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Results for “Compartment Syndromes”

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PubMed1992

Acute foot compartment syndromes.

Twelve cases of compartment syndrome of the foot in 10 patients were retrospectively reviewed. All were high-energy injuries sustained in a fall from a height (six), crush (three), or motor vehicle accident (three). Bone injuries of the foot included five calcaneal fractures, three multiple metatarsal and/or phalangeal fractures, and two Lisfranc fracture-dislocations with multiple metatarsal neck fractures. The most consistent physical finding was tense swelling of the foot. The diagnosis was confirmed with compartmental pressure measurements in all cases. Decompressive fasciotomies were adequately performed by the medial approach of Henry or a combined approach with medial and dorsal incisions. An additional lateral incision was used in two instances.

Adult↗

PubMed1998

Abdominal compartment syndrome.

BACKGROUND: The abdominal compartment syndrome (ACS) is a newly appreciated and potentially fatal consequence of increased intra-abdominal pressure. It can be due to either trauma or surgery, as well as numerous medical conditions. Prolonged, unrelieved elevation of intra-abdominal pressure can produce pulmonary compromise, renal impairment, cardiac failure, shock, and death. A high index of suspicion is imperative. Measurement of the intravesical pressure provides a urometric window for detecting and monitoring this condition. CONCLUSIONS: Reopening the abdominal incision (decompressive celiotomy) has proven a life-saving intervention. Use of delayed wound closure (staged celiotomy) may prevent development of this condition in high-risk surgical patients. It is urgent that all physicians, and surgeons in particular, be alerted to this potentially lethal complication.

Abdomen↗

PubMedDate not supplied

Successful use of recombinant factor VIIa (NovoSeven) in children with compartment syndrome: two case reports.

Compartment syndrome (CS) is an uncommon bleeding manifestation in patients with liver failure and end-stage renal disease (ESRD). Although prompt intervention is paramount in preventing the tissue necrosis and the permanent functional deficits that may be associated with untreated CS, the indications for initiating therapies for children with CS are not standardized. In this report, we present 2 children, one with ESRD and the other with liver failure, who have CS related to life-threatening bleeding complications and were treated with recombinant factor VIIa (rFVIIa). In conclusion, treatment decisions for patients with CS should be made on a case-by-case basis. The use of rFVIIa is an effective and safe treatment in children with liver failure and ESRD. Surgical treatment should be preferred in patients with CS. However, in patients who have a coagulation defect, the first priority is to correct the clotting deficiency. The use of rFVIIa is a treatment option in children with CS due to a coagulation defect.

Abdomen↗

PubMed2000

The chronic venous compartment syndrome.

BACKGROUND: A chronic exertional compartment syndrome has only been observed in athletes and soldiers. In the vast majority, the disease affects the anterior compartment and the fibular muscle group, and only rarely the lateral and dorsal muscle compartments. Muscle tissue necrosis does not occur. In the course of venous diseases with a severe chronic venous stasis syndrome, a chronic venous compartment syndrome develops that differs considerably from the familiar functional syndrome. The predominant symptom is an uncurable cuff ulceration on the lower leg. PATIENTS AND METHODS: From 1993 to 1996 a total of 16 patients with a chronic fascial compression syndrome underwent surgery on 18 extremities. The crural fascia was resected and a mesh graft was applied. RESULTS: In the group of ten controls with healthy veins the average pressure in the deep compartment was 13.6 mmHg (range 9-17 mmHg) lying down and 29.9 mmHg (range 15-42 mmHg) standing up. In 14 patients with chronic fascial compression syndrome, the average pressure was higher, measuring 21.1 mmHg (range 8-47 mmHg) lying down and 62.5 mmHg (range 33-87) standing up. After surgery, the pressure dropped to 15.5 mmHg (range 5-24 mmHg) lying down and 34.5 mmHg (range 10-58 mmHg) standing up, but did not fall as low as the average values recorded in the control group or in the patient's healthy leg. The results from the standing up position were statistically significant (p = 0.003). Computed tomography showed major changes in the muscles indicating muscle atrophy and fatty degeneration. The crural fascia seemed to be incorporated in the scars of the subcutaneous tissue in large areas. After crural fasciectomy and healing of the ulceration, the tissue structure of the muscles recovered. CONCLUSIONS: In chronic fascial compression syndrome, the trellis arrangement of the collagen fibres becomes disordered. This results in a loss of flexibility during muscle contraction. Every step causes an increase of intracompartmental pressure and microstructural injury. The consequence is resection of the crural fascia.

