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PubMedDate not supplied

Rupture of the lateral head of the gastrocnemius muscle at the musculotendinous junction mimicking a compartment syndrome.

This case report documents an acute rupture of the lateral head of the gastrocnemius muscle at the myotendinous junction and a lateral dislocation of the tibialis anterior tendon with a clinical presentation consistent with a compartment syndrome, despite the intraoperative finding of a rupture of the posterior and lateral compartments. Extensive hematoma formation led to marked edema, paresthesias, muscle weakness, and severe pain in the involved leg. Surgical repair of the torn muscle and dislocated tendon and evacuation of the dissecting hematoma resulted in a well-functioning extremity. The authors emphasize the importance of prompt diagnosis of soft tissue injuries, which may place a patient at risk for a compartment syndrome. A compartment syndrome may lead to severe ischemia and irreversible tissue necrosis if intracompartmental hemorrhage of a torn muscle persists, and may require a surgical decompression. The clinical presentation, as well as adjunctive techniques in the diagnosis of a patient with a partial rupture of the gastrocnemius muscle, and a compartment syndrome, were presented.

Adolescent↗
PubMed2001

Intra-abdominal hypertension and abdominal compartment syndrome.

BACKGROUND: The effects of increased intra-abdominal pressure in various organ systems have been noted over the past century. The concept of abdominal compartment syndrome has gained more attention in both trauma and general surgery in the last decade. This article reviews the current understanding and management of intra-abdominal hypertension and abdominal compartment syndrome. METHODS: Relevant information was gathered from a Medline search of the English literature, previous review and original articles, references cited in papers, and by checking the latest issues of appropriate journals. RESULTS AND CONCLUSION: Akin to compartment syndrome in extremities, the pathophysiological effects of increased intra-abdominal pressure developed well before any clinical evidence of compartment syndrome. These effects include cardiovascular, pulmonary, renal and intracranial derangement, reduction of intestinal and hepatic blood flow, and reduction of abdominal wall compliance. Although abdominal compartment syndrome is more commonly noted in patients with abdominal trauma, it is now evident that non-trauma surgical patients could also develop the condition. Early initiation of treatment for intra-abdominal hypertension is currently advocated in view of the possibility of subclinical progress to the full-blown abdominal compartment syndrome.

Abdomen↗
PubMed2003

Noninvasive measurement of compartment syndrome.

This study compared the effectiveness of a commercially available invasive intracompartmental pressure measuring device with an investigational noninvasive hardness measuring device in 75 patients undergoing examination for possible compartment syndrome. Legs, forearms, thighs, and arms were tested. Pressure values and hardness ratios were compared to one another as continuous variables and to the clinical diagnosis of compartment syndrome as discrete variables. The compartment with the highest pressure reading within a limb diagnosed with compartment syndrome was compared to limbs without compartment syndrome. Due to the low specificity of the noninvasive measurement of hardness compared to the invasive pressure measurement (0.82 versus 0.96), this study does not support the use of the hardness monitor in the diagnosis of compartment syndrome.

Adolescent↗
PubMed1991

Hypertonic mannitol ameliorates intracompartmental tamponade in model compartment syndrome in the dog.

Acute compartment syndrome (ACS) is a devastating complication of rhabdomyolysis caused by muscle tamponade secondary to increased intracompartmental pressure (Pi). ACS requires emergency surgical decompression when Pi greater than 30 mmHg (normal less than 4.0 mmHg) and clinical signs exist. The present study was undertaken to examine whether mannitol which has been used extensively for prevention of acute renal failure in rhabdomyiolysis may also improve muscular hemodynamics in ACS. ACS was produced in dogs by injecting dog plasma into the anterolateral compartment of the hind limb. The Pi was directly monitored. Control dogs received saline, whereas experimental dogs received intravenously 20% mannitol (0.15 ml/min/kg) over a period of 1 h. The initial Pi was set arbitrarily at 100 mm Hg. Following the establishment of ACS, the spontaneous mean decrease in Pi in the control group was 40% of initial value over 60 min (n = 5) versus a decrease of 65%/60 min in the experimental (mannitol) group (n = 7, p less than 0.01). The net mean decompressive effect of mannitol treatments was approximately 28 mm Hg (mean control Pi minus mean experimental Pi at time 60 min). Extrapolated to man with ACS, such a decrease in Pi induced by mannitol theoretically could relieve compartmental tamponade noninvasively.

Angiography↗
PubMed2004

Supraspinatus compartment syndrome.

Surgical management of supraspinatus compartment syndrome has not been previously reported. A high index of suspicion for severe shoulder pain of unclear etiology coupled with MRI is necessary for diagnosis. Prompt decompression to avoid irreversible ischemia is warranted. Perhaps mild ischemia of the supraspinatus muscle is an unrecognized cause of recurrent shoulder pain.

Adult↗
PubMed2002

Lower extremity compartment syndrome after coronary artery bypass.

