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Results for “Compartment Syndromes”

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PubMed2005

Results of compartment decompression in chronic forearm compartment syndrome: six case presentations.

BACKGROUND: There are few reports concerning chronic compartment syndrome producing symptoms in the forearm, although in the lower limb this is a well recognised condition. The objective was to demonstrate that chronic compartment syndrome is a cause of exercise induced forearm pain and transient upper limb dysfunction and that forearm compartment decompression can reliably relieve the associated symptoms. METHODS: Six patients with a flexor compartment chronic compartment syndrome, documented by pressure studies, had forearm compartment decompression. RESULTS: All patients had good relief of their exercise associated forearm pain following the decompression. Widening of the incisional scar was frequently reported. CONCLUSION: Forearm compartment decompression is effective in relieving the symptoms related to chronic forearm compartment syndrome.

Adult↗
PubMed2002

The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder?

OBJECTIVE: To assess whether published studies support basing the diagnosis of compartment syndrome of the lower leg on clinical findings. DATA SOURCES: A MEDLINE search of the English literature from 1966 to 2001 was performed using "compartment syndromes" as the subject. A manual search of the bibliographies of retrieved articles and of major orthopaedic texts was also performed. STUDY SELECTION AND EXTRACTION: Of 1,932 titles identified, 433 abstracts of potential relevance were reviewed, and 104 articles from relevant abstracts were examined in their entirety. Four studies met all eligibility criteria. Criteria for inclusion included the following: (a) target population, traumatic or iatrogenic tibia injuries; (b) diagnostic test, presence of data needed to calculate both the sensitivity and specificity of clinical findings; (c) outcome, the presence or absence of compartment syndrome; and (d) methodologic criteria, prospective study design. DATA SYNTHESIS: The likelihood ratio form of Bayes' theorem was used to assess the discriminatory ability of the clinical findings as tests for the compartment syndrome. CONCLUSIONS: There are limited data from which to define the usefulness of clinical findings for the diagnosis of compartment syndrome. Data from eligible studies suggest that the sensitivity of clinical findings for diagnosing compartment syndrome is low (13% to 19%). The positive predictive value of the clinical findings was 11% to 15%, and the specificity and negative predictive value were each 97% to 98%. These findings suggest that the clinical features of compartment syndrome of the lower leg are more useful by their absence in excluding the diagnosis than they are when present in confirming the diagnosis. Likelihood ratio calculations found that the probability of compartment syndrome with one clinical finding was approximately 25%, and the probability was 93% with 3 clinical findings present. However, these findings are based on limited information; because of the paucity of data available, the predictive value of the clinical findings for the diagnosis of compartment syndrome has yet to be defined.

Compartment Syndromes↗
PubMed1999

Abdominal compartment syndrome in gynecologic surgery.

BACKGROUND: Abdominal compartment syndrome is a rare condition in which increased intra-abdominal pressure adversely affects perfusion and viability of the viscera, and the cardiovascular, respiratory, and renal systems. The syndrome follows acute abdominal events such as abdominal trauma, intraperitoneal hemorrhage, or intra-abdominal infection. CASES: Two women who had abdominal hysterectomies postoperatively developed clinical features of multisystem failure with markedly elevated intra-abdominal pressures. The women, one with intra-abdominal infection and diffuse intestinal edema and one with intra-abdominal hemorrhage, were diagnosed by clinical exam and intravesical pressure measurements. Both had follow-up exploration and temporary placement of the small bowel and colon into an intestinal bag until adequate resuscitation was achieved. CONCLUSION: Abdominal compartment syndrome is a rare complication in gynecology that can be diagnosed early and decompressed promptly.

Abdomen↗
PubMed1987

Intramuscular pressure and muscle blood flow during exercise in chronic compartment syndrome.

In nine patients with chronic compartment syndrome, the intramuscular pressure and muscle blood flow during constant dynamic exercise was studied by the microcapillary infusion method and by the 133-xenon clearance technique. Although muscle blood flow was normal at the start of exercise, pain and impaired muscle function eventually developed; muscle blood flow decreased while muscle relaxation pressure increased. The changes of muscle blood flow could not be correlated with any change of mean muscle pressure during exercise. Eight months after fasciotomy the exercise test was repeated. Patients experienced no symptoms and the muscle relaxation pressure and blood flow during exercise were normal. It is suggested that chronic compartment syndrome is due to increased muscle relaxation pressure during exercise which causes decreased muscle blood flow, leading to ischaemic pain and impaired muscle function.

