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PubMed1999

[Tragic results of an untreated compartment syndrome of the lower extremity].

Despite its notorious extensive consequences compartment syndrome is generally underrated high risk states are not adequately monitored and treated and therefore there is a number of seriously injured child patients. Late surgical intervention and incorrect therapy are responsible for consequences and incomplete recovery. The authors present the case of a 9-year-old boy treated for a diaphyseal fracture of the thigh by vertical traction, where compartment syndrome developed during treatment and did not receive adequate attention. A combination of the incorrect procedure and the insufficient monitoring of the patient led to his permanent disability.

Child↗
PubMed1996

Compartment-syndrome of the lower extremity after CABG.

Three cases of compartment-syndrome of the lower extremity are presented as an example of a specific type of compartment syndrome of the donorleg after CABG. The possible factors contributing to this complication are being discussed, and guidelines are given to adequately diagnose and treat this problem.

Amputation, Surgical↗
PubMed2004

Acute compartment syndrome in the absence of fracture.

OBJECTIVES: To determine if there are differences in demographics, referral patterns, and operative findings between patients with and without a fracture who develop an acute compartment syndrome. DESIGN: Retrospective cohort. SETTING: Orthopaedic trauma unit, university teaching hospital. METHODS: This study examines 164 cases of acute compartment syndrome over an 8-year period. Of these, 13 patients had a diagnosis of crush syndrome and are excluded from this study. The remaining 38 cases with no fracture form the basis for this study. MAIN OUTCOME MEASURES: Patient demographics, referral patterns, and operative findings were compared for the "fracture" and "no fracture" groups. RESULTS: Patients who had acute compartment syndrome in the absence of fracture were older (P < 0.05) and had significantly more comorbidities (P < 0.001) than those with a fracture. Cases without a fracture had a significantly greater mean delay to fasciotomy of 12.4 hours (P < 0.05) compared to those with a fracture. At fasciotomy, 20% of patients without a fracture had muscle necrosis requiring debridement compared to 8% for patients with a fracture (P < 0.05). CONCLUSIONS: This study demonstrates that muscle necrosis is more commonly found in acute compartment syndrome in the absence of a fracture than in those with a fracture. Referral of swollen limbs without fracture for an orthopaedic opinion should not be delayed.

Acute Disease↗
PubMed2002

Diagnosis and management of chronic compartment syndrome.

BACKGROUND: This article describes the diagnosis and management of chronic compartment syndrome and functional popliteal entrapment syndrome, unusual causes for claudication in young adults. METHODS: A total of 276 patients (<50 years old) with isolated muscle cramping, swelling, and plantar paresthesia were routinely evaluated with compartment pressures (normal < 15 mm Hg), stress plethysmography, and selectively evaluated with pulse volume recordings and arteriography. RESULTS: Patients were young (mean 28.4 years) with long-standing symptoms (mean 24 months), affecting 1 or both lower extremities (32% vs 68%, respectively). Of the patients, 84 were male (30%) and 192 were female (70%). Common symptoms were isolated muscle cramping (100%) or swelling (40%), and plantar paresthesia (20%). Of 436 treated compartments, 316 were anterolateral, 70 deep-posterior, and 50 superficial-posterior. Mean compartment pressure was 28 mm Hg. Resting pulse volume recordings were abnormal in 6 patients (2.5%); 82 had positive popliteal entrapment tests (30%), but symptoms were present in only 21 (9.7%). Open fasciectomy was performed in all patients with chronic compartment syndrome or functional entrapment. Local anesthesia was used in 243 (88%) and general in 33 patients (12%). Mean follow-up was 60 months. Of the 276 patients, 92% had full relief of symptoms and returned to normal daily or athletic activity. Eight percent obtained symptomatic relief, but activity was limited because of new compartment symptoms or other orthopedic injury. CONCLUSIONS: Open fasciectomy for chronic compartment and functional entrapment syndromes is effective therapy.

Adolescent↗
PubMed1999

Compartment syndrome of the forearm as the initial symptom of systemic Vibrio vulnificus infection.

