Perioperative Compartment Syndrome. A Report Of Four Cases*

Abstract

Compartment syndromes are usually seen following trauma to or arterial reconstruction of an extremity13,14,17,21,26,27. Since the mid-1970's, major improvements have been made in the devices used to irrigate wounds and joints and to infuse fluids. Occasionally, the use of pressurized devices to enhance the flow of fluid may be associated with the development of acute compartment syndromes. We report the cases of four patients in whom an acute compartment syndrome developed during an operative procedure and in whom a large amount of extravasated fluid was found in the soft tissue of the extremity that had been operated on. The compartment syndromes were believed to have resulted from the use of a pressurized pulsatile irrigation system (two patients), the use of a pump for the infusion of fluids into the joint during an arthroscopic procedure (one patient), and the use of a device for the pressurized intravenous infusion of parenteral fluids (one patient). We retrospectively reviewed the hospital records for each patient and obtained information about the nature of the original injury, the interval of time before the compartment syndrome developed, the reasons that a compartment syndrome was suspected, the method for the measurement of tissue pressure, and the treatment of the compartment syndrome. At the most recent follow-up evaluation, all four patients were examined by one of us to determine the functional outcome. CASE 1. A fifty-seven-year-old man who was right-hand dominant sustained a direct blow to the ulnar aspect of the right forearm, resulting in an open fracture of the diaphysis of the ulna; the defect of the skin was less than two centimeters. There was no clinical evidence of a compartment syndrome at the time of presentation. Approximately twelve hours after the injury, the patient was …