Adolescent↗
PubMed1996

Suction injuries in children leading to acute compartment syndrome of the interosseous muscles of the hand: case reports.

Compartment syndromes of the interosseous musculature in the hands of children is a relatively rare phenomenon and is usually associated with crush injury, severe burn, or ischemic events. Two cases of intrinsic compartment syndrome in children, secondary to suction injuries of the hand, are presented. Two children experienced suction injuries to the upper extremity when their hands were caught in a swimming-pool intake pipe filtration system. The filtration system intake suction developed enough negative pressure to induce an acute compartment syndrome of the interosseous muscles, requiring acute surgical decompression. Early diagnosis, prompt surgical decompression, and early postoperative rehabilitation of this unusual etiology of compartment syndrome of the hand provided a favorable and functional outcome.

Accidents↗
PubMed1997

Abdominal compartment syndrome.

PURPOSE: Two cases of abdominal compartment syndrome are described and the pathophysiology associated with it is reviewed. CLINICAL FEATURES: The first patient was a 46-yr-old man who sustained extensive blunt abdominal injuries following a fall. The second was a 54-yr-old man involved in a motor vehicle accident with blunt abdominal trauma. In both cases, the patients developed an extremely tense abdomen, increasing peak inspiratory pressures, hypercarbia and oliguria. Both demonstrated improvement in cardiac performance and ventilatory variables following an emergency decompressive celiotomy. CONCLUSION: Abdominal compartment syndrome results in impairment of organ function secondary to increased intraabdominal pressure. These patients require emergency decompressive celiotomy to relieve the symptoms. However, the incidence of intractable asystole and hypotension during this procedure is high and vigilance must be maintained during the release of the increased intraabdominal pressure.

Abdomen↗
PubMed2001

Acute exertional compartment syndrome in an athlete.

Acute exertional compartment syndrome is a rare condition, associated with strenuous, unaccustomed exercise. This report describes its onset in a professional footballer during a regular training session. It is often diagnosed late due to lack of awareness and patient stoicism. We illustrate the consequences of delay and reinforce the need for prompt and decisive fasciotomy if complications are to be avoided.

Acute Disease↗
PubMed2006

Compartment syndrome of the lower leg after surgery in the modified lithotomy position: report of seven cases.

PURPOSE: Acute compartment syndrome is known to develop after trauma or after postischemic revascularization. It also can occur when a patient has been lying in the lithotomy position during prolonged surgery. Methods were searched for the prevention of this iatrogenic complication after a series of seven patients who developed compartment syndrome after surgery at our hospital. METHODS: A series of seven consecutive patients who developed compartment syndrome of the lower leg(s) after abdominoperineal surgical procedures from 1997 to 2002 is presented and so are the lessons learned to prevent this problem. RESULTS: When comparing our experiences with data from literature, the seven patients had the usual risk factors for development of a compartment syndrome: lengthy procedure (>5 hours); decreased perfusion of the lower leg because of Trendelenburg positioning combined with the lithotomy position; and external compression of the lower legs (because of positioning, stirrups, or antiembolism stockings). Measures have been taken to prevent compartment syndrome from developing after prolonged surgery in the lithotomy position. This complication has not occurred again after the introduction of these measures two years ago. CONCLUSIONS: Acute compartment syndrome can be prevented if adequate measures are taken, but after lengthy surgery, maximum alertness for emerging acute compartment syndrome remains indicated. Early diagnosis and treatment by four-compartment fasciotomy is still the only way to prevent irreversible damage.

Acute Disease↗
PubMed2003

Presentation of compartment syndrome without an obvious cause can delay treatment. A case report.

Compartment syndrome is a serious condition which leads to chronic morbidity unless an urgent decompression of the affected area is performed. An increased intra compartmental pressure commonly occurs after a physical insult though rarer causes have been identified. We report an atypical presentation of compartment syndrome and subsequent delayed intervention where there was no identifiable aetiological factor. Frontline medical staff must rule out compartment syndrome early so that complications secondary to compartment syndrome can be avoided.