Amputation, Surgical↗

PubMed2001

Chronic exertional compartment syndrome after minor injury to the lower extremity.

Since the 1950s, chronic exertional compartment syndrome of the lower leg has been thoroughly reported in the literature. The predisposing factors and pathophysiology of this condition, however, still are not fully understood. We present a case of a well-conditioned individual who developed a chronic exertional compartment syndrome of the left lower leg anterior compartment after a direct blow injury during a softball game. Trauma is not routinely implicated as a risk factor for chronic compartment syndrome, and the literature on this topic is scarce. We suggest that trauma, even low-velocity trauma, may precipitate a chronic exertional compartment syndrome. We review the literature regarding chronic exertional compartment syndromes preceded by trauma and offer explanations regarding the mechanisms by which a traumatic event may induce a chronic compartment syndrome.

Adult↗

PubMed2004

[Exercise-induced acute bilateral isolated anterolateral compartment syndrome of the leg: a case report of a rare condition].

Acute compartment syndrome of the leg is generally a consequence of trauma. Exercise-induced acute compartment syndrome of the leg is an exceptional clinical entity observed in the context of a chronic compartment syndrome or as an isolated acute syndrome subsequent to an intense effort. Our patient was a young athlete with no history of exercise-induced leg pain. Following a soccer game, he developed an acute leg syndrome involving the anterolateral compartment of both legs. The diagnosis was not suggested by the patient's history (no notion of chronic compartment syndrome) nor the natural history of the condition but was retained on the basis of the clinical presentation and course then confirmed by intramuscular pressure measurements. Emergency treatment by fasciotomy under general anesthesia in the operating room led to cure with no sequela. The fasciotomy was closed on day 9 with simple skin sutures. Surgeons should be aware that acute exercise-induced compartment syndrome (with the risk of severe functional consequences) may be the cause of unexplained intense leg pain. The diagnosis is established on the basis of clinical findings and measurement of intramuscular pressures. Pain is the cardinal sign, sometimes associated with sensorial deficit. The compartment is hard and painful at palpation. Passive stretching exacerbates the pain. Compartment pressure is required for certain diagnosis, most Authors accepting > 30mmHg as a positive test. Emergency fasciotomy is required.

Acute Disease↗

PubMed2004

Lower limb (well leg) compartment syndrome after urological pelvic surgery.

PURPOSE: Well leg compartment syndrome (WLCS) is being seen more frequently as the complexity and duration of pelvic urological surgery increases, ie reconstruction/radical cancer surgery. The etiology of WLCS is multifactorial and prevention should form the mainstay of treatment. With significant morbidity and mortality, in particular lower limb morbidity secondary to fasciotomy wounds and long-term neurological sequelae, all urologists should be aware of this iatrogenic complication and how to prevent or treat it when it occurs. MATERIALS AND METHODS: A retrospective review of the world literature using MEDLINE was performed from 1966 to 2002, searching for lower limb compartment syndrome (well leg compartment syndrome), and its association with the lithotomy position and pelvic surgery. RESULTS: Although WLCS is not commonly reported in the urological literature, it has significant morbidity and mortality. The incidence of WLCS is probably under reported due to failed diagnosis or misdiagnosis. With increased awareness the incidence of this iatrogenic complication may be minimized or avoided altogether. CONCLUSIONS: Because the lithotomy position is one of the most common positions used in urology, it is mandatory for urologists to be familiar with the complications associated with it. If this complication is recognized early, prompt treatment decreases morbidity and mortality. Minimizing the risk of WLCS will leave urologists less open to litigation, which may follow this significant iatrogenic complication.

