Acute Forearm Compartment Syndrome Research Articles

Surgical site infection following fasciotomy in patients with acute forearm compartment syndrome: a retrospective analysis of risk factors.

Fasciotomy, a standard therapy for acute forearm compartment syndrome (AFCS), can prevent serious complications, but there may be significant postoperative consequences. Surgical site infection (SSI) may cause fever, discomfort, and potentially fatal sepsis. This study aimed to identify risk factors for SSI in AFCS patients who had undergone fasciotomy. Patients with AFCS who had fasciotomies between November 2013 and January 2021 were recruited. We collected demographic information, comorbidities, and admission laboratory results. Analyses of continuous data were conducted using the t-test, the Mann-Whitney U test, and logistic regression analysis, while analyses of categorical data were conducted using the Chi-square and Fisher's exact tests. Sixteen AFCS patients (13.9%) suffered infections that need further therapy. Using the logistic regression analysis, we identified that patients with a history of diabetes (p = 0.028, OR = 16.353, 95% CI (1.357, 197.001)), open fractures (p = 0.026, OR = 5.239, 95% CI (1.223, 22.438)), and a higher level of TC (p = 0.004, OR = 4.871, 95% CI (1.654-14.350)) were the best predictors of SSI, while ALB levels (p = 0.004, OR = 0.776, 95% CI (0.653-0.924)) were protective for SSI in AFCS patients. Our results showed that open fractures, diabetes, and TC levels were relevent risk factors for SSI following fasciotomy in patients with AFCS, allowing us to personalize the risk assessment and apply early targeted interventions.

Acute forearm compartment syndrome presenting 2 weeks after penetrating arterial trauma.

Acute forearm compartment syndrome presenting 2 weeks after penetrating arterial trauma.

Acute Forearm Compartment Syndrome Postdialysis

Postdialysis compartment syndrome is a rare but very devastating condition which needs emergent diagnosis and treatment. This can happen due to bleeding from puncture site due to inadequately applied pressure/coagulopathy. This case report illustrates a case of postdialysis pseudoaneurysm formation followed by forearm compartment syndrome. The patient was managed by emergency forearm fasciotomy and skin grafting along with rotation flap. This diagnosis should always be kept in mind when evaluating a patient with sudden onset of pain and swelling postdialysis. This will help in salvage of the patient's upper limb as well as of the precious arteriovenous fistula.

Complete Fasciotomy Using a Radial Approach for Acute Forearm Compartment Syndrome: A New Technique.

Acute forearm compartment syndrome is damaging but rare. Early treatment reduces mid and long-term sequelae. The palmar compartment is most frequently involved but the dorsal compartment and mobile wad are also at risk. Multiple fasciotomies approaches have been described but are associated with long-term complications. In particular, wound management is important. Mini-invasive techniques are not available for acute forearm compartment syndrome. Acute leg release via a single approach has been developed and proven effective. Likewise, we present a lateral S-shaped approach for fasciotomies of the 3 forearm compartments in the case of acute forearm compartment syndrome.

Acute compartment syndrome of the forearm associated with transradial coronary intervention.

This study documents our experience with acute forearm compartment syndrome after percutaneous transradial coronary artery intervention and suggests several strategies to achieve good results. A retrospective review identified the medical records of four patients with acute forearm compartment syndrome after transradial intervention who were treated by urgent fasciotomy. The mean time from the onset of symptoms to operation was 5.7hours. In three cases bleeding was from radial artery rupture at the puncture site, and one case was caused by brachial artery rupture at the level of the distal humerus and radial artery rupture at the level of proximal forearm. We obtained satisfactory results without any complications. If acute forearm compartment syndrome after transradial intervention is diagnosed, the site of bleeding should be identified preoperatively. Early surgical decompression produced satisfactory results even in elderly patients.Level of evidence: IV.

Factors Associated With Poor Outcomes in Acute Forearm Compartment Syndrome.

