening titles and abstracts, 164 articles were retrieved and read: 56 articles met the final inclusion criteria; 23 were reviews (narrative or systematic); 16 were original articles containing epidemiological data; and six contained treatment specifications for patients with rhabdomyolysis. Conclusion: Most studies defined rhabdomyolysis based on creatine kinase values five times above the upper limit of normal. Etiologies differ among the adult and pediatric populations and no randomized controlled trials have been done to compare intravenous fluid therapy alone versus intravenous fluid therapy with bicarbonate and/or mannitol.
    [Show full text]
  • Total Knee Arthroplasty in Hemophiliacs: Gains in Range of Motion Realized Beyond Twelve Months Postoperatively Atul F
    Original Article Clinics in Orthopedic Surgery 2012;4:121-128 • http://dx.doi.org/10.4055/cios.2012.4.2.121 Total Knee Arthroplasty in Hemophiliacs: Gains in Range of Motion Realized beyond Twelve Months Postoperatively Atul F. Kamath, MD, John G. Horneff , MD, Angela Forsyth, DPT*,†, Valdet Nikci, BS‡, Charles L. Nelson, MD‡ Departments of Orthopaedic Surgery, *Physical Th erapy, †Hematology & Oncology, Hospital of the University of Pennsylvania, ‡Department of Orthopaedic Surgery, Penn Presbyterian Medical Center, Philadelphia, PA, USA Background: Hemophiliacs have extrinsic tightness from quadriceps and fl exion contractures. We sought to examine the effect of a focused physical therapy regimen geared to hemophilic total knee arthroplasty. Methods: Twenty-four knees undergoing intensive hemophiliac-specifi c physical therapy after total knee arthroplasty, at an aver- age age of 46 years, were followed to an average 50 months. Results: For all patients, fl exion contracture improved from −10.5 degrees preoperatively to −5.1 degrees at fi nal follow-up (p = 0.02). Knees with preoperative fl exion less than 90 degrees were compared to knees with preoperative fl exion greater than 90 degrees. Patients with preoperative fl exion less than 90 degrees experienced improved fl exion (p = 0.02), along with improved arc range of motion (ROM) and decreased fl exion contracture. For those patients with specifi c twelve-month and fi nal follow-up data points, there was a signifi cant gain in fl exion between twelve months and fi nal follow-up (p = 0.02). Conclusions: Hemophiliacs with the poorest fl exion benefi ted most from focused quadriceps stretching to a more functional length, with gains not usually seen in the osteoarthritic population.
    [Show full text]
  • Management of Rhabdomyolysis Complicating Traditional Bone Setters Treatment of Fracture
    Volume : 4 | Issue : 5 | May 2015 ISSN - 2250-1991 Research Paper Medical Science Management of Rhabdomyolysis Complicating Traditional Bone Setters Treatment of Fracture Enemudo RE AIM: To highlight the complications of rhabdomyolysis caused by the use of tight splint for the treatment of humeral and femoral fractures by traditional bone setter in Delta State, Nigeria. PATIENTS AND METHODS: A retrospective study of patients treated for rhabdomyolysis complicating traditional bone setter treatment of humeral and femoral fractures with tight splint in DELSUTH from August 2012 to December2014. Inclusion criterion was those with rhabdomyolysis caused by TBS treatment of humeral and femoral fracture with tight splint. Exclusion criteria were patients with ischemic gangrene, Volkmann ischemic contracture (VIC), sickle cell and diabetic mellitus patients. Investigations done were limb x-ray, electrocardiography, chest x-ray, serum electrolyte, urea and creatinine, urinalysis with dip-stick test, creatine kinase assay and serum calcium. Treatment protocol used was fluid resuscitation with normal saline, frusemide + mannitol-alkaline diuresis. RESULTS: A total of 6 patients were seen in the study. 4 males and 2 female with M:F ratio of 2:1. The age range of patients ABSTRACT seen was 36-77 years (mean=54.3years). Five patients used the treatment protocol and survived while one did not use the protocol and eventually died because the diagnosis of rhabdomyolysis was not made on time. CONCLUSION: Rhabdomyolysis is a fatal complication of reperfusion injury of muscles following release of the very tight splint used by TBS for the treatment of limb fractures. A good knowledge of the mode of presentation of the patients and necessary investigations plus the immediate commencement of treatment or amputation of the affected limb will avert the associated mortality from cardiac arrest and acute renal failure.
