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PubMedDate not supplied

Chronic compartment syndrome: diagnosis, management, and outcomes.

A consecutive operative series of 100 patients with chronic compartment syndrome involving 233 compartments is reported. Seven of every eight were athletes, and runners predominated. Exercise-induced symptoms of consistently recurring tightness, aching (in some, sharp pains) in anatomically defined compartments were pathognomonic. Mean months of symptoms prior to operation was 22; median age was 26 years. Bilaterality occurred in 82. The distribution of compartments was: anterior, 39%; lateral, 12%; and posterior, 48%. Incidental compartment pressures were elevated (mean = 23 mmHg). Fasciotomy using local anesthesia was performed on 70 outpatients. At a median of 4.5 months, over 90% were cured or significantly improved in symptoms and/or function. Median time to walking unassisted was 2 days, and to resumption of conditioned running 21 days. Fasciotomy can be a safe, effective, and economical treatment for chronic compartment syndrome.

Adult↗
PubMed2005

[Neonatal Volkmann's compartment syndrome. A report of two cases].

Neonatal Volkmann's compartment syndrome is a rare entity. This diagnosis may be suspected when a case presents cutaneous damage associated with poor hand and wrist function after delivery. We present two such cases of neonatal Volkmann compartment syndrome with long term clinical and x-ray follow-up. In our patients, a hand surgeon was not consulted in the perinatal period and early fasciotomy was not performed. No particular aetiology or associated cerebrovascular accident was found. A series of operations was necessary in order to improve function of the hand. Neonatal Volkmann compartment syndrome must be recognised early in order to enable further investigation of any underlying condition and to perform early surgical decompression. Long term clinical and x-ray follow-up is necessary to prevent and treat wrist deformation and finger contractures.

Compartment Syndromes↗
PubMed2006

Acute compartment syndrome secondary to diabetic muscle infarction: case report and literature review.

Acute compartment syndrome has a multitude of aetiologies. Unfortunately, the diagnosis is often delayed, resulting in permanent functional loss. Although spontaneous muscle infarction is an uncommon, yet well-recognized complication of diabetes mellitus, subsequent development of compartment syndrome appears to be rare, with only five case reports identified in the literature. This condition has not been reported in the emergency medicine literature. We report a case of a diabetic gentleman who presented with lower limb pain significantly out of proportion to any obvious injury and had a subsequent diagnosis of acute compartment syndrome. Despite fasciotomies, he had a persistent foot drop. Nontraumatic acute compartment syndrome secondary to diabetic muscle infarction should be considered in any diabetic patient presenting with pain out of proportion to sustained injury.

Acute Disease↗
PubMed2003

Abdominal compartment syndrome as a consequence of rectus sheath hematoma.

Abdominal compartment syndrome is a well-documented entity arising from multiple and various causes. The rise of intra-abdominal pressure by the increase in volume of the peritoneal and retroperitoneal contents has been shown in the resuscitation and evaluation of surgical patients. However, the incidence of constriction of the abdomen causing intra-abdominal hypertension is unknown. Previously limited to burn eschar and externally applied devices (such as MAST trousers), external compression leading to abdominal compartment syndrome has been a limited entity. We report the first documented case of an expansive abdominal wall mass, a rectus sheath hematoma, leading to impending abdominal compartment syndrome.

Abdomen↗
PubMed1999

Intraabdominal hypertension and abdominal compartment syndrome in trauma: pathophysiology and interventions.

Intraabdominal hypertension and abdominal compartment syndrome are increasingly recognized as potential complications in patients who have significant intraabdominal trauma. Intraabdominal hypertension and abdominal compartment syndrome affect all body systems, most notably the cardiac, respiratory, renal, and neurologic systems. This complication also affects blood flow to various intraabdominal organs and may play a significant role in the sepsis and multiple organ failure syndrome seen in many trauma patients. Nursing knowledge of the risk factors and clinical signs of intraabdominal hypertension and abdominal compartment syndrome can reduce the morbidity and mortality associated with this syndrome.

Abdominal Injuries↗
PubMed2006

Abdominal compartment syndrome contributing to failure of extracorporeal membrane oxygenation in an infant with congenital heart disease and sepsis.

OBJECTIVE: To provide the first account of extracorporeal membrane oxygenation therapy failure secondary to abdominal compartment syndrome. DESIGN: Case report. SETTING: Pediatric intensive care unit. PATIENT: A 4-month-old infant with cyanotic congenital heart disease and Escherichia coli sepsis developed abdominal distention and venous return failure on extracorporeal membrane oxygenation. INTERVENTION: Emergency cardiac catheterization and atrial septectomy were performed. MAIN RESULTS: Central venous pressure of 120 mm Hg was measured, confirming the diagnosis of abdominal compartment syndrome. CONCLUSIONS: Abdominal compartment syndrome is a life-threatening condition resulting from an increase in intra-abdominal pressure that compromises abdominal organ perfusion, pulmonary function, and cardiac output. Mortality rates from abdominal compartment syndrome are as high as 60% in adults and children. This report of an infant with congenital heart disease and E. coli sepsis represents the first description of abdominal compartment syndrome that contributed to failure of extracorporeal membrane oxygenation and ultimately death. The pathophysiology, diagnosis, and treatment of abdominal compartment syndrome are also reviewed.

