Case Of Compartment Syndrome Research Articles

Compartment syndrome of the leg after thyroid hormone withdrawal; two cases and a systematic review of the literature

BackgroundAcute compartment syndrome is a rare complication of severe hypothyroidism. If the symptoms are not recognized promptly and treatment initiated immediately, there is a high risk of permanent damage. Only few other cases of compartment syndrome due to hypothyroidism have been published and the exact pathophysiological mechanism remains unknown.Case presentationsA 59 year old male developed acute compartment syndrome of his right lower leg after thyroid hormone withdrawal prior to radioiodine remnant ablation after total thyroidectomy for follicular thyroid cancer. He underwent emergency fasciotomy of all four compartments of the lower leg. The muscle tissue in the anterior and lateral compartment was necrotic and was therefore excised. The second patient was a 62 year old female with Hashimoto’s thyroiditis, who developed acute compartment syndrome of both lower legs after thyroid hormone withdrawal due to non-compliance. Emergency fasciotomy of all four compartments of both legs was performed. The muscle tissue was viable in all compartments.ConclusionAlthough compartment syndrome due to hypothyroidism is uncommon, it is a complication physicians should be aware of. The majority of reported cases are caused by an acute withdrawal of thyroid hormones and not by undetected hypothyroidism. No previous case of compartment syndrome caused by an iatrogenic hormone withdrawal in preparation for radioactive iodine has been published. However, as shown in this report, it may be beneficial to inform patients of this rare complication prior to hormone withdrawal in preparation for remnant ablation after thyroidectomy.

Subacute compartment syndrome in case of gunshot injuries of the extremities

A local hypertensive ischemic syndrome or compartment syndrome (CS) is a serious complication of gunshot injuries of the extremities (GIE), it is usually considered as an acute process. However, we have repeatedly observed patients with subacute course of this pathology.Objective: to study cases of subacute CS (SaCS) with GIE, that are characterized by a latent course and veiled clinical picture of the complications.Methods: there were 15 cases of subacute CS after gunshot injuries for the period 2014–2018. 9 (60 %) were combined injuries of trunk and limbs, 6 (40%) — isolated limb wounds. Lesions of the lower extremities predominated — 10 (66.6 %). In 8 (53.3 %) patients, SaCS developed after shrapnel wounds of the limbs, and in 5 (33.3 %) cases — mine-explosive. Results: in 9 (60 %) cases, SaCS was observed in the bone-fascial sheath of the damaged area of the limb, in 6 (40 %) — in the adjacent segment. In 10 (66.6 %) patients, the course of SaCS was preceded by major vessels injury, in 8 (53.3 %) cases — it was combined with peripheral nerves injuries. In 12 wounded at the stages of evacuation, a tourniquet was used for more than an hour. In 5 cases, the course of SaCS was observed in patients with a combined wound of two or more anatomical sites with the development of a shock or prolonged hypotension. The time from the moment of injury to secondary surgical treatment, when the morphological signs of existed local hypertensive ischemic syndrome in bone-fascial sheath were identified, was from 5 days to 3 weeks.Conclusions: CS in case of GIE can have both acute and subacute flow patterns. SaCS usually develops in the intact segment of the injured limb without pronounced clinical manifestations. Risk factors for the course of SaCS: injuries of the main vessels, tourniquet for more than an hour, multilevel injuries with the development of a shock or prolonged hypotension, incomplete (untimely) fasciotomy at the evacuation stages.

Outcomes and Management of Peripheral Intravenous Infiltration Injuries.

Background: Although intravenous (IV) infiltration is relatively common, data regarding complications and outcomes of this problem remain limited. In addition, there is wide variation in institutional protocols for the management of IV infiltrations. Through retrospective review, we aim to delineate complications and outcomes, and propose an algorithm for the management of these injuries. Methods: We performed a retrospective review of all patients who had an IV infiltration at a tertiary care center's inpatient and outpatient facilities between January 1, 2016, and December 31, 2018. Results: In all, 479 patients with 495 infiltrations were included, with a mean age of 36.7 years. The upper extremity was involved in 89.6% of events. Of all the events, 8.6% led to a superficial soft tissue infection, 3.2% led to necrosis or eschar formation, and 1.9% led to ulceration or full-thickness wound formation. There were zero cases of compartment syndrome. Only 5.1% resulted in any long-term defects; none resulted in a functional defect of the extremity. Patients with vascular disease did not experience worse outcomes compared with healthy individuals. Plastic or orthopedic surgery was consulted in 25.3% of events. No emergent surgical intervention was required, 7 (1.4%) required bedside procedures, and 7 (1.4%) patients underwent nonacute operations. Conclusions: A specialist was consulted in about one-quarter of IV infiltrations, yet none were surgical emergencies. Instead, most complications could be monitored and managed by a primary team. Therefore, we propose algorithms involving nursing staff, wound care teams, and primary physicians with limited specialist consultation to manage these injuries.