Background: There is limited literature on risk stratification of patients with acute forearm compartment syndrome. The primary objective of this study was to identify factors associated with poor outcomes in patients with acute forearm compartment syndrome. Methods: We retrospectively identified 130 patients with acute compartment syndrome of 130 forearms treated with fasciotomies from January 2000 to June 2015 at 2 Level 1 trauma centers. Poor outcome was defined as a composite variable, including: (1) death; (2) limb amputation; (3) persistent neurological deficit; and (4) contracture. Patient- and treatment-related variables were collected. Bivariate analyses were used to screen for variables associated with poor outcome, and explanatory variables with a value of P < .05 were included in our multivariable logistic regression analyses. Results: Of the 130 patients, 43 (33%) with acute forearm compartment syndrome had poor outcomes, including 5 deaths, 5 limb amputations, 21 persistent neurological deficits, and 31 contractures. Multivariable logistic regression analyses showed that elevated serum creatine kinase at presentation (P < .05) was associated with poor outcomes in patients with acute forearm compartment syndrome. Receiver operating characteristic curve analysis showed that a serum creatine kinase cutoff of 300 U/L yields 92% sensitivity and a serum creatine kinase cutoff of 10 000 U/L yields 95% specificity for poor outcomes in acute forearm compartment syndrome. Conclusions: Elevated creatine kinase levels above 300 U/L are a useful screening test for the highest risk patients with acute forearm compartment syndrome. Levels above 10 000 U/L may play a role in informed consent and counseling regarding expectations.

A cadaver study into the number of fasciotomies required to decompress the anterior compartment in forearm compartment syndrome.

There is no typical approach for decompression of forearm compartment syndrome, due to contradictory considerations regarding the characteristics of forearm anterior compartment deep fascia. The main purpose of this study was to determine how many fasciae should be opened to fully decompress the forearm anterior compartment. Further, the compliance of the deep anterior compartment was also investigated, to strengthen our results. An experimental study of a laboratory model of acute forearm compartment syndrome was performed. A deep forearm injection of egg white was undertaken to create an acute forearm compartment syndrome in sixteen non-embalmed human forearms from six male and two female donors. The pressure in the superficial and deep anterior compartments was recorded four times, both before and after each fasciotomy and the compliance of the deep anterior compartment was calculated for each step. The first incision of the superficial lamina of the deep fascia was not sufficient to decrease the elevated compartment pressure in the superficial and deep anterior compartments. Whereas the pressures decreased to near-baseline levels, following the fasciotomy of the intermuscular septum observed posterior to the flexor carpi radialis. The last incision of the deep lamina of the deep anterior fascia had no noticeable impact. These observations supported the hypothesis of high compliance of the deep anterior compartment. Two successive incisions were necessary to decompress the anterior compartment: the incision of the superficial lamina of the deep fascia and the incision of the intermuscular septum.

Acute Compartment Syndrome of the forearm in a patient undergoing coronary artery bypass surgery.

Sir, Compartment Syndrome is a life-threatening condition in which rapidly increasing interstitial pressures in a limb compartment compromise the vascular supply to the limb tissues, causing ischaemic tissue injury. If uncorrected, tissue necrosis may ensue, requiring limb amputation.[12] For the prevention of intraoperative compartment syndrome, the importance of an excellent intravenous access and constant visual monitoring of the catheter site is often stressed.[3] We report a unique case in which a patient undergoing coronary artery bypass surgery (CABG) developed forearm compartment syndrome intraoperatively after infusion of about 2000 ml of intravenous fluids via a peripheral 16 gauge intravenous cannula without showing any signs of resistance to flow. A 62-year-old male, known hypertensive and diabetic on medication, was taken up for CABG after a thorough pre-anaesthetic check-up. In the operation theatre, a peripheral vein (cephalic) on the flexor aspect of the right forearm was cannulated with a 16 gauge cannula in a single attempt without any difficulty and a normal saline infusion started. Flow was good without any signs of extravasation. The patient was then induced with intravenous fentanyl 150 μg, thiopentone 250 mg and vecuronium 8 mg through the same cannula. Radial arterial (left arm) and right jugular central line were inserted and positioning done for CABG with the arms tucked in by the side of the patient. After positioning, the flow to the peripheral vein was checked again and found to be satisfactory. Surgery was then started and proceeded as routine. During the surgery, the patient was infused about 1500 ml of crystalloids and 500 ml of colloid (tetrastarch). There was no resistance to flow in the peripheral vein at any point of time. When drapes were removed after the surgery, the patient's right arm was extremely tense and swollen with cyanosed fingers and absent pulses. A diagnosis of acute forearm compartment syndrome was made and a decision to do emergency fasciotomy of the forearm and upper arm was taken to salvage the limb. The limb was draped, and fasciotomy done along the entire length of the forearm and upper arm. The colour of the limb rapidly changed to red as the compartmental pressures reduced. The right arm was kept elevated to reduce the oedema by gravity. The limb circulation was monitored with a combination of limb colour, plethysmography tracing and capillary refill. The fasciotomy was closed on the 3rd day after a considerable amount of oedema had dissipated and capillary refill and plethysmography trace were normal for about 48 h. The patient was then shifted to the ward and recovered uneventfully. Acute forearm compartment syndrome due to intravenous fluid extravasation is uncommon, but many case reports of forearm compartment syndrome due to mannitol extravasation[34] and autologous blood transfusion[5] have been published. This case report highlights the fact that although obtaining a secure intravascular access, securing it properly and constant visual inspection of the cannula site[36] are of paramount importance; this is not always possible particularly in surgeries where the upper limbs are tucked by the patient's side as a part of surgical positioning. Due to the absence of resistance to flow, the compartment syndrome could be recognised only at the end of surgery when the drapes were removed. This case illustrates the fact that prompt recognition and treatment are vital for limb salvage in compartment syndrome. Time is the key when circulation to any tissue is compromised, and the forearm compartment syndrome is no exception.