Sepsis, cellulitis, and necrotizing fasciitis rarely have been described as causes of compartment syndrome. We report a case in which forearm compartment syndrome presented as the initial symptom of systemic infection. Vibrio vulnificus, the etiologic pathogen of the compartment syndrome, was isolated from wound and blood cultures. The patient was treated with systemic antibiotic treatment and multiple forearm fasciotomies. The infectious process progressed rapidly, however and due to underlying liver insufficiency, the patient died of hepatorenal syndrome. This case illustrates the nature of V. vulnificus infections, which are characterized by shellfish transmission, predilection for soft tissue seeding, and a fulminant course in the compromised host.

Animals↗
PubMed1989

[The compartment syndrome after fractures of the calf].

In the submitted paper the authors summarize views regarding the definition, causes of compartment syndrome, its classification, the diagnostic and therapeutic procedure. In a group of 165 fractures of the leg treated in 1984-1987 in the Traumatological Research Institute in Brno the compartment syndrome was found in 26 patients. The author supplements the problem by case-histories of two patients with compartment syndrome. He discusses the need of early and correct diagnosis, differential diagnosis, therapy, involving in the manifest form of the syndrome decompression by fascitotomy.

Adult↗
PubMed1999

Secondary abdominal compartment syndrome: an underappreciated manifestation of severe hemorrhagic shock.

OBJECTIVE: Abdominal compartment syndrome (ACS) has multiple well-described etiologies, but almost no attention has focused on ACS in the absence of abdominal injury. This study describes a secondary ACS that occurs after severe hemorrhagic shock with no evidence of abdominal injury. METHODS: The trauma registry at a Level I trauma center was reviewed for a 13-month period beginning July 1, 1997. RESULTS: During the study period, there were 46 of 1,216 intensive care unit admissions (4%) who required laparotomy and mesh closure of the abdominal wall because of visceral edema. In that subgroup, six patients (13% of mesh closures, 0.5% intensive care unit admissions) had hemorrhagic shock (5/1, blunt/penetrating trauma) but no evidence of intra-abdominal injury. Associated extremity compartment syndrome developed in two of six (33%). Overall mortality was four of six (67%), secondary to sepsis (n = 3), and head injury (n = 1). Time from admission to decompression averaged 3 hours in survivors and 25 hours in nonsurvivors (overall average = 18+/-9 hours). Resuscitation volume before abdominal decompression averaged 19+/-5 liters of crystalloid and 29+/-10 units of packed red blood cells. Bladder pressure averaged 33+/- 3 mm Hg. Decompression significantly improved peak inspiratory pressure (p < 0.003) and base deficit (p < 0.003). CONCLUSION: ACS can occur with no abdominal injury; The incidence of secondary ACS was 0.5% in this cohort trauma intensive care unit patients, so it probably occurs more frequently than is currently appreciated. Because survivors were decompressed 20 hours before nonsurvivors, early recognition might improve outcomes. On the basis of these observations, we recommend that bladder pressures should be routinely checked and acted on appropriately when resuscitation volumes approach 10 liters of crystalloid or 10 units of packed red cells.

Abdomen↗
PubMed1986

[Compartment syndrome].

Among the 4 compartments of the lower leg, the anterior and the deep dorsal compartment show the following significances: both contain important vessels and nerves, both are limited by tense osteofibrous walls. We report on 153 cases of treated compartmental syndrome of the lower leg - in 82 per cent caused by fractures - and 8 cases of CS of the foot. The frequency of irreversible late sequalae such as infection, functional loss or amputation strictly depends upon the time between injury and surgical decompression. The lowest frequency was found in those cases where decompression took place in the phase of impending compartmental syndrome.

Amputation, Surgical↗
PubMed2006

Subfascial hematoma progressed to arm compartment syndrome due to a nontransposed brachiobasilic fistula.

Vascular access-associated compartment syndrome is reported rarely in hemodialysis patients. A 62-year-old female hemodialysis patient experienced left-arm compartment syndrome caused by a nontransposed brachiobasilic arteriovenous fistula. A subfascial hematoma that developed because of perforation of the posterior wall of the basilic vein was not detected by Doppler ultrasound initially, and subsequent heparinized hemodialysis caused progression of the hematoma. Neuromuscular sequelae were prevented by performing an emergent fasciotomy, and transposition of the arterialized basilic vein was performed later to prevent similar complications in the future. This case report shows the risk for the occurrence of such a devastating complication if the nontransposed brachiobasilic fistula is used for hemodialysis vascular access.

