Compartment Pressure Measurements Research Articles

Upper extremity compartment syndrome after minor trauma: an imperative for increased vigilance for a rare, but limb-threatening complication

BackgroundCompartment syndrome of any extremity is a limb-threatening emergency requiring an emergent surgical management. Thus, ruling out compartment syndrome is often high on the list of priorities when treating high-energy injuries and fractures. However, even in the most seemingly benign injuries, this dangerous diagnosis must always remain on the differential and suspicion must remain high.Case presentation23-year-old factory worker presents after a low energy entrapment injury to his left forearm. Initial work-up and evaluation noted an isolated radial head dislocation with a normal physical motor and sensory exam. However, maintaining high suspicion for compartment syndrome despite serial normal physical exams, led objective compartment pressure measurement leading to definitive diagnosis. Emergent surgical intervention via compartment fasciotomies was performed, along with closed reduction and ligament repair. At 1 year follow-up, the patient was well-healed, back to work with full range of motion and not activity limitations.ConclusionDespite a seemingly benign injury pattern, and a relatively low energy mechanism, vigilant concern for compartment syndrome following any kind of entrapment injury should initiate serial examinations and compartment pressure measurements especially in circumstances with continued swelling and inability to perform an accurate clinical assessment due to an obtunded or medicated patient.

Serum creatine kinase levels are associated with extremity compartment syndrome

Limb compartment syndrome (CS) is a difficult diagnosis. Accurate measurement of compartment pressure is user dependent, and there is no consensus on values to define CS. Given the prevalence of extremity CS, difficulty in timely diagnosis, and ramifications of a delay in diagnosis, a precise and reliable means for early diagnosis is needed. The purpose of our study was to determine if a threshold serum creatinine kinase (CK) level is associated with the development of CS. All patients with isolated tibial/fibula fractures or extremity CS admitted to a three-hospital consortium from July 1, 2001, to June 30, 2011, were identified retrospectively using coded data. Age, basic metabolic panel, lactic acid, CK, and troponin I levels were abstracted. Univariate and multivariate regression analysis was undertaken using maximum and minimum values for each laboratory test to evaluate the association between the test and CS versus tibia/fibula fracture. Of the 97 patients in the study, 39 had CS. Tests most strongly associated with CS were maximum CK, minimum calcium, minimum blood urea nitrogen (BUN), maximum chloride, maximum lactate, and minimum HCO3. On univariate analysis, only maximum CK had adequate correlation with CS. Optimal cut points were maximum CK of greater than 4,000 U/L. Using the model CK level of greater than 4,000 U/L, chloride level of greater than 104 mg/dL, and BUN level of less than 10 mg/dL, 0 of 6 patients had CS when all three variables were absent. When one, two, or three variables were present, the percentage of patients with CS was 36%, 80%, and 100%, respectively. Using a cut point of two or more of these three variables being positive produced sensitivity, specificity, positive and negative prediction values, and total accuracy of 0.85, 0.87, 0.76, 0.92, and 0.86, respectively. CK level greater than 4,000 U/L is associated with CS. A model combining maximal CK level greater than 4,000 U/L, maximal chloride level greater than 104 mg/dL, and minimal BUN level less than 10 mg/dL has a 100% association with CS. Diagnostic study, level III.

Functional Outcomes and Patient Satisfaction After Fasciotomy for Chronic Exertional Compartment Syndrome