    [Show full text]
  • Dupuytren's Contracture
    n interview Dupuytren’s Contracture Steven Beldner, MD In this issue of ORTHOPEDICS, Dr Steven Beldner discusses Dupuy- tren’s contracture and the available nonsurgical and surgical treat- ments. among northern Europeans and in regions that were populated by Viking conquest. Because its expression is increased in diabe- tes mellitus, some argue that it is metabolic. Because its expres- sion is increased in human immunodeficiency infection, some argue that it is associated with the immune system. Because its expression is increased with hepatic disease or administration of phenytoin, some argue that it is associated with the cytochrome P450 system. Many patients report that it started after trauma or What is Dupuytren’s contracture? is accentuated by physical tension placed on the tissue. There- Dupuytren’s contracture is a fibroproliferative condition in fore, some argue that this is the cause. Most agree that Dupuy- which normal collagen is placed in abnormal amounts. It has tren’s contracture has a multifactorial etiology. different names depending on location. When in the feet, it is re- ferred to as Ledderhose disease. When on the penis, it is referred What are the symptoms of Dupuytren’s contracture? to as Peyronie’s disease. When on the back of the knuckles, it is Dupuytren’s contracture is a painless condition. In the early called Garrod’s nodules. Under the microscope, a normal cell phases, a small area of thickening, usually on the ulnar side of called the myofibroblast that is producing normal collagen in the hand in the palm, may be noted. As it progresses into cords, abnormal amounts is seen.
    [Show full text]
  • Cocaine/Heroin Induced Rhabdomyolysis and Ventricular Fibrillation B Mccann, R Hunter, J Mccann
    264 CASE REPORTS Emerg Med J: first published as 10.1136/emj.19.3.270 on 1 May 2002. Downloaded from Cocaine/heroin induced rhabdomyolysis and ventricular fibrillation B McCann, R Hunter, J McCann ............................................................................................................................. Emerg Med J 2002;19:264–265 PaO2: 24.3 kPa; base deficit: 18.0 mmol/l; lactate: 8.4 mmol/l. A case of cardiorespiratory arrest in a 28 year old Creatine phosphokinase: 90 500 IU/l (normal range 33–194). man after cocaine and heroin ingestion is described. The Urine: myoglobin: positive; cocaine metabolites: positive; arrest is attributed primarily to hyperkalaemia/ opioids: positive. rhabdomyolysis—a recognised consequence of each of Consequent upon his rhabdomyolysis he developed acute these drugs. The administration of naloxone may have renal failure requiring haemodialysis, disseminated intravas- been contributory. He developed acute renal failure, cular coagulopathy and right lower limb compartment disseminated intravascular coagulopathy with consequent syndrome requiring fasciotomy. Echocardiogram showed a lower limb compartment syndrome requiring fasciotomy. left ventricular ejection fraction of 53%. Respiratory function Ventricular fibrillation was identified at thoracotomy. remained stable. At day 10 (after tracheostomy) he had spon- taneous eye opening, flexed to pain and had no response to verbal commands. Brain stem reflexes were intact. Computed tomographic scan of his brain was normal. 28 year old man was brought to the emergency depart- The patient died two months later. Cause of death was ment after intravenous ingestion of cocaine and heroin. bronchopneumonia complicating multiorgan failure. AHe was noted to be pale, cyanosed, bradypnoeic (6/min), and hypotensive (70/40). DISCUSSION Initial treatment consisted of oxygen via a facemask, and 800 Rhabdomyolysis is a well documented complication of cocaine µg of naloxone intravenously.
    [Show full text]