title: [Reliability of venous blood gas analysis and radionuclide angiography in post-traumatic dystrophy].
abstract: BACKGROUND
  The diagnosis "post-traumatic dystrophy" (PTD) was first defined with clinical and paraclinical criteria by Scola et al. in 2013.
  
  
  OBJECTIVE
  The objectivity and reliability of the paraclinical criteria (venous blood gas analysis [vBGA], radionuclide angiography [RNA]), and recommendations for therapy should be assessed in a prospective study.
  
  
  METHODS
  In five patients with clinical signs of post-traumatic nonbacterial inflammation of the hand, both diagnosis and a 3‑week hospital treatment were carried out in accordance with the publication mentioned above. The primary traumata (four fractures and one soft-tissue injury) were located in either the hand or the forearm. Unsuccessful outpatient treatment always led to hospital admission. One patient with severe osteopenia in the hand skeleton was treated with bisphosphonates for 6 months.
  
  
  RESULTS
  All patients fulfilled the clinical and paraclinical criteria for the diagnosis of PTD. On admission, an elevated venous partial pressure of oxygen was found by vBGA in the affected hand (∆pO2mean 22 ± 3 mm Hg) and a hyperperfusion due to arteriovenous shunts was measured using RNA (mean 75 ± 47%). The symptomatic treatment was extremely well tolerated; by the time of discharge, all patients achieved full functioning of the hand with minor loss of strength (venous ∆pO2mean 5 ± 3 mm Hg). The osteopenia in the one patient treated with bisphosphonates showed recalcification after 6 months.
  
  
  CONCLUSIONS
  The reliability of clinical and paraclinical criteria for PTD were confirmed. vBGA and RNA seem to be good parameters for confirming the diagnosis of PTD. "Rubor," a symptom traditionally interpreted as "hyperemia," contradicts the paraclinical findings and leads to the assumption that the cause of this post-traumatic syndrome is microvascular dysfunction.
authors.affiliation: Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Scola
authors.affiliation: Klinik für Unfall- und Wiederherstellungschirurgie, Dietrich Bonhoeffer Klinikum, 17036, Neubrandenburg, Deutschland. prof.scola@gmx.de.|, Dr. Eibl Str. 41, 92318, Neumarkt/OPf., Deutschland. prof.scola@gmx.de.
authors.forename: E
authors.initials: E
authors.lastname: Scola
mesh_terms: D000368:Aged; D001784:Blood Gas Analysis / Q000379:methods*; D002245:Carbon Dioxide / Q000097:blood*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D011875:Radionuclide Angiography / Q000379:methods*; D012019:Reflex Sympathetic Dystrophy / Q000097:blood* / Q000175:diagnosis* / Q000235:genetics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014680:Veins / Q000378:metabolism; D014947:Wounds and Injuries / Q000097:blood* / Q000150:complications / Q000175:diagnosis
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen
keywords: Arteriovenous shunts; Post-traumatic dystrophy; Radionuclide angiography; Vascular smooth muscle; Venous blood gas analysis