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Results for “Compartment Syndromes”

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At least 397 records · Page 22Linked to original sources

PubMed1999

[Lower leg compartment syndrome after prolonged gynecologic surgeries in lithotomy position].

OBJECTIVE: How to prevent severe complications of lower leg compartment syndrome following gynecologic operations in the lithotomy position? MATERIAL AND METHODS: Two cases of lower leg compartment syndrome following long lasting gynecologic operations are presented. RESULTS: Early diagnosis by clinical signs, measurement of compartment pressure and creatine kinase activity and undelayed surgical intervention can avoid acute renal failure due to rhabdomyolysis and damage of neuromuscular function. CONCLUSIONS: Early diagnosis and undelayed surgical intervention can prevent severe complications of lower leg compartment syndrome following gynecologic operations in the lithotomy position.

Adult↗

PubMed1988

Diagnostic peripheral nerve block resulting in compartment syndrome. Case report.

A hemiplegic patient with severe upper extremity spasticity 2 years after a cerebrovascular accident received a diagnostic median nerve block below the elbow with bupivacaine. He had been placed on Coumadin as prophylaxis for cerebrovascular arteriosclerotic disease, and prothrombin time was kept at twice the control value. Less than 48 hours after the procedure, a compartment syndrome developed in the volar forearm. Compartment syndrome has not previously been reported as a complication resulting from a nerve block procedure. We conclude that (1) compartment syndrome may develop after a peripheral nerve block procedure for spasticity, (2) prophylactic anticoagulation may increase the risk for hemorrhagic events resulting from percutaneous injection and (3) early recognition is essential and appropriate decompressive fasciotomy may be indicated if a compartment syndrome develops after a nerve block procedure.

Bupivacaine↗

PubMed1999

Lower extremity compartment syndrome. When to suspect acute or chronic pressure buildup.

Acute compartment syndrome is a surgical emergency. A high index of suspicion is needed in cases of severe contusion, especially if patient complaints seem to outweigh physical findings. Acute surgical fasciotomy is an effective treatment and should be carried out expeditiously if compartment pressures are elevated over 70 mm Hg in order to avoid complications such as chronic disability due to contractures or rhabdomyolysis with acute renal failure. Chronic exertional compartment syndrome most often occurs in the anterior or the lateral compartment. Patients have only exercise-related symptoms and recover quickly after resting from the inciting activity. Diagnosis is difficult, but the anterior compartment pressure may be checked fairly readily with a handheld pressure catheter. Deep posterior compartment problems are harder to check because of the difficulty in reaching this area. Thallium stress testing appears promising for diagnosing both anterior and posterior problems and may augment, or even replace, the catheter measurement in the deep posterior and perhaps even the anterior compartment. Thallium stress testing is noninvasive and may be a more physiologic measurement. Fasciotomy may be indicated if conservative treatment lacks efficacy. For unknown reasons, the deep posterior compartment does not respond as quickly, or as well, to fasciotomy as the anterior compartment.

Acute Disease↗

PubMed1990

Lower limb compartment syndrome following lumbar discectomy in the knee-chest position.

We report on two cases of compartment syndrome following lumbar discectomy in the knee-chest position. This complication has only been described once since 1953. Seven cases of compartment syndrome following other surgical procedures were found in the literature. Any increases in tissue pressure of a muscle compartment exceeding 35-40 mmHg over a longer period of time can result in this complication for example, too tight cast, space-occupying intrafascial bleeding, or postischemic swelling. The diagnosis is purely clinical and is based on the typical combination of extremely painful edema with rapid onset of sensory loss and subsequent motor deficits. The muscle necrosis leads to myoglobinaemia and myoglobinuria, recognizable by brown urine. The therapy consists of urgent fasciotomy of swollen compartments without skin suture. The prognosis is highly dependent on the time of the surgical decompression: within 6 hours serious deficits are avoidable; after 24 hours irreversible necrosis of muscle occurs. It seems that the possibility of a compartment syndrome is a specific, but a rare risk of a prolonged knee-chest position.

