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Background: Compartment syndrome is a devastating complication after trauma to the extremities. Prompt fasciotomy is essential for avoiding disability and limb loss. The purpose of this study was to determine the incidence and predictors for the need for fasciotomy after extremity trauma., Methods: All trauma patients sustaining extremity injuries admitted to the LAC+USC Medical Centre during a 10-year period ending in December 2007 were identified. Demographics, clinical data, blood requirements and outcomes were abstracted. Patients who required an extremity fasciotomy were compared with those who did not. Stepwise logistic regression analysis was used to identify independent predictors of the need for fasciotomy., Results: During the study period, 288 (2.8%) of a total of 10,315 patients who sustained extremity trauma required a fasciotomy. Despite a stable ISS and extremity AIS over the study period, fasciotomy rates decreased significantly from 3.2% in 1998 to 2.5% in 2002 to 0.7% in 2007 (p<0.001). The need for fasciotomy varied widely by mechanism of injury (from 0.9% after motor vehicle accident to 8.6% in GSWs, p<0.001) and by type of injury (from 2.2% in closed fracture to 41.8% in combined vascular injury, p<0.001). Patients requiring fasciotomy were predominantly male (90.6% vs. 73.5%, p<0.001) and had higher ISS (14.5±9.7 vs. 12.8±10.6, p=0.006). Patients requiring fasciotomy received significantly more units of PRBCs (8.2±13.9 vs. 1.8±5.1, p<0.001) during their hospital stay. Patients requiring fasciotomy were more likely to sustain open fractures (upper: 8.3% vs. 5.2%, p=0.031 and lower: 28.5% vs. 11.8%, p<0.001); joint dislocations (elbow: 25.0% vs. 8.3%, p=0.005, and knee: 31.2% vs. 6.5%, p<0.001) and brachial (8.0% vs. 1.1%, p<0.001), femoral (20.1% vs. 1.1%, p<0.001) and popliteal vessel injuries (15.3% vs. 0.4%, p<0.001). A stepwise logistic regression identified the presence of vascular injury, need for PRBC transfusion, male gender, open fracture, elbow or knee dislocation, GSW, ISS≥16 and age<55 years as independent predictors for the need for fasciotomy., Conclusion: After extremity trauma, approximately 1% of patients will require a fasciotomy. The need for fasciotomy varied widely by injury mechanism and type reaching 42% in patients who sustained a combined arterial and venous injury. The above risk factors were identified as independent predictors for the need for fasciotomy., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Introduction: The purpose of this study was to assess the role of decompressive craniectomy (DC) inpatients with post-traumatic intractable intracranial hypertension (ICH) in the absence of an evacuable intracerebral haemorrhage., Methods: Retrospective study at LAC+USC Medical Centre including patients who underwent DC for post-traumatic malignant brain swelling or ICH without space occupying haemorrhage, during the period 01/2004 to 12/2008. The analysis included the effect of DC on intracranial pressure (ICP) and timing of DC on functional outcomes and survival., Results: Of 106 patients who underwent DC, 43 patients met inclusion criteria. Of those, 34 were operated within the first 24 h from admission. DC decreased the ICP significantly from 37.8 ± 12.1 mmHg to 12.7 ± 8.2 mmHg in survivors and from 52.8 ± 13.0 to 32.0 ± 17.3 mmHg in non-survivors. Overall 25.6%died (11 of 43), and 32.5% (14 of 43) remained in vegetative state or were severely disabled. Favourable outcome (Glasgow Outcome Scale 4 and 5) was observed in 41.9% (18 of 43). No tendency towards either increased or decreased incidence in favourable outcome was found relative to the time from admission to DC.Six of the 18 patients (33.3%) with favourable outcome were operated on within the first 6 h., Conclusions: DC lowers ICP and raises CPP to high normal levels in survivors compared to non-survivors.The timing of DC showed no clear trend, for either good neurological outcome or death. Overall, the survival rate of 74.4% is promising and 41.9% had favourable neurological outcome., (2010 Elsevier Ltd. All rights reserved.)