Background: Patients with chronic exertional compartment syndrome who have failed nonoperative treatment are evaluated with pre-exertion and postexertion compartment pressure testing and may be treated with fasciotomy. Failure rates of up to 20% have been reported and may be related to factors such as age, sex, postexertion compartment pressures, compartment(s) released, and duration of symptoms. Hypothesis: Higher preoperative postexertion compartment pressures are correlated with higher success and patient satisfaction rates after fasciotomy. Study Design: Cohort study; Level of evidence, 3. Methods: From 1999 to 2008, patients with clinical symptoms of chronic exertional compartment syndrome with failed nonoperative management underwent standardized pre-exertion and postexertion compartment pressure measurements. Patients were then offered continued nonoperative treatment or referral to an orthopaedic surgeon for compartment release. Patients with a minimum 2-year follow-up were given a telephone questionnaire describing their pretreatment and posttreatment conditions including quality and duration of symptoms, analog pain scale, symptomatic and functional responses to treatment, and satisfaction with treatment. Medical records and operative reports were reviewed. Results: The mean follow-up period for the nonoperative treatment group (n = 27) was 5.6 years (range, 2.1-10.6) and for the operative group (n = 73) was 5.2 years (range, 2.0-11.3). The operative group had a higher success rate (81%) compared with the nonoperative group (41%) (P < .001), and the operative group had a higher patient satisfaction rate (81%) compared with the nonoperative group (56%) (P = .011). There was no significant correlation between compartment pressures and patient outcomes. Patients with combined anterior and lateral compartment releases had an increased failure rate compared with isolated anterior release (31% vs 0%, respectively; P = .035). Surgical patients who were post-college had a lower satisfaction rate (66%) compared with high school (89%) and college patients (94%) (P = .017). Conclusion: High school and college patients (age <23 years) and isolated anterior compartment release (compared with anterior/lateral release) were factors associated with improved subjective function and satisfaction after fasciotomy. We recommend the avoidance of lateral release unless symptoms or postexertion compartment pressures are clearly indicative of lateral compartment involvement.

Compartment Pressure Measurements Have Poor Specificity for Compartment Syndrome in the Traumatized Limb

BackgroundOsseofascial compartment syndrome is defined by ischemic necrosis of muscle caused by elevated pressure within fascial compartments. The diagnosis can be made either clinically or through compartment pressure measurements. Compartment pressure above 30 mm Hg was traditionally used as the threshold for diagnosis of compartment syndrome, but was challenged due to a high number of false-positive results. Perfusion pressure (diastolic blood pressure − compartment pressure) <30 mm Hg came to be promoted as a confirmatory diagnostic test. ObjectiveThe objective of this article is to review the specificity of perfusion pressure for compartment syndrome in the acutely traumatized limb. DiscussionPerfusion pressure has been shown to generate false-positive results in 18–84% of patients with tibial fractures. Two studies showed that not a single patient with measurements qualifying for fasciotomy actually needed the procedure. ConclusionBoth absolute compartment pressure and tissue perfusion pressure generate a high rate of false-positive results in the acutely traumatized limb. An alternative diagnostic test or process is needed to prevent overtreatment. In the meantime, emergency medicine and orthopedic surgery textbooks and guidelines should promote awareness of the limitations of the test.

Comparison of tissue oxygenation and compartment pressure following tibia fracture

ObjectiveWe investigated the ability of direct continuous measurement of intramuscular tissue oxygenation (PmO2) to detect acute ischaemia in the leg in patients at risk for acute extremity compartment syndrome. Following tibia fracture treated by intramedullary nailing, we compared the proportions of PmO2 and compartment pressure (CP) measurements that met the warning criteria for compartment syndrome. MethodsParticipants included 10 patients sustaining acute isolated closed tibia shaft fractures treated by intramedullary nailing. A tissue oxygenation probe and a CP probe were percutaneously placed into the anterior compartment of the leg. PmO2 and CP in the anterior compartment were measured in the injured leg for 48h postoperatively. Measurements meeting the warning criteria were defined as PmO2<10mmHg, CP>30mmHg and perfusion pressure ΔP<30mmHg. ResultsNone of the patients developed compartment syndrome. Comparison of CP and PmO2 showed a CP>30mmHg in 50.39% of CP measurements in all patients and a PmO2<10mmHg in 0.75% of PmO2 measurements in two patients (P=0.005). Comparison of ΔP and PmO2 showed a ΔP<30mmHg in 31.01% of ΔP measurements in nine patients and a PmO2<10mmHg in 0.76% of PmO2 measurements in one patient (P=0.01). ConclusionIn the absence of compartment syndrome, pressure measurements following tibia fracture treated with intramedullary nailing often met the warning criteria, whereas PmO2 did not, suggesting that measurement of intramuscular tissue oxygenation may represent a potential method for the identification of acute compartment syndrome that deserves continued investigation.