Adult↗

PubMed1996

Compartment syndrome as a complication of skin traction in children with femoral fractures.

We report the history of two 3-year-old children with femoral shaft fractures, who developed severe compartment syndromes after skin traction. Both children were admitted in our department for treatment of their compartment syndromes. In both, important and permanent disability persisted. The causative role of the skin traction is proved since, in one infant, the compartment syndrome developed in the nonfractured limb. Cautious application of skin traction, conscientious observation, immediate diagnosis, and aggressive treatment of threatening compartment syndromes will prevent these tragic complications.

Child, Preschool↗

PubMed1995

[Compartment syndrome. Frequently missed, with severe sequelae].

Experience and late results in patients with a compartment syndrome which was either missed or diagnosed too late are reported. In the case of 14 patients we were consulted after a delay of 24 h, in another three patients 48 h after the causative event. At that time the diseased extremity was severely swollen, blistered and extremely painful. Ten patients presented with loss of sensitivity; in eight the peripheral pulses were not palpable. CPK was elevated in nine patients (up to 30,000); in six patients CPK was not determined. Causative factors included vascular occlusion (n = 6), paravenous infusions or injections (n = 4), compression in heroin or alcohol abusers (n = 4) and infections secondary to i.m. injections, sepsis or snake bites (n = 4). One patient developed a compartment syndrome after the closure of a muscular hernia. The late results were sobering: eight limbs had to be amputated, another 13 showed muscle necrosis necessitating necrosectomy, and both transitory and persistent median, ulnar, radial and peroneal nerve damage was observed. Our experience shows that dermatofasciotomy should be done on a more generous scale, because it obviously prevents sequelae and because the late complications following inadequately treated compartment syndromes are grave.

Adolescent↗

PubMedDate not supplied

Acute compartment syndrome following a minor athletic injury.

An athletic young male presented with right calf pain following a twisting injury during a soccer game. Other than apparently severe calf pain, no symptoms or signs of compartment syndrome were noted. The patient later returned with lateral and anterior compartment syndrome, and suffered partial loss of peroneal nerve and muscle function despite fasciotomy. Although rare, acute compartment syndrome resulting from seemingly minor injury or exertion has been reported. Pain out of proportion to the apparent injury and a history of chronic leg pain with exertion may be helpful in identifying these patients prior to development of more obvious signs and symptoms. The diagnosis of acute compartment syndrome may be confirmed by compartmental pressure measurement. Prompt intervention is indicated once the diagnosis is established.

Adult↗

PubMed1998

Compartment syndrome in the lower limb.

Acute compartment syndrome is a potentially devastating condition which may arise as a complication of a tibial diaphyseal fracture. Early diagnosis and treatment are of tantamount importance in preventing the devastating complications of this condition. Compartment monitoring is of key importance in early diagnosis and significantly reduces the complication rate.

Acute Disease↗

PubMed2003

Acute compartment syndrome of the lower leg: retrospective study on prevalence, technique, and outcome of fasciotomies.

The acute compartment syndrome is caused by bleeding or edema in a closed muscle compartment surrounded by fascia and bone. It is characterized by increased intracompartmental pressure and decreased tissue perfusion. Well-known causative incidents are acute trauma and reperfusion after treatment for acute arterial obstruction. Most commonly the lower leg is involved. Inadequate therapy of the syndrome usually leads to muscle ischemia, rhabdomyolysis, and renal insufficiency. Perioperative morbidity and mortality are high. Although compartment syndromes can be caused by various factors, up until now no comparative studies have been published on clinical outcome of compartment syndromes of different origin. In this retrospective study we analyzed 40 successive cases of fasciotomy for acute lower leg compartment syndrome to study whether different causes of the syndrome lead to different clinical outcomes. We also studied other predictive factors for clinical outcome. The causes for the compartment syndromes were trauma, vascular deobstruction, cardiac surgery, and gastrointestinal surgery in lithotomy position. Clinical outcome showed a mortality of 15% and serious overall morbidity. Multivariate analysis showed the only significant predictive determinant of outcome to be the age of the patient. Fasciotomy for acute compartment syndrome is associated with serious morbidity and mortality. No correlation between causative factors and clinical outcome could be found.