Compartment syndrome is a rare and dangerous complication of coronary artery bypass. All reported cases involved the vein donor limb. Once recognized, immediate fasciotomy is necessary to prevent irreversible ischemia and limb loss. Diagnosis requires a high index of suspicion and close observation of the patient, particularly those remaining intubated during the early postoperative period.

Aged↗
PubMed2001

[Abdominal compartment syndrome: current view].

In the last few years, physiological changes, symptoms, diagnostic tools, and treatment of abdominal compartment syndrome interest surgeons, trauma surgeons and anaesthetists. Sudden, dangerous basic vital function deterioration in patients managed in the intensive care unit, may be results of abdominal compartment syndrome. Abdominal compartment syndrome is secondary to massive intraabdominal haemorrhages, hepatic or retroperitoneal space "packing", fluid collection in tissues, including abdominal organs. Circulatory, respiratory and kidney dysfunction occur, when intraabdominal pressure measured in urinary bladder is 25 H2O or higher. In this condition, rapid surgical decompression is necessary. During decompression abdominal organs reperfusion may produce arterial hypotension and asystole. Abdominal closure must prevent abdominal hypertension. Temporary plastic patch, simple and cheap is the most popular technique.

Abdomen↗
PubMed2000

Effect of early fasciotomy on intramuscular pressure and electrical excitability of muscles in experimental compartment syndrome.

Experiments on rabbits with compartment syndrome of the leg showed that the main pathogenetic factors of muscle injury are postischemic contracture leading to extravascular microcirculatory disorders and tissue necrosis(early postcompression period) and progressive subfascial edema (18 h-4 days). Therapeutic effect of fasciotomy in the early period consists in restoration of bloodflow due to relaxation of contracted muscles and in the late period in decompression of edematous muscles and prevention of secondary ischemia. Fasciotomy through a small section does not lead to sufficient relaxation of rigid muscles and does not essentially increase the subfascial volume. Fasciotomy decreases subfascial pressure and muscle excitability threshold, however they remain considerably elevated during day 1. An electrodiagnostic test is proposed for early (before subfascial edema) detection of postischemic contracture.

Animals↗
PubMed2001

Avoidance of abdominal compartment syndrome in damage-control laparotomy after trauma.

HYPOTHESIS: Abdominal compartment syndrome (ACS) is a morbid complication of damage-control laparotomy. Moreover, the technique of abdominal closure influences the frequency of ACS. DESIGN: Retrospective cohort study. SETTING: Urban level I trauma center. PATIENTS: We studied 52 patients with trauma who required damage-control laparotomy during the 5 years ending December 31, 1999, and who survived longer than 48 hours. MAIN OUTCOME MEASURES: Abdominal compartment syndrome, acute respiratory distress syndrome (ARDS), and multiple organ failure (MOF). RESULTS: Mean (+/- SD) age was 33 +/- 2 years; 38 (73%) were male. Mechanism of injury was blunt in 29 patients (56%), and mean (+/- SD) Injury Severity Score was 28 +/- 2. Development of ARDS and/or MOF was seen in 23 patients (44%); ARDS and MOF increased mortality from 12% (3/26) to 42% (11/26). Abdominal compartment syndrome was a common complication (17/52), and was associated with an increase in ARDS and/or MOF (12 patients [71%] vs 11 patients [31%] without ACS; P =.02, chi(2) test) and death (6 [35%] vs 8 patients [23%] without ACS). Primary fascial closure (n = 10) at the initial laparotomy was associated with ACS in 8 (80%) (P =.001, chi(2) test) and ARDS and/or MOF in 9 (90%) (P =.01, chi(2) test); skin closure (n = 25), with ACS in 6 (24%) and ARDS/MOF in 9 (36%); and Bogotá bag closure (n = 17), with ACS in 3 (18%) and ARDS/MOF in 8 (47%). CONCLUSIONS: Damage-control laparotomy is associated with frequent complications. In particular, ACS is a serious complication that increases ARDS and/or MOF and mortality. Avoiding primary fascial closure at the initial laparotomy can minimize the risk for ACS.

Abdomen↗
PubMed2002

Vascular trauma and compartment syndromes.

Vascular injuries produce ischemia, and their repair produces reperfusion. Ischemia and reperfusion produce compartment syndrome. Although a local event, a compartment syndrome risks not only the affected extremity, but also the life of the patient. A high index of suspicion coupled with adequate knowledge of subtle clinical symptoms (and confirmed by intracompartmental pressure measurement) improve management of compartment syndrome, and this article discusses common pitfalls in its diagnosis and treatment.

Arm Injuries↗
PubMed1993

Muscle function in chronic compartment syndrome of the leg.

