عن الناجت املستعصي األلم عالج من حالة نستعرض املقال هذا في بعد)MS(املتعدد والتصلب)FBSS(الفاشلة الظهر جراحة متالزمة حالة عن نبلغ نحن املريض. في)SCS(الشوكي احلبل حملفز زرع .MS و FBSS باستخدام مريض ل عالج SCS استخدم In the present article, we described a case of treating intractable pain from failed back surgery syndrome)FBSS(and multiple sclerosis)MS(after implantation of spinal cord stimulation)SCS(in a patient. We are reporting a case where SCS has been used for treating a patient with both FBSS and MS.
Joint Diseases and Related Surgery Case ReportsStress fractures are mostly seen in the tibia, fibula, navicular, and metatarsal bones in the lower extremities due to overuse injury. A 27-year-old male patient, working as a surgical resident in a tertiary referral hospital, presented with pain on the right foot and difficulty in weight bearing and walking. His symptoms developed approximately a month after being diagnosed with novel coronavirus disease 2019 (COVID-19) and receiving systemic corticosteroid treatment. His history revealed weight gain and excessive working hours. He was diagnosed with stress fracture of the fourth metatarsal basis and treated conservatively. In conclusion, possible muscle/tendon, and bone pathologies and stress fractures secondary to systemic corticosteroid use and increased body mass index should be kept in mind, while evaluating the complaints of patients who have had COVID-19 and have a history of systemic steroid use in daily orthopedic practice, considering the side effects of steroids on the musculoskeletal system.
Objectives
This study aims to evaluate the effect of hyperbaric oxygen therapy (HBOT) on the amputation level in patients undergoing fasciotomy with a Mangled Extremity Severity Score (MESS) score of ≥7 after 2023 Kahramanmaras earthquake.
Patients and methods
Between February 6
th
, 2023 and March 10
th
, 2023, a total of 23 patients (14 males, 9 females; mean age: 36.8±13.2 years; range, 17 to 64 years) who needed amputation with a MESS score of ≥7 and refused amputation were included in the study. All fasciotomies were performed in an external center, and five of them was incomplete. First, incomplete fasciotomies were completed with debridement due to deep muscle necrosis. Daily two HBOT sessions were performed for the first three days. In the following days, daily one HBOT session was performed. The HBOT was terminated for the patients who were decided by the council that they did not benefit from HBOT treatment.
Results
Six (26.08%) of the patients had a bone fracture (n=2 forearm, n=1 femur, n=2 tibia, and n=1 ankle fracture). The mean number of HBOT session was 13.24±5.4 (range, 7 to 30) and the mean duration of HBOT was 26.5±10.8 (range, 14 to 60) h. The mean MESS score was 9.96±1.36 (range, 7 to 12). All of the patients were trapped under the rubble with a mean time of 12.3±5.4 (range, 6 to 23) h. All fasciotomies were performed within the first 30 h. Twenty-two of the patients were amputated at the level previously determined by the experienced trauma surgeons. The amputation level changed in only one patient. After 38 h of HBOT, transradial amputation was performed to the patient in whom transhumeral amputation level was determined previously. None of the patients had any adverse event related to HBOT.
Conclusion
Our study results suggest that the MESS is a useful scoring system for amputation decision after a high-energy trauma, such as an earthquake, with a high accuracy rate. The outcomes of HBOT are not satisfactory for high-energy traumas, such as earthquakes, in those requiring fasciotomy having more muscle necrosis and a MESS score of ≥7.
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