Venomous Bites and Stings

Fasciotomy has been described in the treatment of rattlesnake-envenomation. We sought to compare the characteristics of patients undergoing fasciotomy with those where fasciotomy was discussed but not performed.A retrospective case-series constructed from a single-statewide-poison-system electronic database for cases of fasciotomy discussion or completion in rattlesnake-envenomation between January 2001 and May 2012. Age, gender, bite location, antivenom administered, compartment pressure measurements, Snakebite Severity Score (SSS) and length of hospitalization (LOS) were recorded. Comparisons were made between fasciotomy completed and where fasciotomy was only discussed.One-hundred-five cases of fasciotomy discussion or completion were identified. Fasciotomy was performed in 28 cases (27%). There was no statistically significant difference (p > 0.05) between groups in age, gender, bite site, SSS, and total number of vials of antivenom administered. Only 2 of 28 (7%) had compartment pressure measurements. Patients undergoing fasciotomy spent an additional 2 days in the hospital.Fasciotomies continue to take place, without compartment pressure measurements, and without repeat dosing of antivenom. In the absence of clear objective evidence that limb-threatening compartment syndrome occurs despite adequate antivenom administration, fasciotomy does not favorably impact morbidity and may be associated with increased costs for care following rattlesnake envenomation.

Foot Compartment Syndrome: A Rare Presentation to the Emergency Department

BackgroundCompartment syndrome of the foot is a rare but life- and limb-threatening condition that is often difficult to diagnose. The common signs and symptoms of compartment syndrome are pain out of proportion to the injury, pain with passive stretch of the compartment, paresis, paresthesias, and often, intact pulses. Foot compartment syndrome is often caused by traumatic injuries, and the clinical presentation may be confusing in this setting. The foot contains nine compartments, which should all be assessed for elevated compartment pressures. Definitive management is fasciotomy. Prompt recognition, diagnosis, and treatment are essential to prevent devastating complications. ObjectivesThis article discusses the key components of presentation, diagnosis, and management of foot compartment syndrome. Case ReportA patient presented to the Emergency Department (ED) with a crush injury of his foot. He had significant swelling and pain in his foot, but no fractures were identified on X-ray study. Given the severity of his injury and pain, foot compartment pressures were measured to accurately diagnose foot compartment syndrome. The patient underwent fasciotomies of the foot within 3 h of presentation to the ED and suffered no sequelae at the time of follow-up in clinic. ConclusionFoot compartment syndrome is a surgical emergency that can be difficult to diagnose. Early diagnosis with compartment pressure measurements is crucial, as definitive management with fasciotomies can prevent long-term sequelae.

REAMED TIBIAL INTERLOCK NAILING;

Objective: The objective is to measure preoperative and postoperative compartment pressure in reamed tibial interlock nailingusing Whitesides infusion technique. Duration: This study is carried out from September 2007 to August 2008 Setting: Department ofOrthopedic and Spine Surgery of Hayatabad Medical Complex Peshawar Material and Methods: Thirty consecutive patients that werecandidates for closed reamed interlock nailing of the tibia and there compartment pressure were measured preoperatively and postoperativelyby Whiteside infusion technique. Results: Average age of patient was 35 years. Male were 26(86.66%) and female were 4(13.34%). Therewere 12(40%) type A and 18(60%) type B fractures according to Orthopedic Trauma Association (OTA) AO classification. Twenty seven (90%)factures were due to motor vehicle accident and 3(10%) were due to fall. The minimum preoperative pressure in superficial posteriorcompartment was 7 millimeter of mercury (mm Hg), deep posterior compartment was 10 mm Hg, anterior compartment was 10 mm Hg, lateralcompartment was 10 mm Hg while maximum pressure in was 25, 25, 25 and 25 mm Hg respectively. The maximum post operative pressure insuperficial posterior compartment was 10 mm Hg minimum and 25 mm Hg maximum, deep posterior compartment was 15 and 28 , anteriorcompartment was 15 and 30 and in lateral compartment was 10 mm Hg minimum and 30 mm Hg maximum. The minimum diastolic bloodpressure was 65 and maximum was 90 mm Hg. Conclusions: Compartment pressure measurement by Whitesides’ infusion technique is asimple and effective method for monitoring the intracompartmental pressure. It avoids unnecessary fasciotomy that has an extra morbidity interms of infection and skin coverage.