Acute forearm compartment syndrome following haemodialysis access fistula puncture in uraemia.

Acute compartment syndrome is a well-described surgical emergency that requires immediate diagnosis and operative intervention. Vascular access-associated compartment syndrome is rarely reported in haemodialysis patients. The purpose of this article is to document evidence that catheter-related puncture, which results in arteriovenous fistula injury in uraemia, may cause acute forearm compartment syndrome. Between September 2007 and September 2012, five consecutive patients presented to our section with tense swollen forearms with skin blistering, decreased hand sensation and reduced capillary return in the fingers. Their ages ranged from 65 to 81 years (mean 72.8 years). All of the patients underwent emergent exploration after the diagnosis of acute forearm compartment syndrome. The patients' details were reviewed. The time interval between dialysis completion and return to the emergency department ranged from 6 to 9 h (mean 7.4 h). During operation, the bleeding was found to originate from the site of the fistula puncture and was repaired with 9-0 nylon suture under microscopy. After adequate wound care, a reconstructive procedure with a split-thickness skin graft was performed in all of the five patients. There was no vascular or neurological deficit of the forearm or hand within the mean follow-up period of 14.8 months (range 12-18 months). In this series, we report five cases of forearm compartment syndrome in uraemia, secondary to bleeding from a catheter-related puncture of a haemodialysis access fistula. However, there is no case series that focuses upon this specific topic in the present literature. This problem deserves more attention.

Forearm compartment syndrome caused by reperfusion injury.

Compartment syndrome is commonly seen following lower extremity ischemia. However, upper extremities' compartment syndrome, especially after any vascular surgical procedures, is infrequent. Herein we report a case of an acute forearm compartment syndrome that was developed after delayed brachial artery embolectomy.

Acute forearm compartment syndrome as first presentation of acquired haemophilia A with factor VIII inhibitor

Acute forearm compartment syndrome as first presentation of acquired haemophilia A with factor VIII inhibitor

Delayed compartment syndrome following brachiocephalic arteriovenous fistula formation in a hemodialysis patient

Delayed compartment syndrome following the surgical creation of an arteriovenous fistula (AVF) for vascular access is rare. A 71-year-old male patient experienced left anterior forearm compartment syndrome caused by a brachiocephalic AVF. The fistula failed after five days. Immediate radiological de-clotting failed and the thrombosed fistula was de-clotted with the help of a Fogarty balloon. On Day 11, the patient developed symptoms and signs of acute anterior forearm compartment syndrome and underwent immediate surgical decompression of the superficial and deep flexor compartments, which resulted in an excellent outcome. Iatrogenic forearm compartment syndrome is a rare but potential complication after creation of AVF. The critical errors regarding compartment syndrome are failure to recognize or failure to act. This case report illustrates that swift diagnosis and immediate surgical intervention results in an excellent outcome and avoids the morbidity associated with this potentially devastating and debilitating process.

Acute Compartment Syndrome of the Forearm: Duckworth A, Mitchell S, Molyneux S, White TO, Court-Brown CM, McQueen MM. J Bone Joint Surg Am 2012;94:e63.