Continuous stellate ganglion block for the effective management of ischemic pain following compartment syndrome of upper limb due to accidental intra-arterial injection

In the present era of advanced medicine and patient safe practice, accidental intra-arterial injection of drugs is a rare occurrence. Compartment syndrome (CS) is one of its most detrimental complications, which leads to loss of circulation, ischemia, myonecrosis, nerve damage, and limb loss. Rapid recognition and emergent fasciotomy to relieve the compartment pressure are imperative to prevent irreversible damage. Sympathetic blockade is one of the most common interventions used in the management of early stages of CS, which interferes with the pain cycle and improves distal flow by vasodilatation. We report a complicated case of CS of the right upper limb following accidental intra-arterial injection. The patient suffered with persistent ischemic pain despite surgical decompression, which was successfully managed by continuous stellate ganglion block.

Paratricepital approach for open reduction and internal fixation of delayed presentation of pediatric supracondylar humerus fracture

<p class="abstract"><strong>Background:</strong> Delayed presentation of pediatric displaced supracondylar humerus fracture is relatively common. Management of such cases have higher incidence of perioperative complications and usually require open reduction and pinning. Open reduction can be done by various approaches, each having its own advantage and disadvantages.</p><p class="abstract"><strong>Methods:</strong> A prospective study was done comprising 20 children with displaced Supracondylar fracture presented 2-14 days of injury, Mean patient age was 6 years. 15 were boys and 5 were girls. Children in whom closed reduction and percutaneous pinning was achieved, vascular injury and more than 2 weeks old fracture cases were excluded. Paratricepital approach was used for Open reduction and pinning for all the cases. The functional outcome was assessed using Flynn criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> In all cases the fracture had united at complete follow-up and the mean follow-up period was 16 months. The outcome was excellent in 15 (75%), good in 3 (15%), fair in 1 (5%), and poor in 1 (5%) patients. The mean Baumann angle was 76º in the affected elbow and 73º in the normal elbow. Average time for complete union in the current study was 7 weeks. Pin tract infection was seen in 2, stiffness in 2 patients, cubitus varus in 1 patient. No case of compartment syndrome or iatrogenic nerve injury was seen was recorded.</p><p class="abstract"><strong>Conclusions:</strong> Finally, we concluded that triceps sparing paratricepital approach is an easy, simple and safe approach for exposure and internal fixation of supracondylar humeral fractures in children with excellent functional outcome.</p>

Hyponatremia induced compartment syndrome of all extremities: Case report and review