Arm↗
PubMed1997

Compartment syndrome and fasciotomy in vascular surgery. A review of 57 cases.

OBJECTIVE: To investigate the occurrence of compartment syndrome and the results of fasciotomy in vascular surgical patients. DESIGN: Retrospective study of case records from 1980-1994. MATERIALS: Fifty-seven limbs in 53 patients had fasciotomies following surgical revascularisation. Fifty-three (93%) limbs were acutely ischaemic, while four (7%) had undergone elective vascular surgery. Forty-four (77%) limbs had signs of compartment syndrome, while 13 (23%) fasciotomies were prophylactic. METHODS: The fasciotomies were done as subcutaneous procedures (n = 40), as double-incision fasciotomies (n = 11), or by an unknown method (n = 6). The skin incisions were closed primarily in 26 (46%) cases, delayed primarily in 11 (19%) cases, and by skin grafting in eight cases (14%). RESULTS: Five (13%) subcutaneous fasciotomies required revision. Surgical debridement was required in four (7%) limbs. At discharge, 36 (68%) patients had kept their limbs, 11 (21%) patients were amputated, and six (11%) had died. No complications relating to the fasciotomies were observed. CONCLUSIONS: Compartment syndrome is usually related to acute ischaemia and rarely following elective vascular surgery. Subcutaneous fasciotomy does not always ensure sufficient decompression of all four lower leg compartments. Complications related to fasciotomy are rare.

Adolescent↗
PubMed1990

Compartment syndromes of the foot: current concepts.

The foot has been mentioned as a site for the development of a compartment syndrome for approximately 9 years. Despite this, very little information exists in the literature containing specifics on the nature of the disorder. Very recent work has shown that crush injuries, forefoot and midfoot fractures and dislocations, and calcaneal fractures are prone to the development of foot compartment syndromes (FCS). The classical clinical signs of pain with passive stretch of the involved muscles, and dysfunction of the nerves that pass through the involved compartments are less helpful in the diagnosis of the syndrome in the foot than elsewhere. Tense swelling of the foot may be of some help in arousing suspicion that a FCS has developed, but the diagnosis is best made by invasive catheterization of the foot compartments. Since recent work has discovered that at least nine foot compartments exist, multi-stick catheterization is recommended. Fasciotomy should be performed when the pressures are significantly elevated, to prevent the development of late contractures. A communication exists between a newly-found compartment of the foot, the calcaneal compartment, and the deep posterior compartment of the leg. A combined pattern of FCS and deep posterior compartment syndromes of the leg exists, and should be remembered by the clinician treating injuries of the foot or leg. Also, a foot injury alone may cause a deep posterior compartment syndrome in the leg. Claw-toe deformity seems to be the primary late sequela of FCS. Local procedures may be of only temporary benefit.

Compartment Syndromes↗
PubMed1997

Abdominal compartment syndrome due to delayed identification of a ureteral perforation following abdomino-perineal resection for rectal carcinoma.

Abdominal compartment syndrome develops whenever the mean intraperitoneal pressure rises above the physiological pressure, leading to renal and mesenteric ischemia and respiratory decompensation due to pressure on the diaphragm. Abdominal compartment syndrome may occur after conditions such as peritonitis, intestinal obstruction, laparoscopic procedures, or abdominal tumors. Leakage from the urinary tract may cause accumulation of urine in the peritoneal cavity which commonly manifests as single or multiple urinomas, or urinary ascites. The case of a patient who had delayed identification of a ureteral perforation following the abdomino-perineal resection of a rectal carcinoma is presented. Massive urinary leakage into the peritoneal cavity led to the abdominal compartment syndrome. Peritoneal drainage and ureteral stenting improved her condition. A high index of suspicion is necessary in order to diagnose this rare condition.

Colectomy↗
PubMed1988

Chronic exertional compartment syndrome of the forearm flexor muscles.

A case of chronic exertional compartment syndrome of the forearm flexor muscles after routine, strenuous work activity is presented. Intramuscular pressure monitoring before and after operation documented the efficacy of decompressive fasciotomy. A higher index of suspicion of forearm chronic compartment syndrome might have led to earlier diagnosis and treatment.

Adult↗
PubMed1995

[Magnetic resonance tomography evaluation of the lower limb after compartment syndrome].

