scholarly journals The Pathophysiology, Diagnosis and Current Management of Acute Compartment Syndrome

2014 ◽  
Vol 8 (1) ◽  
pp. 185-193 ◽  
Author(s):  
James Donaldson ◽  
Behrooz Haddad ◽  
Wasim S Khan
Keyword(s):  
Compartment Syndrome ◽  
Tissue Perfusion ◽  
Surgical Decompression ◽  
Acute Compartment Syndrome ◽  
Definitive Treatment ◽  
Interstitial Pressure ◽  
Compartment Pressure ◽  
Current Management ◽  
Ischaemic Damage

Acute compartment syndrome (ACS) is a surgical emergency warranting prompt evaluation and treatment. It can occur with any elevation in interstitial pressure in a closed osseo-fascial compartment. Resultant ischaemic damage may be irreversible within six hours and can result in long-term morbidity and even death. The diagnosis is largely clinical with the classical description of ‘pain out of proportion to the injury’. Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt. Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and optimizing tissue perfusion by keeping the limb at heart level. If symptoms persist, definitive treatment is necessary with timely surgical decompression of all the involved compartments. This article reviews the pathophysiology, diagnosis and current management of ACS.

scholarly journals Can Extravasation Injury Cause Subcutaneous Compartment Syndrome of the Hand?

2017 ◽  
Vol 3 ◽  
pp. 2513826X1772825
Author(s):  
Victor W. Wong ◽  
Philip J. Hanwright ◽  
Michele A. Manahan
Keyword(s):  
Compartment Syndrome ◽  
Tissue Perfusion ◽  
Acute Compartment Syndrome ◽  
Tissue Loss ◽  
Rapid Improvement ◽  
Subcutaneous Space ◽  
Cutaneous Perfusion ◽  
Compartment Pressures

Background: Compartment syndrome of the hand is a well-described phenomenon with potentially devastating consequences. Although numerous mechanisms have been proposed, the extravasation of peripheral intravenous (IV) fluids remains a relatively rare etiology. Objective: Surgical dogma mandates emergent decompressive fasciotomies in the presence of hand dysfunction and impending tissue loss from supraphysiologic compartment pressures. The role of the subcutaneous space in acute compartment syndrome remains unclear. Methods: In this report, we present a case of a dorsal hand IV extravasation leading to an acute compartment syndrome of the subcutaneous space. Results: An emergent skin-only incision was used for decompression, with immediate improvement in symptoms and no long-term adverse sequelae. Discussion: The subcutaneous space appears capable of sustaining supraphysiologic pressures that impair cutaneous perfusion. This closed anatomic space can be readily decompressed, resulting in rapid improvement in soft tissue perfusion. However, its role in contributing to acute compartment syndrome of the hand requires further research. Conclusion: We propose consideration of the subcutaneous space as a distinct hand compartment and advocate selective compartment release when prudent.

scholarly journals Bilateral compartment syndrome of the lower limbs after urological surgery in the lithotomy position: a clinical case

2019 ◽  
Vol 18 ◽  
Author(s):  
José Maciel Caldas dos Reis ◽  
Lauro José Mendes Queiroz ◽  
Pablo Ferreira Mello ◽  
Renan Kleber Costa Teixeira ◽  
Fábio de Azevedo Gonçalves
Keyword(s):  
Compartment Syndrome ◽  
Wound Closure ◽  
Early Recognition ◽  
Acute Compartment Syndrome ◽  
Lower Limbs ◽  
Lithotomy Position ◽  
Activity Levels ◽  
Urological Surgery ◽  
Baseline Activity

Abstract Acute compartment syndrome of the lower extremities after urological surgery in the lithotomy position is a rare but potentially devastating clinical and medicolegal problem. We report the case of a 67-year-old male who underwent laparoscopic prostatectomy surgery to treat cancer, spending 180 minutes in surgery. Postoperatively, the patient developed acute compartment syndrome of both legs, needing emergency bilateral four-compartment fasciotomies, with repeated returns to the operating room for second-look procedures. The patient also exhibited delayed wound closure. He regained full function within 6 months, returning to unimpaired baseline activity levels. This report aims to highlight the importance of preoperative awareness of this severe complication which, in conjunction with early recognition and immediate surgical management, may mitigate long-term adverse sequelae and improve postoperative outcomes.

scholarly journals Differences between primary and secondary osteosynthesis for fractures of the lower limb with acute compartment syndrome

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0003
Author(s):  
Christopher Ull ◽  
Dominik Seybold ◽  
Matthias Königshausen ◽  
Thomas Schildhauer ◽  
Jan Geßmann
Keyword(s):  
Soft Tissue ◽  
Length Of Stay ◽  
Compartment Syndrome ◽  
Infection Rate ◽  
Lower Limb ◽  
Acute Compartment Syndrome ◽  
Effective Procedure ◽  
Definitive Treatment ◽  
Primary Osteosynthesis ◽  
Classification Type

To analyze the differences between primary and secondary osteosynthesis for fractures of the lower limb with acute compartment syndrome (ACS). From our trauma database, we indentified a total number of 107 patients with 126 fractures of AO/OTA type 41 to 44 and 120 ACS from January 01, 2001 to December 31, 2015 who were treated with primary or secondary osteosynthesis after compartment incision. 71 patients with 77 fractures of AO/OTA classification type 41 to 44 suffering ACS received primary osteosynthesis after compartment incision (POCI) and were compared to 36 patients with 49 fractures of AO/OTA type 41 to 44 and ACS, who were treated by secondary osteosynthesis after compartment incision (SOCI). Patients with POCI showed a significantly shorter length of stay in the hospital with significantly less necessary surgeries for definitive treatment of the fractures and the soft tissue closure than SOCI patients (p < 0,001). The overall rate of infections in both groups were 13% without any difference between POCI and SOCI. The POCI of AO/OTA fractures type 41 to 44 with ACS is a safe and effective procedure for unilateral und single fractures of the lower limb without an increasing infection rate.