Background: Compartment syndrome is a well-recognised complication from trauma, burns, orthopaedic, vascular, or other surgery of the limbs. Hyponatremia related rhabdomyolysis leading to compartment syndrome of all four extremities with renal and hepatic impairment is rare.1,2,3 Although the rhabdomyolysis can occur without hyponatremia. Young men have the highest incidence of compartment syndrome, particularly after long-bone extremity fractures and strenuous exercise.4,5 We present a case of compartment syndrome of all four extremities following a brief episode of recreational jogging. Case: A 39-year-old Indian male, known hypertensive on nifidipine and indapamide was presented to the emergency department with generalized weakness, lower leg pain and cramps for 3 days. He had jogged for 2 km in warm temperatures. His symptoms worsened and he was unable to walk. Other complaints were headache, pain in both arms, and passing dark coloured urine for two days. Both his calf muscles were tender, tense to feel, and painful on flexion and extension. Dorsalis pedis pulses were weak but palpable bilaterally. Capillary refill was less than three seconds and sensation were intact in both lower limbs. Oxygen saturation of toes on both feet was 99%. Other body systems were unremarkable. His respiratory rate was 20 min− 1, blood pressure 210/110 mmHg, temperature 36.6°C, oxygen saturation (SpO2) 99%. Initial biochemistry results were serum creatinine 142 umol.l− 1, myoglobin 5791 ng.ml− 1, creatinine phosphokinase 19032 U.l− 1, sodium: 124 mmol.l− 1, aspartate aminotransferase (AST) 167 U.l− 1, and alanine aminotransferase (ALT) 49 U.l− 1 (Table 1). Doppler ultrasound of leg vessels showed no evidence of deep venous thrombosis, echogenicity of the muscles in the thigh and lower leg appeared within normal limits. Rhabdomyolysis was diagnosed and rehydration begun with Hartman's solution 1000 ml followed by 125 ml.h− 1. The patient was admitted to the ward for continued hydration and analgesia to treat the pain. His leg pain worsened overnight despite intravenous analgesia. His pulse in both feet became feeble and renal and hepatic function worsened. Compartment syndrome was suspected and orthopaedic surgery was consulted. He had an emergency fasciotomy of all compartments and in all four limbs. Post-procedure pulse oximetry of digits and toes had a 99% saturation, but peripheral pulses remained weak. He was able to move fingers of both hands, but had no movement of his ankles and toes. The patient was transferred to the intensive care unit (ICU) for further management. His maintenance intravenous fluid was changed to 0.9% sodium chloride due to persistent hyponatremia. His wounds were re-explored and debrided on the fifth post-operative day. Wounds culture were growing pseudomonas aeruginosa that was treated with Meropenam according to the sensitivity. Six sittings of wound debridement and irrigation were performed. Over two weeks his renal function, liver function, and serum sodium concentration normalised (Table 1) without requiring renal replacement therapy. He was transferred to the ward on day 16 and discharged home to be followed in outpatient clinic. Conclusion: Physical exercise in the presence of hyponatremia can cause rhabdomyolysis and compartment syndrome of all extremities leading to multi-organ failure.

Outcome of Delayed Treatment of Supracondylar Elbow Fractures in Children in Hasan Sadikin Hospital Bandung and Santosa Hospital Bandung

Objectives:Supracondylar fractures of the elbow are common in children and percutaneous pinning usually advocated as a treatment for this kind of fracture. However, the treatment is often delayed in areas where healthcare resources are limited. The objective of this retrospective study was to assess functional outcomes after delayed treatment of supracondylar elbow fractures in children.Methods:We retrospectively reviewed the medical charts of 38 children aged 2 to 15 years in whom surgery for extension-type supracondylar elbow fractures was delayed by more than 1 week. The 22 boys and 16 girls with a mean age of 5 years 3 months had severe fracture displacement (12 stages III and 26 stage IV according to Lagrange and Rigault classification scheme). The mean time to treatment was 7 days (range: 1-4 weeks). Open reduction and crossed K-wire fixation via the posterior approach were performed in all patients. Functional outcomes were evaluated using Flynn’s criteria.Results:Outcomes were satisfactory in 31 (81,5%) of patients. At last follow-up after a mean of 3 months, three (7,8%) patients had limited in elbow motion. No case of compartment syndrome, surgical site infection and re-operation.Conclusion:Despite an average time to surgery of 16 days, the outcome was satisfactory in (81,5%) of cases. Delayed treatment was not associated with an increased rate of postoperative complications.

Severe malaria complicated by bilateral compartment syndrome of the forearms – A case report

Abstract We describe here the first reported case of compartment syndrome complicating malaria. Compartment syndrome has previously been reported secondary to a number of infectious aetiologies including meningococcal septicaemia, dengue fever, and primary infection of muscles in affected compartments. Capillary leakage in sepsis and localised inflammation in myositis have previously been hypothesised as pathophysiological mechanisms. The patient's muscular physique, owing to his bodybuilding hobby, likely predisposed to compartment syndrome in this case. Whilst sequestration of parasitized red blood cells in skeletal muscle has been previously reported it is unclear whether this could have contributed to the development of this unusual complication.