Compartment Syndromes↗

PubMed1989

Changes in tibial venous blood flow in the evolving compartment syndrome.

A sustained increase in muscle compartment pressures can cause tissue necrosis. When compartment pressures exceed recumbent tibial vein pressures, blood flow in tibial veins may be impaired. These changes can be detected by Doppler venous flow evaluation. In 26 patients at risk for compartment syndrome, serial examinations, Doppler venous flow, and measurements of compartment pressures were performed. All patients with abnormal Doppler venous flow results had or developed neuromuscular deficits. Patients with normal Doppler venous flow either initially or after fasciotomy did not develop the compartment syndrome. This syndrome can be evaluated and followed up sequentially by measuring Doppler venous flow in tibial veins.

Adolescent↗

PubMedDate not supplied

Compartment syndrome: a complication of acute extremity trauma.

Compartment syndrome is a serious potential complication of trauma to the extremities. Fractures, crush injuries, burns, and arterial injuries, among others, can result in increased tissue pressure within closed osseofascial or compartmental spaces. Prolonged exposure to elevated pressure can result in nerve and muscle necrosis. Extreme pain unrelieved with analgesia, subjective complaint of pressure, pain with passive muscle stretching, paresis, paresthesia, and intact pulses, in the presence of a physically tight compartment, should alert the physician to the presence of a compartment syndrome. The diagnosis is a clinical one, but it may be aided by measurements of intracompartmental tissue pressures. Compartment syndrome is a surgical emergency requiring prompt treatment by fasciotomy. Time is a critical factor; the longer the duration of elevated tissue pressure, the greater the potential for disastrous sequelae. Emergency medicine providers must be cognizant of this clinical syndrome so that early emergent surgical consultation can be obtained to avoid complications.

Acute Disease↗

PubMed1997

Acute atraumatic compartment syndrome in an athlete: a case report.

OBJECTIVE: To present the case of a college football player with acute, atraumatic, exercise-induced compartment syndrome in the leg. BACKGROUND: Acute, atraumatic, exercise-induced compartment syndrome is an infrequently reported cause of leg pain in the athlete. If left untreated, acute compartment syndrome can cause muscle necrosis. DIFFERENTIAL DIAGNOSIS: Chronic exertional compartment syndrome, medial tibial syndrome, stress fracture. TREATMENT: Treatment consists of compartment fasciotomy. UNIQUENESS: This previously healthy, but unconditioned, athlete developed severe anterolateral left leg pain after two days of fall practice in which he was unable to run a mile in 7.5 minutes. Physical examination by the team physician revealed acute compartment syndrome, and an emergency anterolateral compartment fasciotomy was performed. Second-look débridement performed 48 hours later revealed no significant change in the necrotic appearance of the anterior compartment soft tissue. Therefore, the dead muscle was completely débrided, and a free-flap latissumus dorsi graft was used for coverage of the wound. With recovery, strength returned to normal in the lateral compartment but remained 0/5 in the anterior compartment. The patient had persistent sensory loss in the distributions of the superficial and deep peroneal nerves. CONCLUSIONS: Although much less common than the more frequent causes of leg pain (ie, chronic exertional compartment syndrome, medial tibial syndrome, stress fracture), acute compartment syndrome is potentially more devastating. When the increased intracompartmental pressure within a closed tissue space exceeds capillary perfusion pressure, tissue perfusion is decreased, the soft tissue becomes ischemic, and cells die. The most important clinical diagnostic signs of compartment syndrome are pain with passive stretching of the compartment and pain out of proportion to the results of the physical examination.

