Bedside Surgery Can Treat Compartment Syndrome

Compartment Syndrome pic
Compartment Syndrome
Image: webmd.com

Throughout his career, orthopedic surgeon Dr. Nabil Ebraheim has been credited with both encyclopedic knowledge of his field and contributions to its further advancement. Among these contributions is an improvement on the procedure known as fasciotomy, a surgery used to treat compartment syndrome, which in severe cases can cause irreversible muscle damage within a few hours of its occurrence. Fasciotomies are usually performed in operating rooms, but the difficulty in providing timely surgery for diagnosed patients led Dr. Nabil Ebraheim to develop the “bedside fasciotomy,” allowing a patient to receive critical treatment without the need for full surgical preparation.

Compartment syndrome is a situation in which blood flow expands muscle tissues during physical activity, but the fascia – the connective tissue binding the muscle fibers – doesn’t expand with them, creating pressure that can cut off blood flow and begin causing weakness and numbness as the muscle begins to die. The exact cause of compartment syndrome isn’t fully understood, but it is often associated with athletic exertion, and can frequently be confused with other painful athletic injuries, such as shin splints. Mild cases of compartment syndrome can be treated with therapy, but more serious cases require a fasciotomy, which treats the condition by cutting or removing the damaged fascia to relieve the pressure and restore normal blood flow.

The bedside fasciotomy simplifies the process as much as possible for the sake of expedience. Instead of a general anesthetic, the patient is given conscious sedation to prevent pain or reflexive movement while the patient remains awake, and a local anesthetic is administered at the site of the surgery. The surgery itself consists of a single long incision at one of several specific locations, allowing access to the muscle compartments of each limb, ensuring the doctor has ready access to the damaged fascia in need of removal.

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The Difficulties of Ensuring Proper Healing in the Clavicle

Dr. Nabil Ebraheim guides the University of Toledo Medical Center’s Department of Orthopedic Surgery as its chairman and a professor and has experience treating a variety of complex fracture cases. Maintaining a popular educational YouTube channel, Dr. Nabil Ebraheim discusses issues such as malunion of the clavicle.

Given the complexity of the collarbone, it is difficult to reduce fractures and maintain unity in healed bone. Whether or not a figure-eight strap or sling is employed, the clavicle heals quickly and overcomes issues such as fracture displacement. However, the clavicle’s midshaft area is subject to deforming forces, which involve the counteracting forces of gravity and the weight of the arm on the one hand and a superior pull by the sternocleidomastoid muscle on the other.

The result is non-alignment of the clavicle and the formation of a bony callus around the fracture, as well as shortening. This often results in decreased shoulder strength and overall endurance in the injured patient. To counteract this, surgery is often undertaken to perform fraction reduction and set a fixating plate in place.