Opioid-related compartment syndrome and associated morbidity

IntroductionOpioid-related compartment syndrome (ORCS) is an understudied complication related to opioid overdose. We hypothesized that ORCS would be associated with worse clinical outcomes, including higher amputation rates, need for multiple surgical procedures, and rhabdomyolysis on admission, compared with nonopioid-related compartment syndrome (NORCS). MethodsWe used Current Procedural Terminology codes for fasciotomy as a proxy marker for cases of compartment syndrome treated at 1 health system from January 1, 2016, to December 21, 2018. We excluded patients younger than 18 years, those treated for exertional compartment syndrome, and those who underwent elective fasciotomies. Seventy-four patients met our inclusion criteria. Data reviewed included patient characteristics, cause of compartment syndrome, time until evaluation for compartment syndrome, peak creatinine kinase levels, number of surgical procedures required, duration of hospital stay, and postoperative inpatient morbidity and death. Patients were categorized as having ORCS (n = 8) or NORCS (n = 66). Alpha = .05. ResultsAll cases of ORCS occurred in men. Opioid use was the third most common cause of compartment syndrome. Two patients underwent amputation, both in the ORCS group (p < 0.01). The median number of debridements was significantly higher for the ORCS group (median, 4; interquartile range [IQR]: 3–6) than for the NORCS group (median, 3; IQR 2–4) (p = 0.03). Duration of hospital stay was longer for the ORCS group (median, 27 days; IQR 16–38) compared with the NORCS group (median, 9 days; IQR: 5–13) (p < 0.001). Mean (± standard deviation) peak creatinine kinase level was significantly higher in the ORCS group (224,000 ± 225,052 U/L) compared with the NORCS group (7550 ± 32,500) (p < 0.001). The proportion of patients who underwent hemodialysis was higher in the ORCS group (88%) than in the NORCS group (35%) (p < 0.001). All ORCS patients presented >8 h after immobilization in a dependent position. ConclusionPatients in the ORCS group had delayed presentations and significantly more morbidity compared with patients in the NORCS group.

Challenges in the management of floating knee injuries: Results of treatment and outcomes of 224 consecutive cases in 10 years

IntroductionFloating knee is a flail knee joint resulting from fractures of the shafts or adjacent metaphyses of the femur and the ipsilateral tibia. It is usually associated with several complications and mortality. This study was designed to present our experience with the treatment of this injury. Material and methodThis study was performed between January 2004 and December 2014. 224 cases of floating knee injuries gathered from the 34,480 lower extremities trauma files were studied, and the target information recorded. The injuries most frequently occurred in subjects between 16 and 35 years of age (60.71%), and in male subjects (85.71%). The most frequent mechanism of injury was traffic accident (92.85%). External fixation was the common type of treatment (82.14%) in emergency or as a definitive treatment. The treatment was performed within 24 h of the trauma. We performed a 36-month follow up with clinical examination, radiographs, assessing the complications, and using the Modified Cincinnati Rating System Questionnaire (MCRSQ) and the Karlström/Olerud Score (KOS) to evaluate the progression of the outcomes. ResultsEarly complications included 8 cases of compartment syndrome, 60 open fractures and 24 partially amputated limbs. A total amputation was performed in 3 patients. The most common late complication was heterotopic calcifications of the knee (n = 68, 30.6%). Good scores for MCRSQ and KOS were obtained only after patients were sent to a reference center for knee surgery. ConclusionsOur experience revealed that the complication rate associated with floatingknee injuries remains high, regardless of the performed treatment. Surgeons should focus on reducing complications while treating these severe injuries.

Fasciotomy in compartment syndrome from snakebite.

BackgroundLocal symptoms and signs of snake envenomation mimic the clinical features of compartment syndrome. It is important to measure the intracompartmental pressure to diagnose compartment syndrome. In this study, we present our experiences of confirming compartment syndrome and performing fasciotomy in snakebite patients based on high intracompartmental pressure findings.MethodsThe medical records of patients who visited the trauma center of Wonju Severance Christian Hospital from January 2010 to December 2015 for the management of venomous snakebite were retrospectively reviewed. Starting in 2014, fasciotomy was performed in patients with an intracompartmental pressure of more than 40 mmHg in addition to the clinical symptoms of compartment syndrome.ResultsA total of 158 patients with snakebite came to the hospital within 48 hours for treatment. Most patients (110 patients) were bitten at the upper extremities (69.6%). Since 2014, 33 out of 59 patients were suspected to have compartment syndrome, and their intracompartmental pressures were measured. Seventeen of those patients had a high intracompartmental pressure (average, 49.6 mmHg; range, 37–88 mmHg), and fasciotomy was performed. ConclusionsIn this study, as many as 10.8% of all cases were in need of fasciotomy when compartment syndrome was diagnosed by measuring the intracompartmental pressure. Previously, it was reported that fasciotomy was not required in many cases of compartment syndrome originating from snakebite. However, some patients may develop very severe compartment syndrome, requiring fasciotomy.