Evaluation of Strength Recovery after Traumatic Acute Compartment Syndrome of the Thigh. A Case Study

2017 ◽  
Vol 19 (4) ◽  
pp. 0-0
Author(s):  
Alban Fouasson-Chailloux ◽  
Pierre Menu ◽  
Marc Dauty
Keyword(s):  
Compartment Syndrome ◽  
Acute Compartment Syndrome ◽  
Intramuscular Pressure ◽  
Rehabilitation Care ◽  
Fracture Reduction And Fixation ◽  
Strength Recovery ◽  
Prompt Diagnosis

Acute compartment syndrome of the thigh is an underestimated serious pathology which can cause long term morbidities. The management, recovery and follow-up of the case of a 20-year-old Caucasian man, who presented an acute compartment syndrome of the thigh, are described. After femoral fracture reduction and fixation by nail, intramuscular pressure measurements confirmed the diagnosis before treatment by fasciotomies. 12-months’ follow-up showed the presence of neurological femoral complications and physical impairment in spite of rehabilitation care. Because compartment syndrome of the thigh after a trauma is rare but potentially devastating, prompt diagnosis is required for performing early fasciotomies.

scholarly journals Compartment pressure changes after closed fractures of tibia

2016 ◽  
Vol 2 (3) ◽  
pp. 188
Author(s):  
Manju G. Pillai
Keyword(s):  
Compartment Syndrome ◽  
Great Majority ◽  
Signs And Symptoms ◽  
Definitive Treatment ◽  
Compartment Pressure ◽  
Intracompartmental Pressure ◽  
College Hospital ◽  
Medical College ◽  
Closed Fractures ◽  
Upper Third

<p><strong>Background: </strong>Compartment syndrome is a potentially devastating situation. Raised intracompartmental pressure has been implicated as the primary pathogenic factor in compartment syndrome. The purpose of the study was early detection of compartment syndrome and corroborating the findings with other physical signs and symptoms, to prevent the onset of ischaemia and subsequent tissue changes that lead to crippling deformities.</p><p><strong>Methods:</strong> The present study was conducted in the Department of Orthopaedics, Pushpagiri medical college hospital, Thiruvalla over a period of 12 months.  Closed fractures of tibia admitted to the casualty unit within 36 hours of injury were selected for the study. A total of 24 patients were included with the majority in the age group of 31– 45 years. Whitesides technique was used to measure the compartment pressure. A differential pressure of less than 30 mm Hg was taken as the criterion for diagnosis of compartment syndrome. </p><p><strong>Results:</strong> The present study included 24 patients with affected 25 limbs.15 out of 25 limbs were with lower third fractures (60%) followed by upper third 6 (24%) and middle third 4 (16%). Out of 25 limbs 20 cases (80%) had associated fracture of fibula and 5 (20%) were not associated. In this study, out of 32% cases with increased compartment pressure, one case with upper third fracture (above 45 mm Hg) and one of the case with middle third fracture (20-30 mm Hg) with associated fibula had underwent immediate fasciotomy.</p><strong>Conclusion:</strong> Compartment pressure measurement is a very good index for predicting and preventing compartment syndrome. Fasciotomy to fully decompress all involved compartments is the definitive treatment for compartment syndrome in the great majority of cases. Delays in performing fasciotomy increase morbidity.

scholarly journals Acute upper limb compartment syndrome in children: special focus on nerve recovery

2020 ◽  
Vol 3 (3) ◽  
pp. e000158
Author(s):  
Terrence Jose Jerome
Keyword(s):  
Compartment Syndrome ◽  
Upper Limb ◽  
Full Range ◽  
Nerve Fibers ◽  
Surgical Decompression ◽  
Acute Compartment Syndrome ◽  
Time Interval ◽  
Special Focus ◽  
Sensory Recovery

BackgroundMany studies have discussed acute compartment syndrome in children associated with or without fractures and have given their visible perspectives. Little is known about the nerve involvement and the factors associated with recovery patterns in these patients. We intend to propose that ischemic nerve and muscles tend to regenerate after surgical decompression but in a different pattern and the given circumstances.MethodsTwenty-four children with acute compartment syndrome in the upper limb were analyzed between 2009 and 2015. Data included demographic features of these patients, the time interval between the injury and surgery, and the attempt to correlate with motor and sensory recovery.ResultsThe average follow-up was 67.3 months (range 59–80). Of the 24, 14 patients (58%) had immediate recovery of motor and sensory functions. The remaining 10 patients had variable recovery patterns with a mean time for the radial nerve, median nerve and ulnar nerve motor recovery of 6.0, 7.5 and 8.5 months, respectively, and sensory recovery at 12, 12 and 13 months, respectively. The overall study had a mean sensory recovery as per the Medical Research Council (MRC) of S3 in 3 (12%) and S4 in 21 (88%). The mean 2-point discrimination (2PD) was 6.9 mm (range 5–10). Twenty-one patients (88%) had a full range of movements at their final follow-up with a mean Visual Analog Scale score of 0.6; a quick Disabilities of the Arm, Shoulder and Hand score of 5.9 (range 2.3–25.0) and a Mayo wrist score of 79.ConclusionsThere was a definite motor and sensory recovery in patients who underwent surgical decompression in acute compartment syndrome of the upper limb irrespective of age, gender, delay in presentation and various etiologies. The motor and nerve fibers can regenerate after ischemic sequela of compartment syndrome.

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