Adult↗
PubMedDate not supplied

Osteofascial compartment syndrome in the dog.

Experimentally induced osteofascial compartment syndrome (OFCS) has been reported in the craniolateral compartment of the canine crus. In this study, anatomic dissections and contrast radiographs were used to describe three additional osteofascial compartments in canine limbs. Experimental OFCS was produced in four different compartments, and caused muscle and nerve pathology in each. When compartment pressures were evaluated in traumatized animals, moderate elevations in compartment pressures were found. A compartment syndrome that developed in one dog was surgically decompressed, returning elevated pressures to a safe level.

Animals↗
PubMed1997

Prevention of abdominal compartment syndrome by absorbable mesh prosthesis closure.

OBJECTIVE: To determine whether prevention of the abdominal compartment syndrome after celiotomy for trauma justifies the use of absorbable mesh prosthesis closure in severely injured patients. DESIGN: Retrospective analysis of case series from July 1, 1989, to July 31, 1996. SETTING: University-based level I trauma center. PATIENTS: Seventy-three consecutive trauma patients requiring celiotomy who received absorbable mesh prosthesis closure and 73 control patients matched for injury severity and trauma type who received celiotomy without a mesh prosthesis closure. INTERVENTIONS: Absorbable mesh prosthesis closure was used in cases of excessive fascial tension, abdominal compartment syndrome, necrotizing fasciitis, traumatic defect, or planned reoperation. MAIN OUTCOME MEASURES: Demographics, Injury Severity Score, Abdominal Trauma Index, highest abdominal Abbreviated Injury Scale score, number of abdominal/pelvic injuries, highest head Abbreviated Injury Scale score, shock, indication for mesh closure, complications, number of operations and time required for closure, days in the intensive care unit, length of stay, and mortality were determined. The highest abdominal Abbreviated Injury Scale score was multiplied by the number of abdominal/pelvic injuries to calculate the abdominal pelvic trauma score. RESULTS: Group 1 consisted of 47 patients who received mesh at initial celiotomy, and group 2, 26 patients who received mesh at a subsequent celiotomy. These 2 groups were statistically similar in demographics, injury severity, and mortality. However, group 2 had a significantly higher incidence of postoperative abdominal compartment syndrome (35% vs 0%), necrotizing fasciitis (39% vs 0%), intra-abdominal abscess/peritonitis (35% vs 4%), and enterocutaneous fistula (23% vs 11%) compared with group 1 (P < .001). Group 1 patients with preoperative abdominal compartment syndrome had more abdominal/ pelvic injuries and higher abdominal trauma index than matched controls (P < .05). There was a trend toward higher abdominal pelvic trauma score in patients who developed abdominal compartment syndrome. The Pearson coefficient of correlation between the abdominal trauma index and the more easily calculated abdominal pelvic trauma score was 0.91 (P < .001). CONCLUSION: The use of absorbable mesh prosthesis closure in severely injured patients undergoing celiotomy was effective in treating and preventing the abdominal compartment syndrome.

Abdomen↗
PubMed1989

Acute compartment syndrome of the thigh. A spectrum of injury.

Twenty-one compartment syndromes of the thigh in seventeen patients were identified for retrospective review. Ten of the compartment syndromes were associated with an ipsilateral femoral fracture; five of these femoral fractures were open. In five patients, the syndrome followed femoral intramedullary stabilization. The remaining eleven syndromes followed blunt trauma to the thigh, prolonged compression by body weight, or vascular injury. The patients who were awake and alert at the time of the examination complained of intense pain in the thigh, and they had neuromuscular deficits. For the patients who could not cooperate with a subjective physical examination because they were under general anesthesia or because of associated injuries, the measurement of compartment pressure assumed a more important diagnostic role. All of the patients had tense swelling of the involved thigh. The predisposing risk factors for the development of compartment syndromes of the thigh, which are common in the multiply injured population, include: systemic hypotension, a history of external compression of the thigh, the use of military antishock trousers, coagulopathy, vascular injury, and trauma to the thigh, with or without a fracture of the femur. In approximately one-half of these patients, a crush syndrome developed, with myoglobinuria, renal failure, and collapse of multiple organ systems. Eight patients (47 per cent) died as a result of multiple injuries. Of the nine patients (ten compartment syndromes) who survived, infection developed at the site of the fasciotomy in six. Follow-up examination revealed marked morbidity, including sensory deficit and motor weakness of the lower extremity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Gluteal compartment syndrome after prostatectomy caused by incorrect positioning.