Chronic compartment syndrome (CCS) is a recognized cause of recurrent leg pain in the exercising patient. Decreased muscle function has been implied in this condition. This study compared the ankle dorsiflexion torque of 10 CCS patients with that of 18 control subjects during 20 repeated, maximal, isokinetic contractions at 60 degrees/sec. Peak torque, relative peak torque, and endurance data were collected. Results showed significantly lower peak torque and relative peak torque in the CCS group (p < or = 0.05), supporting the implication of muscle weakness in CCS. Paradoxically, endurance was significantly higher in the CCS group (p < or = 0.01), and there was a significant (p < or = 0.01), negative correlation (r = -0.50) between peak torque and endurance. The relationship between the findings and CCS is discussed. Strengthening may be useful in very mild cases or in postfasciotomy patients.

Adult↗
PubMedDate not supplied

Iatrogenic compartment syndrome from hypertonic saline injection in Bier block.

A case study of an iatrogenic forearm compartment syndrome is presented. The patient underwent intravenous regional anesthesia (Bier's block) for an attempted closed reduction of a Bennett's fracture. Hypertonic saline (23.4%) was inadvertently used as a lidocaine diluent for the Bier's block, and after tourniquet release, the patient developed signs and symptoms of an acute compartment syndrome. An emergent fasciotomy was required. A review of the theoretical pathogenesis of compartment syndrome resulting from intravenous injection of hypertonic saline is presented. While vein sclerosis from i.v. hypertonic saline may play a role in the development of a compartment syndrome, we speculate that the major factor was an increase in the extracellular tissue fluid volume resulting from osmotic equilibrium after the tourniquet was released. The need for meticulous attention to details when performing this technique is emphasized.

Adult↗
PubMed1994

The use of the unreamed nail in tibial fractures with concomitant preoperative or intraoperative elevated compartment pressure or compartment syndrome.

Twelve patients with tibial shaft fractures and evidence of compartment syndrome or with documented elevated compartment pressures were treated with an unreamed locked intramedullary nail and a single-incision lateral four-compartment fasciotomy. There were six closed fractures and three grade I and three grade II open fractures. Ten fractures have achieved a solid union without shortening or significant angulation at an average follow-up of 8.1 months (range 4-26). Two patients were lost to follow-up. There were two delayed unions and one nonunion, all of which healed after additional treatment. Average time to tibial union was 5.8 months (range 2-24), with six fractures healing in < or = 4 months. One patient whose treatment was delayed > 12 h after his injury has a persistent neurologic deficit with a claw toe deformity. There were no superficial or deep infections. All patients obtained an excellent range of motion of the knee and ankle. Unreamed nailing of diaphyseal tibial fractures with an associated compartment syndrome provides optimal internal fixation while allowing excellent access for soft tissue care. We believe that the unreamed tibial nail, when combined with a single-incision, lateral, four-compartment fasciotomy, offers substantial advantage in the treatment of this injury, permitting optimal treatment of a difficult fracture and soft tissue injury.

Adult↗
PubMed1987

Diagnosis of chronic anterior compartment syndrome in the lower leg.

Intramuscular pressure was recorded in 80 patients suspected of suffering from chronic anterior compartment syndrome in the lower leg; the diagnosis was verified in 22 of these patients. The history and clinical findings of the chronic compartment syndrome patients were compared with those of the 58 patients without the syndrome. Pain induced only by athletic activity and only in the anterior lower leg forcing the patient to interrupt running indicated chronic compartment syndrome. The history and clinical findings alone were found to be insufficient to establish the diagnosis. In relation to generally accepted pressure parameters at rest, the muscle relaxation pressure during exercise was found to be a reliable parameter for diagnosing chronic compartment syndrome, whereas mean muscle pressure and muscle contraction pressure were found to be unreliable.

Adolescent↗
PubMed1989

Compartment syndromes of the lower leg.

Increased lower-leg intracompartmental pressure compromising neuromuscular function within that compartment is termed compartment syndrome. This condition may be acute (often trauma induced) or chronic (usually exercise related). In a conscious, alert patient, acute compartment syndromes usually are easy to diagnose clinically; however, in the unconscious patient, a diagnostic aid such as the intracompartmental pressure monitor is useful. Using the slit catheter device, compartmental pressures in excess of 30-35 mmHg in a normally perfused patient suggest the need for open compartment fasciotomy. Chronic compartment syndromes require dynamic pressure measurements for an accurate diagnosis. The most important parameters are elevated postexercise pressures and delayed restoration of normal compartmental pressures. Subcutaneous fasciotomy may be sufficient in accurately diagnosed cases of chronic compartment syndrome.

Acute Disease↗
PubMed1994

Compartment syndrome after fracture of the distal radius.

A compartment syndrome of the forearm after a fracture of the distal radius is presented. This rare complication should be considered after high velocity trauma in young people. In this setting, we prefer general anesthesia for fracture reduction. Fracture fixation and avoidance of circular casts are recommended. Repeated evaluation allows early detection of compartment syndrome. Fasciotomy should be done if this syndrome occurs.

Adult↗