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Results for “Compartment Syndromes”

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PubMed2005

Revision surgery for exertional anterior compartment syndrome of the lower leg: technique, findings, and results.

BACKGROUND: Recurrent symptoms or failure after fasciotomy for exertional anterior compartment syndrome is not uncommon. HYPOTHESIS: Symptoms from high compartment pressures can be secondary to involvement of the entire compartment or to localized constrictions from postsurgical fibrosis, as well as to entrapment of the superficial peroneal nerve. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Eighteen patients who underwent revision surgery for exertional anterior compartment syndrome were available for follow-up. All were athletes who had either a failure or a recurrence of symptoms at a mean of 23.5 months (range, 8-54 months) after the index fasciotomy. Pressure measurements using a slit catheter at rest, at 1 minute postexercise, and at 5 minutes postexercise were performed in 2 places within the compartment: in the area of the previous incision and in the proximal muscle belly of the tibialis anterior. Surgical technique consisted of a 2-incision approach with partial fasciectomy, exploration and decompression of the superficial peroneal nerve, and excision of all fibrotic tissue. An objective examination and a comprehensive subjective questionnaire previously described were performed at a mean follow-up of 42 months (range, 22-67 months). RESULTS: Sixty percent of patients had abnormal pressures only in a localized area, whereas 40% had high pressures throughout the compartment. Eight of 18 (44%) patients had symptoms, signs, and surgical findings of entrapment of the superficial peroneal nerve. At follow-up, 72% of patients had a satisfactory outcome (5 excellent, 8 good), and 28% had an unsatisfactory outcome for intense running sports (4 fair, 1 poor), although 3 patients with the fair results reported improvement with low-level activity. All 8 patients with documented peroneal nerve entrapment had a satisfactory outcome. CONCLUSION: Symptoms from high pressures can be secondary to involvement of the entire compartment or localized to a certain area from postsurgical fibrosis. Pressure measurements should be performed in at least 2 separate areas.

Compartment Syndromes↗
PubMed2001

Compartment syndrome of the leg after plantaris tendon harvest: a case report.

A case of lower extremity compartment syndrome following plantaris tendon harvest for use as an upper extremity tendon graft is described. Compartment syndrome seems to be a rare complication after plantaris harvest, but expedient management is required to avert adverse sequelae. Exploration of the course of the plantaris tendon may be a viable alternative to the traditional lateral approach in attempting to reverse the condition.

Adult↗
PubMed2001

Abdominal compartment syndrome with massive lower-extremity edema caused by colonic obstruction and distention.

Abdominal compartment syndrome is a well-described condition in which increased intra-abdominal pressure causes various physiologic derangements with adverse effects on cardiac, pulmonary, and renal function. A patient presented with radiation-induced distal colonic obstruction, abdominal distention, and severe bilateral leg edema. We performed a diverting transverse loop colostomy as treatment for her obstruction. This resulted in massive, spontaneous diuresis with complete resolution of her lower-limb edema. Abdominal compartment syndrome due to colonic obstruction can contribute to the development of lower-extremity edema. Colon decompression with reduction of intra-abdominal pressure can lead to resolution of edema in this situation.

Abdomen↗
PubMedDate not supplied

Anterior tibial compartment syndrome associated with ergotamine ingestion.

This is the first reported case of acute anterior tibial compartment syndrome following ergotamine tartrate overdosage. A 25-year-old man developed signs and symptoms of ergotism after ingestion of 72 mg of ergotamine tartrate over the 12 days prior to his hospital admission. On the fourth hospital day, the patient developed bilateral anterior tibial compartment syndrome. The development of this syndrome is postulated to have been due to the progressive edema and tissue pressure in the anterior tibial compartments, worsened by the gradual improvement of the peripheral circulation which followed the diminished vasopastic effect of the ergotamine.

Adult↗
PubMed2005

[Generalized compartment syndrome after excessive drinking. A rare complication of psychological disorders?].

Psychogenic polydipsia can lead to compartment syndromes, which is too infrequently considered in psychiatric patients who binge-drink on hypotonic fluids. If masked by the leading clinical presentation of cerebral edema, compartment syndromes of the extremities may be diagnosed too late or remain undetected. Based on a literature review and case report, we discuss additional factors and the specific features of diagnosis and treatment.

Adult↗
PubMed1991

[Compartment syndrome of the lower leg. Long-term results].