For the purpose of follow-up of the disease as well as the availability of magnetic resonance imaging (MRI) as a method for diagnosing soft tissue changes 20 patients with imminent and manifest compartment syndrome were examined for their fluid content of the lower limb. Considering the normal side as well as 10 healthy volunteers a significant reduction of fluid content was diagnosed in the manifest compartment syndrome after fasciotomy in the late phase of disease (r = 0.49, p > 0.005, n = 29). This was interpreted as a sign of fibrosis. The patients with imminent compartment syndrome and fasciotomy (r = 0.83, p > 0.001, n = 19) demonstrated no significant changes compared to the normal volunteers (r = 0.91, p > 0.001, n = 40) as well as the normal compartments of the diseased lower extremities (r = 0.85, p > 0.001, n = 32). MRI is a useful method in the examination of soft tissue changes and underlines the importance of an early fasciotomy in case of imminent compartment syndrome.

Adolescent↗
PubMed2005

Acute compartment syndrome of the upper arm: a report of 2 cases.

Compartment syndromes of the upper arm are rare clinical entities but can be a serious problem, especially in unconscious patients or those presenting with altered mental status. A high index of suspicion is needed to make an accurate diagnosis. Measuring compartment pressures is helpful, but the role of pressure measurement in the diagnosis and treatment may be secondary to the clinical examination. In patients presenting without histories of trauma, who have sustained long periods of immobilization, a suspicion of a crush syndrome should also be included during the workup of a compartment syndrome. Fasciotomy and débridement of necrotic and nonviable tissue are the treatments of choice for a patient with a compartment syndrome, but initiating medical management and providing medical stability for systemic complications resulting from a crush syndrome may be necessary prior to surgical intervention to prevent organ failure and death. Overall, prognosis is improved by early diagnosis and treatment.

Accidental Falls↗
PubMed2003

Forearm compartment syndrome from intravenous mannitol extravasation during general anesthesia.

IMPLICATIONS: Complications of IV mannitol administration resulting in compartment syndrome may warrant surgical intervention. Compartment syndrome is difficult to diagnose in the anesthetized patient. Infusing mannitol in an observed IV site permits discontinuation of mannitol before complications ensue. Early recognition and surgical intervention averted potential impairment in our patient.

Anesthesia, General↗
PubMed2001

[Acute compartment syndrome. Results of a clinico-experimental study of pressure and time limits for emergency fasciotomy].

BACKGROUND: Acute compartment syndrome of the leg is to be regarded as a traumatological emergency. Most specialists already agree that only a timely operative decompression of the afflicted compartment can prevent serious tissue damage. What still remains subject to discussion, however, is the precise tissue pressure above which the operation becomes imperative. Experimental human studies focusing on tissue pressure and muscle oxygenation have not yet been carried out. It was thus the aim of the present study to analyze oxygen partial pressure of the anterior tibial muscle and peroneal action potential in a model compartment syndrome in man. METHODS: In 22 healthy, normotensive volunteers, constant pressure values from 0 to 100 mmHg were induced in the anterior tibial muscle with antishock trousers. Over a period of up to 6 h measurements were made of (1) tissue pressure, (2) intramuscular oxygen partial pressure (pO2), and (3) muscle response potential (MRP) of the n. peroneus profundus by electroneurography. RESULTS: We achieved a 97.7% (Q25%/Q75%: 89.2/99.8) transfer of the pneumatic pressure to the lower leg. Already at intramuscular tissue pressures of 30-40 mmHg, hypoxia and reduction of MRP appeared. A reduction of the MRP to zero and pO2 < 1 mmHg was observed from a pressure of 50 mmHg. Tissue pressure values of over 75 mmHg resulted almost without exception in anoxia of the muscle. CONCLUSIONS: Even under normal perfusion conditions, already slight increases in pressure of above 30 mmHg lead to reduced tissue oxygenation and neural function. We have to consider that with additionally traumatized muscle the ischemic tolerance is markedly reduced and due to unknown influences such as local vasoreactivity and capacity of autoregulation the nutritive perfusion cannot be determined. In the case of a severely injured muscle, to be on the safe side decompressive fasciotomy should therefore be carried out if pressure values remain above 30 mmHg.

Adult↗