Adult↗

PubMed2006

Posterior compartment syndrome associated with clopidogrel therapy following trivial trauma.

Haematomata caused by blunt trauma may potentially induce a compartment syndrome by raising intra-compartmental pressure. We report a case of acute posterior compartment syndrome following minimal trauma to the leg of an elderly patient on the antiplatelet agent clopidogrel. This case highlights the high index of clinical suspicion required to detect compartment syndrome in those on long term antiplatelet therapy and prompt surgical decompression is recommended.

Accidental Falls↗

PubMedDate not supplied

Thigh compartment syndrome: diagnosis and surgical treatment.

Thigh compartment syndrome is uncommon and may go unrecognized. Signs and symptoms include a history of thigh swelling and/or hematoma and pain after minor injury in a patient who is anticoagulated. Surgical approaches to the deep thigh compartments are described.

Aged↗

PubMed2000

Acute compartment syndrome. Who is at risk?

We have analysed associated factors in 164 patients with acute compartment syndrome whom we treated over an eight-year period. In 69% there was an associated fracture, about half of which were of the tibial shaft. Most patients were men, usually under 35 years of age. Acute compartment syndrome of the forearm, with associated fracture of the distal end of the radius, was again seen most commonly in young men. Injury to soft tissues, without fracture, was the second most common cause of the syndrome and one-tenth of the patients had a bleeding disorder or were taking anticoagulant drugs. We found that young patients, especially men, were at risk of acute compartment syndrome after injury. When treating such injured patients, the diagnosis should be made early, utilising measurements of tissue pressure.

Acute Disease↗

PubMedDate not supplied

Hypokalemia, hypophosphatemia, and compartment syndrome of the leg after downhill skiing on moguls.

Any process that increases intracompartmental pressure may precipitate compartment syndrome. We report the case of a patient with hypokalemia and hypophosphatemia who presented with compartment syndrome of the legs after a day of downhill skiing on moguls. The presentation is followed by a review of the pathophysiology, etiology, clinical presentation, and management of compartment syndrome, as well as the relationship between hypokalemia, hypophosphatemia, and the development of muscle injury.

Adult↗

PubMed1996

Acute compartment syndrome in tibial diaphyseal fractures.

We reviewed 25 patients with tibial diaphyseal fractures which had been complicated by an acute compartment syndrome. Thirteen had undergone continuous monitoring of the compartment pressure and the other 12 had not. The average delay from injury to fasciotomy in the monitored group was 16 hours and in the non-monitored group 32 hours (p < 0.05). Of the 12 surviving patients in the monitored group, none had any sequelae of acute compartment syndrome at final review at an average of 10.5 months. Of the 11 surviving patients in the non-monitored group, ten had definite sequelae with muscle weakness and contractures (p < 0.01). There was also a significant delay in tibial union in the non-monitored group (p < 0.05). We recommend that, when equipment is available, all patients with tibial fractures should have continuous compartment monitoring to minimise the incidence of acute compartment syndrome.

Acute Disease↗

PubMed2001

Proximal ulna shaft fractures and associated compartment syndromes.

In 1996, 6 (7%) of 84 ulna shaft fractures treated at our institution developed compartment syndrome. These 6 isolated, comminuted, proximal-third ulna fractures were secondary to low-velocity gunshot (5) or high-velocity blunt trauma (1). The 5 gunshot-induced fractures did not initially require immediate surgical intervention, but increasing compartment pressure prompted fasciotomy and open reduction and internal fixation. The blunt trauma fracture developed compartment syndrome while the patient awaited surgery; emergent fasciotomy and open reduction and internal fixation were performed. Three patients had vascular injury (interosseus system). The orthopedist must have a high index of suspicion for compartment syndrome in association with isolated, comminuted, proximal-third ulna fractures.