Gluteal compartment syndrome is an uncommon and rare disease. Most reasonable causes for the development of this disease are trauma, drug induced coma, Ehlers-Danlos syndrome, sickle cell associated muscle infarction, incorrect positioning during surgical procedures and prolonged pressure in patients with altered consciousness levels. The diagnosis requires a high index of suspicion, especially in postoperative patient where sedation or peridural anaesthesia can confound the neurological examination. Early signs include gluteal tenderness, decrease in vibratory sensation during clinical examination and increasing CK in laboratory findings. We present a case of a 52 year-old patient, who developed gluteal compartment syndrome after radical prostatectomy in lithotomic position. After operation, diuresis decreased [<50 ml/h] and CK [93927 U/l], LDH [1528 U/l], creatinin [1.5 mg/dl] and urea [20 mg/dl] increased in laboratory findings. Despite peridural anaesthesia, the patient complained about increasing pain in the gluteal region and both thighs. His thighs and the gluteal region were swollen. Passive stretch of the thighs caused enormous pain. The compartment pressure was 92 mmHg. Therefore, emergency fasciotomy was performed successfully. The gluteal compartment syndrome was most likely caused by elevated pressure on the gluteal muscle during operation. We suggest heightened awareness of positioning the patient on the operating table is important especially in obese patients with lengthy operating procedures.

Buttocks↗
PubMed2001

[Intracompartmental pressure measurement in in acute compartment syndrome. Results of a survey of indications, measuring technique and critical pressure value].

The early diagnosis of acute compartment syndrome is very important, compartment monitoring is advocated. There is however still some controversy regarding the use of compartment pressure measurement devices in the diagnosis of acute compartment syndrome. We present the results of a survey that was designed to explore this issue in Germany. In the case of suspected acute compartment syndrome 50.9% (n = 214) of the surgeons perform intracompartmental pressure measurement. Pressure measurement is of lower significance for 61.8% (n = 215) surgeons questioned. Additional apparative diagnostics is performed by 41.7% of the surgeons. A large majority apply the Stryker device (63.1%, n = 135), followed by the Coach device (12.1%, n = 26). The pressure threshold for intervention is recommended by 51.4% (n = 110) of the traumatologists as an absolute compartment pressure value. The remaining 48.6% (n = 104) include haemodynamic parameters in their decision. The surgeons employ widely differing methods of approach in the diagnosis of acute compartment syndrome. Some of these are extremely different from the methods recommended in the literature.

Acute Disease↗
PubMedDate not supplied

Long-term outcome of fasciotomy with partial fasciectomy for chronic exertional compartment syndrome of the lower leg.

BACKGROUND: Fasciotomy with partial fasciectomy for compartment syndrome has had good short-term results, but no long-term studies have been performed. HYPOTHESIS: Combining a partial fasciectomy with fasciotomy for compartment syndrome relieves pain and eliminates symptoms in the long term. STUDY DESIGN: Retrospective cohort study. METHODS: A self-administered questionnaire was given to 62 patients at a mean follow-up of 51 months after surgery. RESULTS: Of the 50 patients who underwent a single operation, 60% (30) reported an excellent or good outcome. Average pain and pain-on-running were significantly reduced, although some subjects still reported considerable levels of pain. Fifty-eight percent (36 of 62) were exercising at a lower level than before injury and, of these, 36% (13) cited the return of their compartment syndrome or the development of a different lower leg compartment syndrome as the reason for a reduction in exercise levels. Some subjects indicated early initial improvement followed by subsequent deterioration. CONCLUSION: This surgical technique reduces pain and allows the majority of patients to return to sports; however, patients should be counseled that they may not be able to return to their preinjury level of exercise or remain pain-free.

Adolescent↗