Forearm compartment syndrome is rare, but is associated with significant morbidity. This retrospective case series out of Edinburgh, United Kingdom identified cases of acute forearm compartment syndrome that were treated with decompressive fasciotomy. The goals were to obtain a better understanding of the etiology and characteristics of forearm compartment syndrome and to identify risk factors for complications after fasciotomy.

A single volar incision fasciotomy will decompress all three forearm compartments: A cadaver study

IntroductionAlthough there are three distinct compartments of the forearm, the typical approach for decompression of forearm compartment syndrome is a single incision fasciotomy of the volar compartment. This study had two purposes. The first purpose of this study was to investigate the compartment pressure changes within the forearm compartments following the creation of an acute compartment pressure using fresh-frozen cadaver forearm specimens. The second purpose was to compare the compartment pressure changes of the volar, dorsal, and mobile wad compartments at frequent intervals following a compartment fasciotomy of the forearm. Materials and methodsAn experimental study of a laboratory model of acute forearm compartment syndrome was performed at a level-one, university-based trauma centre. Eight non-embalmed human forearms from 5 male and 3 female donors with an average age of 71 years (range, 51–91) were used. Compartment pressures in the volar, dorsal, and mobile wad compartments were recorded both before fasciotomy and 1, 10, 20, and 30min after fasciotomy. ResultsA single incision volar fasciotomy was sufficient to decrease the elevated compartment pressures in the volar, dorsal and mobile wad compartments to near-baseline levels after 10min. The mean compartment pressures 30min post-fasciotomy in the volar, dorsal, and wad compartments were 2, 4, and 3mmHg, respectively. DiscussionIn a laboratory model of an acute forearm compartment syndrome, a single compartment fasciotomy may be sufficient to decrease compartment pressures in the non-released compartments (dorsal and mobile wad). Further study is necessary before changes in clinical management can be recommended.

Acute Compartment Syndrome of the Forearm

The aims of this study were to document our experience with acute forearm compartment syndrome and to determine the risk factors for the need for split-thickness skin-grafting and the development of complications after fasciotomy. We identified from our trauma database all patients who underwent fasciotomy for an acute forearm compartment syndrome over a twenty-two-year period. Diagnosis was made with use of clinical signs in all patients, with compartment pressure monitoring used as a diagnostic adjunct in some patients. Outcome measures were the use of split-thickness skin grafts and the identification of complications following forearm fasciotomy. There were ninety patients in the study cohort, with a mean age of thirty-three years (range, thirteen to eighty-one years) and a significant male predominance (eighty-two patients; p < 0.001). A fracture of the radius or ulna, or both, was seen in sixty-two patients (69%), with soft-tissue injuries as the causative factor in twenty-eight (31%). The median time to fasciotomy was twelve hours (range, two to seventy-two hours). Risk factors for requiring split-thickness skin-grafting were younger age and a crush injury (p < 0.05 for both). Risk factors for the development of complications were a delay in fasciotomy of more than six hours (p = 0.018) and preoperative motor symptoms, which approached significance (p = 0.068). Forearm compartment syndrome requiring fasciotomy predominantly affects males and can occur following either a fracture or soft-tissue injury. Age is an important predictor of undergoing split-thickness skin-grafting for wound closure. Complications occur in a third of patients and are associated with an increasing time from injury to fasciotomy.

Experimental study into forearm compartmental pressures

IntroductionChronic compartment syndrome is well recognised, although rare in the forearm. In our chronic compartment syndrome clinic, we successfully identified and treated four cases. This prompted a literature review searching...

