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BODYCAST - THE OFFICIAL JOURNAL OF THE CSOT Plaster cast immobilization during air travel-Analysis of current practice and aircraft-simulated experimental study By NeedhiRahan Senbaga, Evan M. Davies, R. Miller,
Michael Glanfield, Simon Lambert, and David O'Connor Summary Background: There is an increase in aircraft transportation of patients with lower limb fractures. Current practice is variable. Our aim was to study current practice and to analyze the situation in an experimental simulated aircraft flight. Methods: Current advice supplied by commercial airline offices in the U.K. was noted. Postal questionnaires were sent to orthopaedic consultants in the U.K. to obtain their current practice. Experimental aircraft travel was simulated in a decompression chamber with five medically fit volunteers with no fracture, immobilized in an above knee plaster cast. Compartment pressure and venous return were documented and the results analyzed in two different positions with the leg elevated and dependent. Results: Airlines do not have any formal guidelines. Orthopaedic consultants in the U.K. showed that two volunteers developed significant increase in compartmental pressure with the leg elevated to 90°, which settled after the plaster cast was split. There was no increase in compartment pressure noted with leg dependent on the floor with 45° of flexion at the hip. Conclusion: The literature on this issue is limited. Without analysis, we feel that patients can be transported with the plaster cast split with limb dependent on the floor, i.e., hip flexion less than 45°. Our volunteers had no fractures, so direct comparison with pathological changes in acute fracture is problematical. Further studies into this problem are recommended. Key words: tibial fractures, air travel, cast immobilization in air travel, compartment syndrome Introduction Increasing numbers of patients are becoming injured abroad during both recreational and commercial activities. During 1991, 15% of the United Kingdom population that was abroad during that year required some form of medical assistance, amounting to at least 30,000 patients (Martin & Rodenberg, 1996). In 2001, there were approximately 100,000 medical assistance cases arising from people who travelled abroad from the United Kingdom, about 25% of these being due to injuries. These generated 6,000 scheduled repatriations escorted by a doctor or nurse, and in excess of 700 air ambulance or air taxi repatriations (Glanfield, M., 2002, personal communication). In our fracture clinics, we are transferring and accepting increasing numbers of patients requiring aircraft transportation following trauma to the lower limb. Normal lower limbs tend to swell during aircraft transportation (Belcaro, Cesarone, Nicolaides, et al., 2003). In the Lonflit4venoruton study (Belcaro, Cesarone, Nicolaides, et al.), 77% in the control group had an evident increase in the ankle circumference and volume. We hypothesized that an individual travelling with a lower limb fracture would have an increase in lower limb swelling. We hypothesized that the swelling associated with aircraft transportation while wearing a complete plaster cast would increase the risk of compartment syndrome in this group of patients. Since the physiology of patients in flight with lower limb trauma was unknown, we decided to assess the physiology of the uninjured subject first. During discussion, with aviation medicine specialists at the Defence Evaluation Research Association (DERA). FarnborouQh. U.K.. and with representatives of the National Aeronautics Space Agency (NASA), it became clear that there were no known experiments that assessed the physiology of uninjured lower limb compartment pressures during aircraft transportation in the civilian, military and space industries. There is no evidence-based literature on this increasing problem. Our aim of this study was to analyze the situation in an experimental aircraft simulation study. Materials and methods During the second phase of our study, we sent questionnaires to 675 consultant orthopaedic surgeons in the U.K. They were given the scenario of acute tibial fracture and their views on air travel for these fractures were obtained.
This abstract is a portion of the article
which appears in the Winter 2009 issue of BodyCast. |