Abdomen↗
PubMed2004

Modified separation of parts as an intervention for intraabdominal hypertension and the abdominal compartment syndrome in a swine model.

Standard therapy for abdominal compartment syndrome is laparotomy. In many patients, laparotomy involves a recent incision; for others, volume of resuscitation may be the cause. The components separation technique allows difficult abdominal closure. The authors studied the effect of a modified separation of parts on abdominal compartment syndrome in an animal model. Eight pigs were instrumented for measurement of central venous pressure, mean arterial pressure, peak airway pressure, and intraabdominal pressure. Intraabdominal hypertension to 25 mmHg was established with intraperitoneal fluid infusion. Modified separation of parts was performed by sequential release of the abdominal wall layers. With increased intraabdominal pressure, mean arterial pressure (55.3 +/- 12.0 to 65.3 +/- 11.0), central venous pressure (7.7 +/- 2.4 to 13.3 +/- 6.9), and peak airway pressure (20.2 +/- 2.4 to 25.3 +/- 4.1; p < 0.05) also increased. Maximum intraabdominal pressure was 26.0 +/- 1.2 mmHg. Skin incision resulted in a decrease in intraabdominal pressure to 21.7 +/- 4.5, external oblique release to 18.3 +/- 3.9, internal oblique release to 13.2 +/- 4.0, and transversus muscle incision to 7.0 +/- 2.5 mmHg (p < 0.05). With completion of components separation, mean arterial pressure remained increased (63.2 +/- 16.9), central venous pressure decreased (6.8 +/- 3.6; p < 0.05), and peak airway pressure decreased (22.7 +/- 3.9; p < 0.05). Modified separation of parts technique effectively releases intraabdominal hypertension and reverses the physiologic derangements associated with abdominal compartment syndrome in the animal model.

Abdomen↗
PubMed1998

Current concepts in the pathophysiology, evaluation, and diagnosis of compartment syndrome.

This article reviews present knowledge of the pathophysiology and diagnosis of acute compartment syndromes. Recent results using compression of legs in normal volunteers provide objective data concerning local pressure thresholds for neuromuscular dysfunction in the anterior compartment. Results with this model indicate that a progression of neuromuscular deficits occurs when IMP increases to within 35 to 40 mm Hg of diastolic blood pressure. These findings provide useful information on the diagnosis and compression thresholds for acute compartment syndromes. Time factors are also important, however, and usually are incompletely known in most cases of acute compartment syndrome. Although the slit catheter is a very good technique for monitoring IMP during rest, these catheters and their associated extracorporeal transducer systems are not ideal. Recently developed miniature transducer-tipped catheters and, perhaps, future development of noninvasive techniques may provide accurate recordings of IMP in patients with acute compartment syndromes.

Acute Disease↗
PubMed1996

Acute compartment syndrome of the thigh after weight training.

Compartment syndrome of the thigh is a rare but serious condition that is normally associated with closed trauma or compressive injury. A case of acute compartment syndrome of the thigh occurred in a 16 year old boy after intensive weight training. There was no evidence of muscle tear or focal haemorrhage during subsequent fasciotomy.

Acute Disease↗
PubMed1991

Compartment syndrome after surgery in the lithotomy position.

Compartment syndrome developed in five patients after prolonged surgery in the lithotomy position. Four different surgeons performed the operations. Serious morbidity resulted from the syndrome and could have been prevented by consideration of the factors that predispose to its development: tight bindings; direct pressure on the calves; and prolonged time in the lithotomy position. The pathogenesis of compartment syndrome in this group of patients is discussed.

Adult↗
PubMed2001

The diagnostic value of MRI scans for the diagnosis of chronic exertional compartment syndrome of the lower leg.

OBJECTIVE: A prospective descriptive study to determine the value of magnetic resonance imaging (MRI) as an aid in diagnosing (chronic) exertional compartment syndrome. DESIGN AND PATIENTS: MRI was performed in 21 patients (41 anterior compartments) with chronic compartment syndrome at rest and following physical exercise. Median (T2-weighted) signal intensity on the MRI scan was determined in the anterior and the (superficial) posterior compartment of the lower leg before and after exercise. Postexercise increases in the signal intensity in these two compartments were compared. After fasciotomy, a second MRI scan was performed in 13 patients (25 anterior compartments) on the basis of the same protocol. MR studies were performed in 12 normal controls (24 anterior muscle compartments) on the basis of the same protocol. RESULTS: T2-weighted signal intensity increased by 27.5% (range 13.6-38.6%) following exercise in the anterior compartment of patients with a chronic compartment syndrome. In the posterior compartment this increase amounted to 4.25% (range 0-10.2%). Following fasciotomy, the increase in the anterior compartment was 4.1% (range 1.0-5.2%), while the increase in the posterior compartment amounted to 5.6% (range 0-11.0%), In normal controls, the increase in the anterior compartment was 7.6% (range 0-9. 1%), while in the posterior compartment it was 4.0% (range 0-7.2%). CONCLUSIONS: In patients with a chronic compartment syndrome, the affected (anterior) compartment shows a statistically significant increase in (T2-weighted) signal intensity during exercise compared with both the (superficial) posterior compartment and the anterior compartment of normal controls. This effect disappeared after fasciotomy. In view of the substantial increase in T2-weighted signal intensity, MRI can be used in diagnosing chronic compartment syndrome.