An analysis of 134 surgically treated compartment syndromes of the lower leg was combined with a long-term follow-up concerning late sequelae. Direct trauma including simple closed as well as severely comminuted open fractures of the tibia and fibula were predisposing factors for the development of a compartment syndrome. Clinical symptoms led to the correct diagnosis, supported by intracompartmental pressure measurements. A unilateral parafibular dermatofasciotomy involving opening all four compartments was the therapy of choice. Fifty-nine per cent of the patients had no late sequelae at the 4.2 year follow-up. 12% poor results were characterized by loss of function and neurological deficits. This group included 8 amputations above the knee due to ischemic/infectious muscle necrosis. The time interval between trauma and operation was found to be the main contributing factor to the poor results, with a delay of 23 h due to secondary referral of the patients. Fasciotomy per se showed only minimal morbidity and is strongly recommended as an emergency procedure.

Adolescent↗
PubMed1991

[Compartment syndrome of the hand. Diagnosis, therapy, results, late sequelae].

Ischemic necrosis of the intrinsic muscles of the hand has been known about for decades, as has the resulting local ischemic contracture in the hand. As isolated compartment syndrome of the hand is a rare condition, this term has not yet become established. The etiopathology, diagnosis, therapy and results of treatment in 13 patients treated for compartment syndrome of the hand are presented. At the time of our follow-up study, 3 patients had died and 2 did not attend. In 1 patient the upper limb had meanwhile had to be amputated. Thus, late results were examined in 7 patients, but 2 of these had not recovered any hand function, as they had suffered a brachial plexus lesion on the affected side. In 5 patients the range of motion was unimpaired, but a slight loss of strength persisted in 4 patients and 1 patient complained of moderate paresthesia at the palmar scar. Despite the small number of patients, we feel that these results emphasize the need for early and adequate decompression in the case of compartment syndrome of the hand.

Compartment Syndromes↗
PubMed1979

Chronic anterior tibial compartment syndrome. A light-microscopic, histochemical and electronmicroscopic analysis.

A case of chronic anterior tibial compartment syndrome is reported where the entity was accompanied with a primary neurogenic type of muscle atrophy. Histology, histochemistry and electronmicroscopy indicated the diagnosis. The authors concluded that in a moderate case of leg trauma with peroneal nerve involvement, when it is complicated by intermittent arterial spasm, the anterior tibial compartment syndrome may develop chronically.

Aged↗
PubMed1995

Late management of compartment syndromes.

Four patients have presented secondarily to this unit in recent years with rhabdomyolysis following prolonged compartment syndromes consequent upon drug overdoses or severe injury. Multiple complications arose due to the severe nature of the compartment syndrome itself and also its late and sometimes incomplete initial treatment. In two cases out of four a secondary amputation was required. Our experience with these cases demonstrates the importance of repeat examination under anaesthetic of the affected limbs following fasciotomy, even if apparently healthy granulation tissue is forming, and the value of persistent oedema and elevated creatine phosphokinase levels as markers of continued pathology. Observation of these factors may enable amputations and prolonged nerve palsies to be avoided in future patients.

Accidents, Traffic↗
PubMed2005

Absolute compartment pressure versus differential pressure for the diagnosis of compartment syndrome in tibial fractures.

We studied 39 patients with 42 diaphyseal tibial fractures in whom we suspected a high risk for the development of a compartment syndrome. We measured the anterior absolute compartment pressure (ACP) every 12 h for 72 h and also recorded the differential pressure (DeltaP=diastolic blood pressure-ACP). Fasciotomy of the extremity was only performed when the differential pressure was less than 30 mmHg for more than 30 min. The highest values of the ACP were recorded between 24 h and 36 h after admission. Three fractures had a differential pressure less than 30 mmHg and all were treated by fasciotomy. In three fractures the ACP was equal to or higher than 50 mmHg, of which two had a differential pressure less than 30 mmHg. The patients were followed up for a mean of 36 months (29-45). All fractures healed, and none of our patients showed any sequelae of compartment syndrome at their last review.

Adolescent↗
PubMed1998

[Postoperative compartment syndrome in a patient with acute aortic dissection (DeBakey type I)].

We report a case of compartment syndrome caused by femoral arterial cannulation during cardiopulmonary bypass. A 62-year-old man who had been diagnosed as acute aortic dissection (type I) received a operation of partial arch replacement with reconstruction of brachiocephalic and left carotid arteries. Compartment syndrome was noticed just after the operation, which was caused by long-term ischemia during femoral arterial cannulation combined with poor collateral circulation by the dissection of iliac arteries. The emergency fascitomy was performed, therefore, he could be discharged without any complications. It is concluded that in case of acute aorte aortic dissection, the back-flow of blood should be checked at the time of femoral arterial cannulation, and whenever the back-flow is poor, some procedures should be added to increase distal blood flow.

