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Results for “Compartment Syndromes”

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PubMed1995

[Chronic compartment syndrome].

Among causes of leg pains, a usual disability in athletes, chronic exertional compartment syndrome is far from being uncommon. To the opposite, descriptions concerning the others compartments such as the forearm or thigh are still scarce and poorly documented. A variety of techniques have been described for the measurement of intramuscular pressure. Intramuscular pressure measurement is a valuable and essential tool for diagnosing a compartment syndrome, but it is somewhat controversial when the deep posterior compartment is concerned. Conservative treatment is unsuccessful, whereas surgical decompression yield favorable results; two procedures are performed subcutaneous fasciotomy or open fasciotomy.

Chronic Disease↗

PubMed2005

Hyperacute abdominal compartment syndrome: an unrecognized complication of massive intraoperative resuscitation for extra-abdominal injuries.

Primary and secondary abdominal compartment syndrome (ACS) are well-recognized entities after trauma. The current study describes a "hyperacute" form of secondary ACS (HACS) that develops intraoperatively while repair of extra-abdominal injuries is being carried out simultaneous with massive resuscitation for shock caused by those injuries. The charts of patients requiring abdominal decompression (AD) for HACS at time of extra-abdominal surgery at our level I trauma center were reviewed. The following data was gathered: age, Injury Severity Score (ISS), mechanism, resuscitation details, time to AD, time to abdominal closure, and outcome. All continuous data are presented as mean +/- standard error of mean. Hemodynamic and ventilatory data pre- and post-AD was compared using paired t test with significance set at P < 0.05. Five (0.13%) of 3,750 trauma admissions developed HACS during the 15-month study period ending February 2004. Mean age was 32 +/- 7 years, and mean ISS was 19 +/- 2. Four of five patients arrived in hemorrhagic shock (blunt subclavian artery injury, 1; chest gunshot, 1; gunshot to brachial artery, 1; stab transection of femoral vessels, 1) and were immediately operated upon. One of five patients (70% burn) developed HACS during burn wound excision on day 2. HACS developed after massive crystalloid (15 +/- 1.7 L) and blood (11 +/- 0.4 units) resuscitation during prolonged surgery (4.8 +/- 0.8 hours). Pre- versus post-AD comparisons revealed significant (P < 0.05) improvements in mean arterial pressure (55 +/- 6 vs 88 +/- 3 mm Hg), peak airway pressure (44 +/- 5 vs 31 +/- 2 mm Hg), tidal volume (432 +/- 96 vs 758 +/- 93 mL), arterial pH (7.16 +/- 0.0 vs 7.26 +/- 0.04), and PaCO2 (52 +/- 6 vs 45 +/- 6 mm Hg). There was no mortality among the group, and all patients underwent abdominal closure by fascial reapproximation in 2-5 days. Two (40%) of the five patients required extremity fasciotomy for compartment syndrome. HACS is a rare complication of massive resuscitation for extra-abdominal injuries. It should be considered in such patients in the face of unexplained hemodynamic and/or ventilatory decompensation. Prompt AD is life saving. Early abdominal closure is usually possible. Vigilance for compartment syndromes elsewhere in the body is warranted in any patient with HACS.)

Abdomen↗

PubMed2000

Silent compartment syndrome complicating total knee arthroplasty: continuous epidural anesthesia masked the pain.

Posterior dislocation is an uncommon complication of total knee arthroplasty (TKA) using a posterior stabilized total knee prosthesis, and it usually results from flexion instability. Acute posterior dislocation of a posterior stabilized prosthesis complicated by compartment syndrome of the leg has not previously been reported in the literature. We report a 62-year-old woman with posterior dislocation of her posterior stabilized TKA when her knee was in extension. It was further complicated by compartment syndrome with severe muscle necrosis. The diagnosis of compartment syndrome was delayed, partly because of continuous epidural anesthesia that completely abolished the pain and partly because of the low index of suspicion, as compartment syndrome is not well recognized as a possible complication of TKA. This case report strongly emphasizes that continuous epidural anesthesia is contraindicated in the case of complicated TKA because important clinical cues to neurovascular complications could be masked.

Anesthesia, Epidural↗

PubMed2005

Compartment syndrome and fatal rhabdomyolysis in sickle cell trait.