Adolescent↗

PubMed2000

Acute compartment syndrome of the forearm in association with ulnar shortening osteotomy: a case report.

A 41-year-old man experienced severe pain in the forearm after undergoing ulnar shortening osteotomy to treat positive ulnar variance, a complication of a fracture of the distal end of the radius. The patient had compartment syndrome with compartment pressure of 55 mm Hg. A decompressive fasciotomy of the volar compartment provided total relief of pain and, subsequently, full recovery of all functions. We report the case and discuss the serious nature of compartment syndrome, its associated complications, and methods of diagnosis and management.

Accidental Falls↗

PubMed1989

Compartment syndrome in a five-year-old child following femoral cannulation for cardiopulmonary bypass.

The compartment syndrome is uncommon in children. It has been seen following bony trauma and has also been reported in two patients following cardiac catheterisation. We report its occurrence in a 5-year-old child following femoral artery and femoral vein cannulation for cardiopulmonary bypass. We believe that the presence of a cannula in the femoral vein as well as in the artery was an important factor in impeding the circulation and thus causing the compartment syndrome. Prompt diagnosis and early fasciotomy saved the limb from amputation; however, a residual footdrop persists. The development of the compartment syndrome following femoral cannulation for cardiopulmonary bypass has not been reported previously.

Cardiopulmonary Bypass↗

PubMed1996

An experimental assessment of the risk of compartment syndrome during knee arthroscopy.

The purpose of this study was to objectively evaluate the risk of compartment syndrome as a complication during arthroscopy, particularly with the use of mechanical infusion systems. Little experimental data are available. This study shows that when elevated compartment pressures occur, extravasated fluid dissipates quickly, minimizing the risk of compartment syndrome and subsequent neuromuscular damage. Twelve live pig hind limbs (six swine) were used. Three additional limbs were used as shams. After anesthesia and portal placement for mechanical fluid infusion, two standardized capsulotomies were created to allow free extravasation of fluid. We dynamically monitored intraarticular pressure, and intracompartmental pressure in the anterior (leg), deep posterior (leg), and quadriceps (thigh) compartments. Nerve conduction studies were performed on the tibial and peroneal nerves. Data collection began at the onset of fluid infusion and continued after infusion ceased until elevated compartment pressures fell below 20 mm Hg. There were two study variables: intraarticular pressure (100, 150, or 200 mm Hg) and time of fluid ingress (30, 60, or 90 minutes). Following this, the swine were evaluated serially for 13 to 16 days. Repeat nerve conduction studies, muscle biopsies (in the three previously mentioned compartments), and electromyography were performed 13 to 16 days following the operation. Maximum compartment pressures during fluid infusion averaged 78.75 mm Hg. Significant variability existed when comparing the interrelationships of infusion time, maximum compartment pressures, time of resolution of elevated pressures, and intraarticular pressures. Most importantly, elevated compartment pressures resolved quickly (mean, 25.5 minutes; range, 0 to 100 minutes; n = 36 compartments) when stopping fluid infusion. Nerve conduction studies were normal on all postoperative studies. Electromyographic (EMG) analysis showed normal study results in the biceps, gracilis, abductor digiti quinti, and adductor digiti segundi. Although EMG analysis of the tibialis anterior and extensor digitorum brevis showed 1+ fibrillation (1+ to 4+ scale), this was seen in sham studies with tourniquet alone (no fluid infusion). Muscle biopsies were without evidence of myonecrosis. Finally, 5 of 6 swine ambulated without difficulty on the first postoperative day, whereas 1 swine limped for 2 days. All swine were normal by the 3rd postoperative day and also at the end of the study. These data show that in this model, the risk of developing sequela from compartment syndrome during arthroscopy is minimal, even when there exists significant fluid extravasation and elevated compartment pressures.

Animals↗