Acute Disease↗
PubMed2001

Unusual development of acute compartment syndrome caused by a suction injury: a case report.

There have been recent reports of acute compartment syndrome secondary to suction injuries of the hands of children. We report the case of a 68-year-old patient who developed an acute compartment syndrome of the forearm after his arm had been sucked into an exhaust port. He was treated by emergency fasciotomies and the wound was closed five days later with a small skin graft. His recovery was uneventful.

Acute Disease↗
PubMedDate not supplied

Compartment syndrome associated with bupivacaine and fentanyl epidural analgesia in pediatric orthopaedics.

Two patients had a compartment syndrome after surgery at a remote site performed under a continuous lumbar infusion of a mixture of narcotic (fentanyl) and local anesthetic (bupivacaine 0.1%). Each patient had inadvertent excessive pressure applied to the limb distally and had no perception of pain in the presence of this analgesic combination. After the relief of this pressure from a sling or traction apparatus, each child had signs of a compartment syndrome, and this sensation of pathologic pain was not masked by the epidural infusion. A discussion of the literature questions the benefits of bupivacaine local anesthetic as a routine addition to epidural analgesia for orthopaedic surgery.

Adolescent↗
PubMed2005

[The abdominal compartment syndrome].

In two patients, a man aged 67 and a woman aged 80, an abdominal compartment syndrome was diagnosed. The man had been treated surgically for an abdominal aortic aneurysm; he recovered after re-operation. The woman had been treated by sigmoidectomy because of ileus. A Bogota bag and a vacuum-assisted wound-closure system were applied to the abdominal wound. Her condition deteriorated, an intestinal perforation became apparent, of which she did not recover and died. An abdominal compartment syndrome should always be kept in mind when a patient at risk presents with increased intra-abdominal pressure and at least one of the following symptoms: oliguria, decreased cardiac output, increased pulmonary-artery pressure, hypotension and acidosis. Measurement of the bladder pressure remains the method of choice to establish the abdominal pressure level. However, there is a lack of correlation between the measured pressure and the clinical condition of the patient. Therefore, the combination of clinical findings and the observed trend in serial measurements of the bladder pressure is preferred to a single pressure measurement.

Abdomen↗
PubMedDate not supplied

Unrecognised arterial injury of the forearm: a secondary bleed presenting as acute compartment syndrome.

This case describes an arterial injury that remained unrecognised for 3 days, when a sudden secondary bleed caused acute compartment syndrome of the forearm. We have been unable to find another case of compartment syndrome presenting in this manner. The importance of thorough wound exploration is highlighted and the diagnosis and treatment of the syndrome discussed.

Adolescent↗
PubMed2006

Abdominal compartment syndrome after late repair of bochdalek hernia.

Abdominal compartment syndrome is a potential complication of laparotomy, but it is rarely anticipated by thoracic surgeons. We present the case of a 16-year-old girl who manifested this syndrome after emergency repair of a Bochdalek congenital diaphragmatic hernia. Techniques for recognition, measurement, treatment, and prevention are discussed.

Abdomen↗
PubMed2003

[The effects of hyperbaric oxygen and surgical decompression in experimental compartment syndrome].

BACKGROUND: To determine the beneficial effects of adjuvant hyperbaric oxygen therapy (HBO) in an experimental compartment syndrome model. METHODS: Twenty Wistar albino male rats, weighing between 270-325 g. were divided into four groups as: Control, Fasciotomy, HBO and HBO-Fasciotomy. Rear legs of all animals were strangulated with a tourniquet for 4 hours. Fasciotomy was performed by double incisions. HBO protocol was set as: 6 sessions/day in the first two days, 4 sessions/day in the 3rd and 4th days. The intra-compartmental pressure and leg volume in all groups were measured daily. The legs of the sacrificed animals underwent histopathological examination. RESULTS: Fasciotomy was more effective than HBO to decrease leg volume and intra-compartmental pressure. The combination of HBO and fasciotomy was more effective than the single application of HBO and fasciotomy. The findings of inflammation and necrosis were less in the HBO group when compared with the fasciotomy and HBO-fasciotomy groups. This result was attributed to the higher risk of infection and mechanical damage in the groups with fasciotomy. CONCLUSION: Adjuvant HBO is beneficial in the treatment of compartment syndrome.

Animals↗