Sickle cell trait is a relatively common condition in the African-American population. Individuals with this condition may have any of several complications under rare circumstances. We report a patient who presented with extensive compartment syndrome leading to death. A 31-year-old African-American male with known history of sickle cell trait developed extensive compartment syndrome followed by rhabdomyolysis, severe acidosis, acute renal failure, and coagulopathy. Although the patient underwent multiple fasciotomies for extensive compartment syndrome and received aggressive resuscitation with massive transfusions of blood, blood products and intravenous fluids, he died. Multiple compartment syndromes in patients with sickle cell trait represent a very unusual complication and can cause significant morbidity and mortality. Avoidance of strenuous exercise, especially in hot climates, early diagnosis, and aggressive therapy are very important to prevent this catastrophic complication.

Acidosis↗

PubMed1991

[Surgical treatment and late results of foot compartment syndrome].

From 1982 to 1988 a total of 29 patients with compartment syndrome of the foot were treated by fasciotomy. The most common causes were fracture dislocations of the Lisfranc (n = 14) and Chopart joints (n = 4). Since these injuries lead to a severe damage to soft tissue structures--joint capsules, ligaments, fasciae--the muscular compartments often communicate and decompression can be achieved by a longitudinal dorsal incision of the skin and fasciotomy of the fascia dorsalis pedis and the retinacula extensorum superior and inferior. Subsequent measurement of intracompartmental pressure dictates whether blunt dissection of the interosseous muscles and separate fasciotomy of the medial, lateral and plantar compartments have to be performed. Follow-up was possible in 18 patients: half had good results, while 9 patients had limited motion of their toes and/or paresthesia. It is impossible to know whether these negative findings are caused by the compartment syndrome itself or by the severe soft tissue damage resulting from the initial trauma.

Adolescent↗

PubMed2003

Acute volar and dorsal compartment syndrome after a distal radius fracture: a case report.

We present a case of an acute volar and dorsal compartment syndrome of the forearm secondary to a distal radius fracture. The patient sustained a low-energy injury (fall) and presented within 12 hours with signs and symptoms of a compartment syndrome prior to any treatment. Emergent volar and dorsal fasciotomies were performed, and the fracture was reduced and pinned. The fracture and fasciotomies healed without complication, and the patient was doing well on the last follow-up examination. To our knowledge, this is the first report in the literature of a volar and dorsal compartment syndrome after a low-energy fall prior to a patient receiving any treatment.

Accidental Falls↗

PubMed2001

Outcome of compartment syndrome following intramedullary nailing of tibial diaphyseal fractures.

Seventeen cases of compartment syndrome were treated in a group of 626 consecutive patients with tibial diaphyseal fractures. Clinical and radiological follow-up was performed at an average of 24 months (range 8-54 months). Functional outcome was assessed using Edward's classification. All patients who developed compartment syndrome had fracture stabilisation with a reamed intramedullary nail using skeletal traction. The average interval between the nailing procedure and fasciotomy was 11 h. Results were good in 10 cases, fair in four cases and poor in the remaining three cases. Patients who had decompression within 12 h had a good functional outcome. Patients with poor results were all treated at an interval greater than 24 h.

Adult↗

PubMed2002

Lower extremity compartment syndrome following a laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Bariatric surgery has the potential for serious complications. A case is presented of unilateral lower extremity compartment syndrome after a laparoscopic Roux-en-Y gastric bypass performed in the modified lithotomy position. CASE REPORT: A 38-year-old female (weight 134.5 kg, BMI 49.6) underwent a laparoscopic Roux-en-Y gastric bypass (operating time 375 min). Postoperatively, she complained of bilateral lower extremity pain that gradually subsided over the course of the day. However, on the 1st postoperative day she developed numbness on the dorsum of the foot and compartment syndrome was diagnosed (anterior compartment pressure 71 mmHg). She underwent emergency fasciotomy, which resulted in a reduction of the pain and numbness on the dorsum of the foot. The next day she ambulated without difficulty and was discharged home on the 5th postoperative day. 12 days after her operation, delayed primary closure of the fasciotomy wound was done with the assistance of a novel device (Proxiderm) that applies constant tension to the wound edges. Subsequent recovery was uneventful, and at 4-month follow-up the patient had a weight loss of 28 kg without any right leg motor or sensory deficits. CONCLUSION: Bariatric surgeons should be aware of compartment syndrome as a rare but serious complication. Prevention, early recognition, and prompt fasciotomy are crucial for a favorable outcome.

Adult↗

PubMed1991

Management of compartment syndromes of the foot.