Two Cases of Thenar Compartment Syndrome from Blunt Trauma

BackgroundCompartment syndrome is a limb-threatening complication associated with extremity trauma. The existence of compartment syndrome involving the thenar space is considered controversial and has not been reported in association with blunt traumatic injury of the hand. ObjectiveWe report two cases involving compartment syndrome of the thenar space in association with blunt trauma to the hand. Case ReportPatient A was a young man who suffered a fracture/dislocation of the right thumb after a fall. Compartment pressures were measured at 70 mm Hg in the thenar space. The patient underwent successful fasciotomy and K-wire stabilization of the thumb and was ultimately discharged with good function on day 4. Patient B suffered a crush injury of the right hand and presented with diffuse swelling associated with median nerve paresthesia. Radiographs revealed a fracture of the triquetrum and of the base of the third metacarpal bone. The patient underwent multiple fasciotomies of the hand, including a release of the thenar space. He was discharged on day 2 with improving function of his thumb. ConclusionCompartment syndrome of the thenar space may be more common than previously reported. Given the limited time frame after which permanent damage occurs, clinicians should consider measurement of thenar compartment pressures in high-risk injuries.

A RAPID AND CONVENIENT METHOD FOR DETERMINING LIMB COMPARTMENT PRESSURE

Compartment syndrome (CS) is the pressure increasing within a confined anatomic space, which results in ischemia to the encompassed tissues and then leads to cells death. If left untreated, CS results in irreversible cell damage, further permanently postischemic scarring and contracture. The intracompartmental pressure is a major diagnostic consideration. Various methods of compartment pressure (CP) measurement have been developed since the late 1800s. They can be classified into invasive and noninvasive categories. Invasive methods are accurate but painful; whereas noninvasive approaches are more comfortable but less accurate. Both methods provide reproducible outcomes but also require specific CP measurement instrument to be performed. This research proposes a rapid and convenient method via examining ultrasonographic fascia wall displacement. For the viscoelastic nature of the compartment fascia, our experiment results have shown the ultrasonographic fascia displacement accurately reflects even small changes of the compartment diameter. There is a strong correlation between compartment pressure and fascia displacement ratio. It also recommends that the ratio of 1.4 could be chosen as the critical value for determining acute compartment syndrome. These results suggest that ultrasonography may serve as an adequate noninvasive tool to monitor CP variations.

Spontaneous compartment syndrome of the foot

Compartment syndrome of the foot is usually associated with trauma, and if untreated may result in deformity and loss of function. We report a case of spontaneous compartment syndrome of the foot presenting with severe unremitting pain. The diagnosis was supported by measurements of compartment pressures and the symptoms resolved after surgical decompression. Spontaneous compartment syndrome in the leg has been described in a small number of cases, but there has been no previous report involving the foot. We believe that this case highlights the importance of suspecting a spontaneous compartment syndrome of the foot if the appropriate symptoms are present but there is no clear cause. We also believe that compartment pressure measurement assists in the decision to undertake surgical decompression.

Le syndrome chronique des loges. À propos d’une série de 234 patients opérés

Diagnosis of chronic compartment syndrome of the lower leg, which occurs in a young and athletic population, is often delayed. We studied postoperative outcomes after fasciotomy in patients with compartment syndrome in order to identify specific postoperative complications. Long-term functional outcomes were also evaluated. All patients with a diagnosis of chronic exercise-related compartment syndrome of the lower leg who underwent surgery from January 1985 to August 2009 were studied prospectively. The type of compartment and whether surgery was uni or bilateral was recorded. One year after surgery, patients completed a questionnaire to evaluate their functional outcome. Two hundred and thirty-six compartment procedures were performed in 234 patients. Only one compartment (constantly the superficial posterior compartment) was treated in 56/236 (23.7%) procedures. Two compartments (anterior and lateral) were involved in 90/236 procedures (38.1%). Three compartments (anterolateral and superficial posterior) were noted in 74/236 procedures (31.4%) and four compartments (anterolateral and superficial and deep posterior) were described in 6.8%. Involvement of the deep posterior compartment was always associated with another compartment. Surgery was bilateral in 70% of patients. The questionnaire response rate was 65%. The success rate of fasciotomy was 68.4% and a significant improvement was reported by 23.9% of responders; outcome was unsatisfactory for 7.7%. The diagnostic criteria used to confirm chronic exercise-related compartment syndrome of the lower leg were based on the compartment pressure measurement after exercise. In this study, all patients underwent fasciotomy. The surgical technique was standardized. Outcomes have been satisfactory with few surgical complications.