Experimental Study of Forearm Compartmental Pressures

Chronic compartment syndrome is well recognized, although it is rare in the forearm. Diagnosis is based on history, clinical examination, and compartment pressure readings. Existing normal pressure ranges for the forearm are based on lower limb measurements. This study aimed to establish normal pre- and post-exercise forearm compartment pressures. Using a Stryker intracompartmental pressure monitor (Stryker, Kalamazoo, MI), 41 volunteers had pressure measurements of the extensor and flexor forearm compartments before and after exercise. Normal ranges were established for pre-exercise extensor compartment (2-27 mm Hg; upper confidence interval [CI] 18.8-25.2 mm Hg), post-exercise extensor compartment (2-24 mm Hg; upper CI 16.8-22.8 mm Hg), pre-exercise flexor compartment (1-19 mm Hg; upper CI 13.3-17.4 mm Hg), and post-exercise flexor compartment (0-19 mm Hg; upper CI 16-21.4 mm Hg) pressures. No significant difference was found between pressures before and after exercise. There was no correlation between whether pressures increased or decreased following exercise. There was a significant gender difference. Normal ranges were 0 to 25.2 mm Hg for the extensor compartment and 0 to 21.4 mm Hg for the flexor compartment. This study has shown a significant difference in normal forearm compartment pressures between genders. A normal reference range of flexor and extensor forearm compartment pressures to aid diagnosis of chronic compartment syndrome has been determined. This might also prove useful in aiding the diagnosis of acute forearm compartment syndrome.

Acute Compartment Syndrome of the Forearm following Autologous Blood Reinfusion: A Case Report

Compartment syndrome is a condition with multiple reported etiologies, and permanent disability may ensue if not treated in a timely fashion. We report the first case, to our knowledge, of acute forearm compartment syndrome caused by intravenous autologous blood reinfusion. The patient underwent forearm fasciotomy, and hematoma was encountered deep to the superficial volar fascia, presumably extravasated from the reinfusion catheter. With the rise in the number of knee and hip arthroplasties, surgeons need a heightened awareness of the possible complications and morbidity associated with a presumed increase in autologous blood reinfusion.

Acute Forearm Compartment Syndrome Secondary to Local Arterial Injury After Penetrating Trauma

Acute compartment syndrome (ACS) is a well-described surgical emergency that requires an immediate diagnosis and emergent operative intervention. Failure to either make the diagnosis or to implement the appropriate treatment quickly can result in severe long-term morbidity. The purpose of this article is to document evidence that penetrating trauma which results in arterial injury may cause acute forearm compartment syndrome. As a result, this mechanism should alert surgeons to the possibility of acute compartment syndrome secondary to arterial injury. A retrospective review of all penetrating trauma patients treated at our Level 1 Trauma Center was performed within 2001 and 2005. Patients who sustained penetrating injuries to the forearm were reviewed in detail and all patients diagnosed with acute forearm compartment syndrome in this setting were included in this article. Five cases of ACS of the forearm secondary to a mechanism rarely described in the surgical literature were documented over five years. All cases in this series were the result of a named forearm arterial injury sustained by penetrating trauma. Every patient in this article was taken emergently to the operating room for a fasciotomy following diagnosis. This article establishes the incidence of a specific mechanism of ACS in our penetrating trauma population. As a result of these findings, a thorough evaluation of the forearm vasculature and a careful search for arterial injury is recommended at the time of fasciotomy. Securing a rapid diagnosis and executing early definitive management will result in fewer devastating long-term outcomes.

Acute Forearm Compartment Syndrome Secondary to Digit Avulsion Injury

Patients with mutilating hand and finger injuries often present first to orthopaedic, plastic, or general surgeons covering emergency room call and sometimes present only by telephone consultation. The present report describes a patient who presented with a severe finger avulsion in whom the most urgent issue was an ipsilateral forearm compartment syndrome secondary to the avulsion. The patient was informed that data concerning the case would be submitted for publication, and he consented. A fifty-five-year-old man was using a high-speed rotary tool, which caught a nylon cord that became wrapped around the right, dominant index finger. He presented to the emergency room with an open dislocation of the proximal interphalangeal joint. The soft tissues were nearly circumferentially avulsed (Fig. 1). Distally, the finger was dusky and insensate. The remaining fingers had normal color and capillary refill. The patient was otherwise healthy and denied taking any regular medications, including Coumadin (warfarin) and anti-inflammatory medications. Fig. 1 Near circumferential degloving injury of the index finger. The patient complained of severe and worsening pain in the forearm and required 8 mg of intravenous hydromorphone in one hour. Physical examination revealed tense swelling and tenderness, which was greatest at the volar aspect of the middle part of the forearm and was worse with passive extension of the uninjured digits. He also complained of numbness in the median and ulnar nerve distributions, where he had corresponding decreased sensibility on examination. Radial and ulnar pulses were palpable at the wrist. Radiographs of the hand reflected dislocation of the proximal interphalangeal joint of the …