Twelve patients with isolated extremity injuries had 14 compartment syndromes of the feet. An interstitial pressure of more than 30 mm of mercury in either the central or interosseous compartment was considered pathologic and was treated by fasciotomy, performed dorsally in nine feet and medially in five. Open reduction of fractures amenable to internal fixation (eight tarsometatarsal, three calcaneus, and one metatarsal) was performed after completion of the fasciotomies. The fasciotomy wounds were covered by primary split-thickness skin excision (three), delayed split-thickness skin grafting (eight), and delayed primary wound closure (three). Patients were evaluated at a mean of 22 months (range, 17-36 months) after injury, and the examination was directed specifically toward symptoms and signs of myoneural ischemia. Absolute compartment pressure measurements are more accurate than clinical findings in the diagnosis of a compartment syndrome of the foot. Fasciotomy may be performed medially or dorsally, depending on the configuration of the pattern of fracture or dislocation. To ensure satisfactory results, all compartments should be decompressed, and the pressures remeasured after the completion of fasciotomy.

Adult↗

PubMed2001

[Compartment syndrome or gas gangrene? A case report].

A case of forearm compartment syndrome due to a minor trauma is reported. The severe clinical conditions due to a shock state lead to an initial misdiagnosis of clostridial myonecrosis. The patient, 68 y-old woman, was admitted to the intensive care unit of Authors' hospital for a traumatic injury of the right forearm. A diagnosis of gas gangrene due to clostridial myonecrosis was done and forearm amputation suggested. In spite of this indication a decompression fasciotomy of the forearm compartments was performed as well as a hyperbaric oxygene therapy. Since culture of necrotic tissue samples did not demonstrate any bacterial growth, the Authors decided to avoid amputation and perform a radial arteriovenous fistula to improve venous return and reduce distal edema and continuous bleeding, with a complete recovery within 40 days. Good evaluation of patient with suspected compartment syndrome means correct and not delayed treatment, avoiding invalidating outcome.

Aged↗

PubMed2003

Chronic compartment syndrome of the forearm in competitive motor cyclists: a report of two cases.

Exertional compartment syndrome of the forearm is rare. However, it should be considered in cases of a painful forearm during motorcycle racing. Pressure measurements of all compartments during exercises that simulate the actions of racing confirm the diagnosis. An exertional electromyography may be useful to reveal a nerve compression associated with the compartment syndrome. Fasciotomy of the affected compartments allows relief of symptoms and return to previous activities in all cases.

Adult↗

PubMed2000

Review and case report of idiopathic lower extremity compartment syndrome and its treatment in diabetic patients.

Diabetic muscle infarction is a rare complication of diabetes mellitus. However, idiopathic compartment syndrome in the diabetic patient is even a rarer disease, which has been reported only in three cases up to date. The disease seems to occur in patients affected by type 1 diabetes mellitus with a history of poorly controlled glucose levels. MRI aids in the diagnosis by delineating the edema of the muscle. However, definitive diagnosis is made using the Stryker needle unit. Treatment is accomplished by immediate two-incision fasciotomy. We present a case where a 34 yr-old female with a long standing history of poorly controlled Type 1 diabetes mellitus presented with a painful right lower extremity and was diagnosed with compartment syndrome. In our patient, a single incision fasciotomy to release the pressure was sufficient and might be considered as an alternative and less morbid procedure in the diabetic patient with already poorly healing tissues. We conclude that the muscle infarction in these patients is from diffuse microangiopathic disease leading to muscular infarction and fluid accumulation in the cells causing a decrease in the space in the compartment in question causing compartment syndrome.

Adult↗

PubMed2003

Acute compartment syndrome of the lower leg: changing concepts.

The acute limb compartment syndrome is caused by bleeding or edema in a closed muscle compartment surrounded by fascia and bone, leading to muscle and nerve ischemia. The value of fasciotomy has been demonstrated in the management of acute compartment syndrome, but if performed after a delay of 8 to 10 hours, it can prove to be a double-edged weapon, as necrotic muscle would get exposed leading to muscle infections and massive bleeding.

Journal Article↗

PubMed1994

Acute exertional compartment syndrome occurring after performance of the army physical fitness test.

Acute exertional compartment syndrome has been described as occurring after sustained maximal exertion. The case described is that of acute exertional compartment syndrome of the leg occurring in a soldier after he attempted to complete the Army physical fitness test. This condition was initially neglected; necrotic muscle and acute tubular necrosis were sequelae. Earlier intervention could have occurred if the signs and symptoms were considered by the treating health care professionals. All active duty troops are required to perform to maximum exertion. Their complaints should be considered with the same differential diagnosis as those of a highly trained athlete.