Adolescent↗
PubMed1990

Compartment syndrome after intramedullary nailing of the tibia.

Three patients had compartment syndrome of the leg after tibial intramedullary nailing with reaming. They were all treated successfully with emergency fasciotomy. A prospective study was done of seven additional patients who had continual monitoring of the pressure in the deep posterior compartment during tibial intramedullary nailing with reaming. In five of them, the procedure was performed three weeks or less after injury and in the remaining two, the nailing was performed later for the treatment of non-union. Two pressure peaks in the deep posterior compartment were noted: one after strong longitudinal traction was applied and the fracture was reduced and the other during intramedullary reaming. Intraoperative pressure of thirty millimeters of mercury or more were recorded in three of the seven patients. In the treatment of tibial fractures, operative procedures that involve forceful traction for a long time may predispose the patient to compartment syndrome in the leg. Close clinical observation of such patients is needed. When there is a high risk of compartment syndrome, monitoring of the pressure in the compartment may be prudent.

Adolescent↗
PubMed1999

Lower limb compartment syndrome resulting from malignant hyperthermia.

We report a case of compartment syndrome complicating malignant hyperthermia (MH) in a previously healthy patient. An intraoperative MH crisis responded to treatment with intravenous dantrolene. The patient subsequently developed a lower limb compartment syndrome which required fasciotomy. Recognition of the link between MH and compartment syndrome helps ensure prompt diagnosis and treatment of this rare complication of MH.

Adolescent↗
PubMed1998

Acute compartment syndrome of the forearm.

The forearm is the most common site for compartment syndrome in the upper extremity. The three compartments of the forearm include the volar (anterior or flexor), the dorsal (posterior or extensor), and the mobile wad. Both-bone forearm fractures and distal radius fractures are common initial injuries in adults that lead to acute forearm compartment syndrome. Supracondylar fractures, especially those with associated vascular injuries, are frequent causes of compartment syndrome in children. The flexor digitorum profundus and flexor pollicis longus are among the most severely affected muscles because of their deep location, adjacent to bone. Initial treatment consists of removal of occlusive dressings or splitting or removal of casts. If symptoms do not resolve rapidly, fasciotomy is indicated. Decompression fasciotomy of the forearm is performed through volar or dorsal approaches. The medial nerve is decompressed throughout its course, including high-risk areas deep to the lacertus fibrosus; between the humeral and ulnar heads of the pronator teres, the proximal arch, and deep fascial surface of the flexor digitorum superficialis; and the carpal tunnel.

Acute Disease↗
PubMed1993

Split skin grafting of defects from fasciotomy after compartment syndrome.

Proper treatment of compartment syndrome is fasciotomy. Secondary skin defects often complicate the course and require skin-grafting procedures. The present investigation is a retrospective study based on 17 fasciotomies. Their courses are reported, and the possibility of primary skin excision with the purpose of delayed grafting is demonstrated. This procedure would probably reduce the number of hospital days and the number of surgical procedures.

Adolescent↗
PubMedDate not supplied

[Fascia compartment syndrome of the iliac-psoas compartment].

The iliacus compression syndrome has a kind of exceptional position--as to genesis, development and therapy--in comparison with the other compartment-compression syndromes of the limbs. Indeed there exist similar pathophysiological, rules, but the special anatomic facts enlarge the etiological, differential-diagnostic and therapeutic spectrum. Thus, concerning the frequency of causes, not the trauma but the spontaneous bleeding in coagulation disturbances takes the first place, and unusual causes, such as rupturing aortic aneurysms, have to be included in the differential diagnostic discussion. The finest diagnostic sign besides pain is the palsy of the Nervus Femoralis. As to the treatment, operative measures are possible. The exact knowledge of the anatomy is important for the understanding of the specialties mentioned above.

Adult↗
PubMed2006

Nontraumatic compartment syndrome of the extremities in children.

Acute compartment syndrome of an extremity poses a threat to both life and limb. The usual cause in children is trauma, especially fractures and burns. Two recent cases of nontraumatic compartment syndrome of the extremities in children are presented, both owing to infection followed by myositis or fasciitis. Both cases required urgent decompression by fasciotomy, resulting in limb salvage and full recovery of neuromuscular function of the extremity. The value of prompt recognition and treatment of this condition is emphasized.

Anti-Bacterial Agents↗