CSM 2019 American Academy of Sports Physical Therapy Poster Presentations (Abstracts SPO1–SPO132)

CSM 2019 American Academy of Sports Physical Therapy Poster Presentations (Abstracts SPO1–SPO132)

Identifying Complications and Optimizing Consultations following Transradial Arterial Access for Cardiac Procedures

The radial approach to cardiac procedures has become increasingly common. Although previous studies have suggested a favorable risk profile, serious complications can occur. The purpose of this study is to examine the incidence, subsequent treatment, and outcome of all suspected significant neurovascular complications following transradial cardiac procedures at a large US hospital. We reviewed all patients who underwent a left heart catheterization, coronary angiogram, or percutaneous coronary intervention via the transradial approach at a single large academic medical center in the United States between 2010 and 2016. Consultations to the vascular and hand surgery services were examined to assess demographic variables, risk factors, presenting symptoms, subsequent treatment, and outcome of all serious complications. A total of 9,681 radial access cardiac procedures were performed during the study period. Twenty-four cases (0.25%) were suspected to have major complications and subsequently received consults. A total of 18 complications were diagnosed, including 8 vascular injuries or perforations, 4 hematomas, 4 radial artery occlusions, 1 case of compartment syndrome, and 1 severe radial artery spasm. Of the complications noted, 3 (16.7%) required operative interventions, but all recovered neurovascular function. Radial artery access for cardiac procedures has become increasingly common and has been associated with a low rate of major peripheral neurovascular complications. The majority (83.3%) of complications were successfully treated with a nonoperative management algorithm.

Intravenous Infiltration Resulting in Compartment Syndrome: A Systematic Review.

To determine characteristics of patients who develop compartment syndrome (CS) from IV infiltration requiring surgical intervention. A systematic review was conducted of available English literature from 1990 to date. Key terms were entered into a MEDLINE search in addition to searching grey literature and references of included manuscripts. Inclusion criteria were cases of CS requiring surgical intervention from IV infiltration. Exclusions were cases associated with phenytoin because of the unclear mechanism leading to injury (purple glove syndrome). Cases were reviewed for demographics, clinical information, and outcomes. Literature search resulted in 32 manuscripts meeting inclusion with 51 cases. Age ranged from 3 days to 81 years (19.6% age <1 year [10/51], 21.6% age 1-18 years [11/51], and 58.8% age >18 years [30/51]). IV sites were reported in 43 cases: hand 46.5%, forearm 46.5%, foot 4.7%, and leg 2.3% ([20/43], [20/43], [2/43], [1/43]). Of the 42 cases reporting patient mental status, 76.2% (32/42) had impaired mental state or limited communication including young age defined as younger than 3 years. Common associated agents were contrast 36.2%, IV fluid 34%, and mannitol 8.5% ([18/47], [16/47], [4/47]). One patient required hand amputation, 5 had persistent deficits, 36 had no long-term deficits, and 9 cases did not report patient outcomes. Compartment syndrome affects patients of all ages with a significant number of patients being pediatric and specifically younger than 1 year. Patients at highest risk of developing CS requiring surgery from IV infiltration are likely to have barriers to communication.

A Case of Compartment Syndrome and Rhabdomyolysis After Alcohol Consumption

A Case of Compartment Syndrome and Rhabdomyolysis After Alcohol Consumption

Aesthetic Improvement of Undeveloped Calves After Treatment of Congenital Clubfoot Deformity.

Even when clubfoot deformity is treated in a timely manner, the consequences observed in adulthood include hypoplasia of the calf muscles, gait impairment, decreases in foot size, and it can also affect the tibial length. These consequences may have negative impacts on the patient's subjective appraisal of long-term outcomes, and can influence the patient's self-esteem in both male and female patients. We present our experience in the treatment of undeveloped calves after surgical treatment of congenital clubfoot. In total, 72 patients underwent corrective surgery in order to improve undeveloped calves resulting from a congenital clubfoot deformity. We used calf silicone implants in combination with fat grafting in multistaged procedures, in order to decrease complication rates and improve aesthetic outcome. Amongst our patients there were 54 (75%) females and 18 (25%) males. All of the patients, except one, had unilateral calf hypoplasia. The procedures were divided into several groups: (1) medial calf augmentation with silicone implants; (2) medial calf augmentation with silicone implants and fat grafting; and (3) medial and lateral calf augmentation with silicone implants and fat grafting. We had one case of a hyperpigmented scar and one case of partial scar dehiscence. There were no cases of compartment syndrome. The average follow-up period was 9.8 months. Calf enhancement surgery in patients with congenital clubfoot deformity is very gratifying. When combining calf implants with fat grafting in multistaged procedures, we can achieve excellent results with low complication rates.