Acute Disease↗

PubMed1991

Compartment syndrome after closed intramedullary nailing of the tibia: a canine model and report of two cases.

Two patients developed an anterior tibial compartment syndrome after closed reamed intramedullary nailing of their fractured tibial shaft. Subsequently, a study was undertaken using a canine model to evaluate the risk of compartment syndrome after this operative procedure. A closed tibial fracture was created in 20 mongrel canines by applying a torsional load localized to the tibial shaft through a stress riser made with an intramedullary drill. Compartment pressures were measured in the canine anterolateral and deep posterior leg compartments. In 10 dogs, closed intramedullary nailing with reaming was performed while compartment pressures were measured. The remaining 10 dogs served as controls. Compartment pressures were monitored for 4 hours. In the experimental group, one dog attained and maintained a pressure greater than 50 mm Hg; a second dog maintained a pressure of 20 mm Hg during the postoperative monitoring period. In both of these cases, fasciotomy reduced the pressures to zero. The high tissue pressure readings were localized to the anterolateral muscle compartment. In the control group, no pressures higher than 8 mm Hg were recorded. Compartment syndrome is a potential complication of closed intramedullary nailing of the tibia, and the anterior muscle compartment appears to be the one most at risk. Therefore, perioperative tissue pressure monitoring is recommended.

Adult↗

PubMed2005

Bilateral gluteal compartment syndrome after elective unilateral hypogastric artery ligation and revascularization of the contralateral hypogastric artery during open abdominal aortic aneurysm repair.

Gluteal compartment syndrome is an uncommon entity that has been described in the literature after drug overdose and orthopedic procedures. We describe the first case of bilateral gluteal compartment syndrome that followed pelvic revascularization after the repair of an abdominal aortic aneurysm with bilateral common and internal iliac aneurysms. The patient was treated with aggressive fluid hydration and bilateral gluteal fasciotomies with resolution. The bilateral gluteal compartment syndrome was likely caused by increased pressure on the gluteal muscles, secondary to increased patient weight combined with a period of local ischemia to the watershed areas during iliac cross-clamp.

Aortic Aneurysm, Abdominal↗

PubMed1978

Acute compartment syndromes: diagnosis and treatment with the aid of the wick catheter.

Intracompartmental pressures were measured by the wick catheter technique in sixty-five compartments of twenty-seven patients who were clinically suspected of having acute compartment syndromes. A pressure of thirty millimeters of mercury or more was used as an indication for decompressive fasciotomy. The range of normal pressure was from zero to eight millimeters of mercury. Eleven of these patients were diagnosed as actually having compartment syndromes and in these patients, twenty-seven compartments were decompressed. Only two patients had significant sequelae. In the sixteen patients (thirty-eight compartments) whose pressures remained less than thirty millimeters of mercury, fasciotomy was withheld and compartment syndrome sequelae did not develop in any patient. Intraoperatively the wick catheter was used continuously in eight patients to document the effectiveness of decompression. Fasciotomy consistently restored pressures to normal except in the buttock and deltoid compartments, where epimysiotomy was required to supplement the fasciotomy. Continuous intraoperative monitoring of pressure by the wick catheter technique allowed us to select the few cases in which primary closure of wounds was appropriate and to decide which patients were best treated with secondary closure.

Adolescent↗

PubMed2006

Ischemic orbital compartment syndrome as a complication of spinal surgery in the prone position.

OBJECTIVES: To report a patient with ischemic orbital compartment syndrome as a complication of spinal surgery in the prone position. DESIGN: Interventional case report. METHODS: An 80-year-old man underwent a prolonged lumbar decompression laminectomy for spinal stenosis, under general anesthesia in the prone position. Several hours later, the patient complained of left periocular pain and reduced vision. Examination revealed significant facial edema, left proptosis, and a tight orbit, as well as no light perception and elevated intraocular pressure in the left eye, with complete internal and external ophthalmoplegia. MAIN OUTCOME MEASURES: Clinical course, imaging findings, management, and final outcome. RESULTS: Magnetic resonance imaging confirmed the clinical diagnosis of a compartment syndrome with elevated intraorbital tension. A lateral canthotomy and cantholysis were performed, and high-dose IV steroids were started. The proptosis and facial swelling subsided gradually, but no improvement was noted in left visual acuity or left ocular movements. CONCLUSION: It is important to be familiar with this rare complication after prolonged surgery in the prone position. Although the prognosis seems to be poor, it is essential to monitor these patients perioperatively and to intervene surgically and medically once the diagnosis of orbital compartment syndrome is established.

Acetazolamide↗