Avoiding surgical procedures due to swelling?

[Dragonash]

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Aloha All,
I'm terribly sorry if this is in the wrong place, but I couldn't think of anyone else to ask.

I'm a kinesiology and rehab science student taking an "athletic injury prevention and rehabilitation" course, and my professor said something today that she danced around and avoided answering when I asked for further clarification.

"If swelling is present (presumably at the site of injury), surgery is to be avoided."

Why is this? I couldn't get a strait answer out of her, and my google-fu is apparently not strong enough to help me figure this out. Again, terribly sorry if this is not the place for this type of question, but I could use some help here. Thank you! 🙂

 

[Dr.LeoSpaceman]

You could ask in the ortho forum to give you an answer specific to sports injuries, but I suspect it's the same as why general surgery procedures are more difficult in the face of acute inflammation.

Acute swelling and inflammation distorts tissues and makes them more friable. Dissection becomes a challenge not only because of that distortion, but because the structures and surrounding tissue don't separate cleanly. That means it's possible to damage delicate structures--like small nerves and blood vessels--that you might otherwise be able to identify and preserve. That same friability also means the tissues do not hold suture very well, making repair suboptimal.

 

[Dragonash]

Exactly the answer I was looking for. Thank you FaytIND 👍

 

[droliver]

The answer is, it depends. Sometimes you want to intervene before maximal swelling and sometimes you want to let things resolve first. With most sports injuries on high performance athletes, they intervene real early. You see a lot of athletes going in for complex knee or shoulder reconstructions within 48 hours. OTOH with something like facial fractures other then mandibular fractures, you typically wait a few days for the swelling to come down before you operate to facilitate the exposure.

 

[skiz knot]

The answer is, it depends. Sometimes you want to intervene before maximal swelling and sometimes you want to let things resolve first. With most sports injuries on high performance athletes, they intervene real early. You see a lot of athletes going in for complex knee or shoulder reconstructions within 48 hours. OTOH with something like facial fractures other then mandibular fractures, you typically wait a few days for the swelling to come down before you operate to facilitate the exposure.

Dr. Oliver, I have to respectfully disagree with the statement that complex shoulder and knee reconstructions are commonly done within 48 hours. There is plenty of literature to support unfavorable outcomes in these types of injuries when performed during the acute inflammatory phase. ACL reconstruction, shoulder labral/rotator cuff repair is often delayed several weeks (or even months) after the initial injury. Most would advocate obtaining (near) full passive range of motion before surgery. Multiligamentous knee injuries (dislocations) are the one exception where outcomes are improved with early (<3 weeks) intervention.

In the scenario of trauma and periarticular fracture, there is typically an early window (<24 hours) and a late window (>5-21 days) after injury where the soft tissues are safe to proceed with surgery.