Successful Treatment of Compartment Syndrome Following Animal Envenomation by Fasciotomy through Small Incisions, Case Reports

Three cases of compartment syndrome caused by Habu-Snake bite and stone fish sting are treated by fasciotomies through small skin incisions. In Okinawa, the most southern prefecture in Japan, many suffer animal envenomation including 140 cases of Habu-Snake bites. Some of them develop compartment syndrome but usually recover soon after the fasciotomy and take uneventful course if diagnosis is not delayed. Different from compartment syndrome caused by trauma, ischemia, or others, those caused by water-soluble toxins following animal envenomation were expected to be treated successfully with small incisions for fasciotomy. The consecutive three cases of compartment syndrome following Habu-Snake bite and stone fish sting had fasciotomies through 1.5 to 3 cm skin incisions, instead of long skin incisions which are usually made in the same length as the underlying compartment, under following close observations with high index of suspicion of recurrence. Through small skin incisions, compartment syndrome could be released completely and the wounds could be maintained uneventfully with negative pressure therapy without recurrence, infection, or contracture. This method should be considered as an option to treat compartment syndrome caused by animal envenomation and may allow victims to avoid large scars that they should carry for the rest of their life.

Outcomes of segmental tibia fractures treated with circular external fixation at a single centre in a developing world setting

Background: Segmental tibia fractures historically are treated with special consideration due to their complexity, high complication rate and the propensity for associated injuries. Circular external fixators (CEFs) offer several potential advantages in this situation due to their modularity and minimally invasive application. These advantages have been demonstrated in several developed countries but not as yet in the developing world. This analysis aimed to evaluate if these beneficial outcomes are reproducible in a developing world environment. Methods: We retrospectively assessed the data pertaining to skeletally mature patients who sustained segmental tibia fractures and were treated with CEFs between January 2008 to December 2015. These cases were performed in our tertiary hospital and overseen by a consultant with limb reconstruction experience. Union rates, time to union and complications encountered over a median of 10 months (range 6–20 months) follow-up period were among the outcomes measured. Results: Fourteen male and three female patients with a median age of 34 years were included. Sixteen patients (94%) were injured as a result of high energy trauma, nine patients (53%) had associated injuries, fourteen cases (83%) were compound injuries and there were no cases of compartment syndrome. Fifteen patients (88%) united with the use of the initial CEF at a median of 25 weeks (16–52 weeks), the two cases of non-union were treated with adjustments to the CEF and distraction across the affected fracture site with ultimate union. Two cases (12%) of superficial pin infection were encountered and one case (6%) of deep infection occurred after union of the fractures necessitating removal of the CEF. Three cases (18%) developed malunion. Conclusion: Circular external fixators used for segmental tibia fractures, when applied in a developing setting by clinicians with limb reconstruction experience, display a satisfactory union rate and acceptable complication frequency, as compared to that achieved in developed countries. Level of evidence: Level 4

Spontaneous compartment syndrome in a patient receiving oral anticoagulation therapy

Compartment syndrome (CS) is an emergency condition caused by muscle necrosis that can lead to locomotor dysfunctions. Intra-fascial bleeding of a limb due to direct trauma, reduction of fractures, or tight casting or bandages may cause acute CS. Although acute CS has many causes, few cases of spontaneous CS have been reported in the literature without any apparent reasons. We present a case of a 53-year-old male who had a spontaneous CS in his right forearm. There was no any evidence of acute major or minor repetitive trauma. He had a history of taking multiple anticoagulants due to previous femoral artery repair and still uses anticoagulants. After evaluation, we performed fasciotomy and removed an organized hematoma between the deep and superficial flexor tendons. The patient has recovered completely without any relapse at the 2-year follow-up. Detailed information should be given to patients who are taking anticoagulants about acute CS.

Patterns of botulinum toxin treatment for spasticity and bleeding complications in patients with thrombotic risk

The purpose of this study was to assess the prevalence of compartment syndrome or major bleeding episodes and compare compartment syndrome, patient and intervention characteristics in 110 patients with stroke (treated with Warfarin, new oral anticoagulants, antiplatelet, or no anticoagulants) treated for spasticity in deep leg compartment muscles with botulinum toxin injections [onabotulinumtoxinA (n = 77); incobotulinumtoxinA (n = 33)]. We reviewed 674 injection cycles (range 1–25 cycles per patient) and found no cases of compartment syndrome in any patient groups.