Journal Article↗

PubMed2002

Delayed presentation of acute compartment syndrome after contusion of the thigh.

Acute compartment syndrome has been described as a result of thigh contusion in several contact sports, and emergent fasciotomy has routinely been recommended. However, recent data suggest that thigh contusions in athletes presenting with isolated elevation of compartment pressures in the absence of neurovascular deficits may be treated expectantly. We describe a case of anterior thigh contusion, which initially presented with isolated compartmental hypertension without neurovascular symptoms. Under nonoperative treatment the patient developed delayed acute compartment syndrome from persistent muscular hemorrhage ten days after the initial trauma, requiring operative treatment. This case demonstrates that expanding hematoma formation may result in delayed increase of intramuscular pressures and compromise of myoneural perfusion in patients with severe thigh contusions. Early evacuation of the hematoma may help to prevent late development of compartment syndrome and reduce the risk for long-term complications.

Acute Disease↗

PubMed1990

Pseudoaneurysm of the radial artery as a cause of a late compartment syndrome. A case report.

Pseudoaneurysm has been reported in the literature as a cause of compartment syndrome. The onset of the subsequent compartment syndrome is usually early. Often, while the compartment syndrome is diagnosed and treated, the pseudoaneurysm is missed. A second operative procedure is then necessary. A 40-year-old woman illustrates an unusual case of a late compartment syndrome, following the development of a radial artery pseudoaneurysm three weeks after a penetrating injury. It is important to investigate the vascular tree in compartment syndromes after a penetrating injury, no matter how late the patient is seen.

Adult↗

PubMed1991

[Pathophysiology and pressure measurement in compartment syndrome].

Traumatic or ischemic damage of the musculature and soft tissue may cause compartment syndrome. In trauma, mechanical influences provoke humeral disorders and liberation of vasoactive substances with early onset of compartment syndrome, but isolated total ischemia of more than 6 h is commonly followed after revascularization by compartment syndrome caused by post-ischemic dilation of vessels. An understanding of the pathophysiology in compartment syndrome provides a better possibility of predicting this severe complication in trauma and vascular surgery patients. Several techniques are described for intracompartmental pressure monitoring. In normotensive patients, an intracompartmental pressure of more than 40 mmHg indicates "apparent" compartment syndrome, while pressures between 30 mmHg and 40 mmHg are interpreted as "imminent" compartment syndrome. In these cases therapeutic/prophylactic dermatofasciotomy is necessary. In hypotensive patients the lower limit for conducting a dermatofasciotomy must be reduced. According to the pathophysiology, an intracompartmental pressure of about 30 mmHg for more than 6 h duration must be treated by dermatofasciotomy.

Compartment Syndromes↗

PubMed1991

[Reconstructive measures for the foot after compartment syndrome].

Following severe indirect and/or direct trauma to the foot, compartment syndrome can easily develop in this foot. Untreated, the compartment syndrome results in a complex post-traumatic deformity--the "short foot syndrome." This may manifest itself as a contracted pes equinovarus foot with clawing of the toes. Isolated compartment syndrome of the foot due to local injury may result in the formation of hammer toes. During childhood and adolescence, severe soft tissue injuries to the lower leg or foot, with subsequent compartment syndrome of the foot or a neurovascular injury to the lower limb, may result in an alteration in growth of the affected region or may involve the foot. Radiological assessment of this contracted "short foot" using sonography or MRI demonstrates scarred, necrotic musculature mainly involving the muscles of the posterior tibia, the flexor hallucis and the flexor digitum. Muscular imbalance due to long-standing muscle palsies, or chronic post-traumatic osteitis of the tibia contribute to the development of rigid equinus foot and ankle. Treatment of the contracted foot includes complex soft tissue release, muscle and tendon transfer, tendon-lengthening procedures, and intrinsic releases to correct the toe deformities. In the adult with a severe post-traumatic pes equino-varus deformity, triple arthrodesis is recommended.

Arthrodesis↗

PubMed1996

Compartment syndrome of the hand. Etiology, diagnosis, and treatment.

Isolated acute compartment syndrome of the hand is relatively rare phenomenon, Acute compartment syndrome occurs when the tissue pressure within an enclosed space is elevated to the extent that there is decreased blood flow within the space, decreasing tissue oxygenation and impairing metabolic function. In this review, compartment syndrome of the forearm and wrist involving the hand will not be included because the clinical presentation of these patients can be quite different compared with compartment syndrome within the hand.

Compartment Syndromes↗

PubMed2004

[Missed acute compartment syndrome of the lower leg].

After some considerable delay, acute compartment syndrome of the lower leg was diagnosed in a 17-year-old man, a 32-year-old man and a 76-year-old woman. The first patient was an accident victim whose leg was continuously bandaged for three days following treatment of a complicated femur fracture and lower leg wounds, so that inspection was not possible. In the second patient who was also an accident victim, the haemodynamics and the neurological condition initially required so much attention that the compartment syndrome was only noticed after 48 hours. The woman presented with a cold, painful left foot. She had atrial fibrillations. A thrombus mass was removed endovascularly from the femoral artery. She controlled her own pain medication by means of an epidural catheter, but as a result of that a reperfusion compartment syndrome was only noticed at a later stage. These cases reveal that it can be very difficult to establish the diagnosis of acute compartment syndrome, especially if this is masked by the already quite subjective symptoms of the clinical picture. The consequences of a missed compartment syndrome are serious, with a considerable impairment of the limb concerned that often necessitates amputation. Awareness and healthy suspicion are the keys to a quick and timely diagnosis. Prophylactic fasciotomies must be carried out on the basis of several clear indications.

Adolescent↗

PubMed2006

Lower limb acute compartment syndrome after colorectal surgery in prolonged lithotomy position.

PURPOSE: Acute compartment syndrome in patients undergoing prolonged colorectal procedures is uncommon but can have catastrophic consequences for the patient with the development of metabolic acidosis, myoglobinuric renal failure, Volkmann's contracture, limb loss, and death. The potential to produce long-term disability in a patient has important medicolegal implications, particularly if the complication is avoidable. Why only some patients develop acute compartment syndrome is not fully understood. The purpose of this study was to highlight current knowledge and suggested prevention strategies. METHODS: A review of the relevant English language articles was performed on the basis of a MEDLINE search of the keywords: acute compartment syndrome, lithotomy position, reperfusion injury, and fasciotomy. RESULTS: Different factors play a role: lithotomy position with or without head down, ankle and knee position, external compression for deep vein thrombosis prophylaxis, method of leg support, duration of surgery, and physiologic factors, such as gender, age, and body mass index. All efforts should be directed to prevent the establishment of acute compartment syndrome and there are accepted suggestions, such as limiting the time of leg elevation, positioning the leg below the atrium level, and monitoring postoperatively patients at risk. There is still debate on the intraoperative use of pulse oximetry to detect hypoperfusion and the appropriate use of sequential compression devices and antithromboembolic stockings. CONCLUSIONS: Acute compartment syndrome is uncommon but cases have been reported after prolonged pelvic procedures in the lithotomy position and it is a preventable condition. More research is required to set clear guidelines on patient positioning during surgery.

Compartment Syndromes↗

PubMed1981

Subacute anterior tibial compartment syndrome.

Although acute anterior tibial compartment syndrome has been discussed frequently in the literature, there are few reports on the subacute or chronic syndrome. This problem may result from running or strenuous exercise, or even from walking. Additional demands are placed on the muscles of the anterior compartment by exercise, and this may result in varying degrees of symptomatology. Rest, elevation of the limb, and ice packs should be included in the treatment of this condition.

Anterior Compartment Syndrome↗