Evaluation and Management of Peripheral Vascular Injury. Part 1. Western Trauma Association/Critical Decisions in Trauma

This is a position article from members of the Western Trauma Association (WTA). Because there are no prospective randomized trials on the evaluation and management of peripheral vascular trauma, the algorithm (Fig. 1) is based on the expert opinion of WTA members and published observational studies. It may not be applicable at all hospitals caring for injured patients. The algorithm contains letters that correspond to lettered text that is intentionally concise. This Part I algorithm emphasizes evaluation, diagnosis, and need for operation versus a therapeutic procedure performed in interventional radiology, while a Part II algorithm (2011) will focus on operative techniques. Peripheral vascular injures defined as axillobrachial and branches in the upper extremity and femoropopliteal and branches in the lower extremity account for 40% to 75% of all vascular injuries treated in civilian trauma centers.1–4 With the exception of the axillary artery, the long tracks of named arteries and veins in the extremities make them particularly susceptible to either penetrating or blunt trauma. This fact coupled with the smaller diameter of many of these vessels (as compared with those in the thorax or abdomen) and the ability of the patient and others to control external hemorrhage with compression contribute to a low incidence of death in the field.

Acute exertional medial compartment syndrome of the foot after playing basketball

Compartment syndrome of the foot is an uncommon event. The most common cause of compartment syndrome of the foot is a crush injury. Exceedingly rare is acute compartment syndrome of the foot occurring in the absence of trauma. We describe the clinical scenario involving a 23-year-old healthy male who developed acute exertional compartment syndrome isolated to the medial compartment of the foot after playing basketball. The patient had no evidence of injury nor trauma, and the diagnosis was made based on physical exam, magnetic resonance imaging (MRI), and compartment pressure measurements. The patient did undergo successful fasciotomy on the day of presentation to the emergency department and has since completely recovered. We found four cases reported in the literature of acute exertional medial compartment syndrome of the foot in the absence of trauma or injury. This is the second case reported after playing basketball, while the others occurred after aerobics, a long distance run, and football. The most recent case was reported by Miozzari et al. [Am J Sports Med. 36(5):983-6, 2008] and involved a marathon runner who developed an isolated medial compartment syndrome of the foot. We would like to increase awareness of this uncommon clinical presentation in the absence of trauma and present the dramatic radiographic findings.

Posterior Arm Compartment Syndrome After a Combined Supracondylar Humeral and Capitellar Fractures in an Adolescent

Supracondylar humeral fractures in children are common, with associated bony injuries typically being fractures of the forearm or distal radius. To our knowledge, a combined supracondylar humeral fracture associated with a Hahn-Steinthal capitellar fracture has not been reported earlier. Similarly, posterior arm compartment syndrome is extremely rare, with most instances having occurred after chronic compression and bleeding into the compartments from anticoagulation, direct trauma including crush, or tendon ruptures. Only 2 cases have been reported after a fracture of the humerus. One of these described fractures was localized to a distal shaft and the other involved the surgical neck. No cases have been reported in children, nor have any been reported after a supracondylar humeral fracture. In this case report, we describe a patient who presented with an ipsilateral Wilkins type-3A supracondylar humeral fracture, Hahn-Steinthal capitellar fracture, Salter-Harris II distal radius fracture, and posterior arm compartment syndrome. The patient was taken to the operative room for closed reduction and percutaneous pinning of the radius fracture with open reduction, internal fixation of the distal humeral fractures. Elevated compartment pressure measurements were anticipated because of the nature of the injuries. After fixation of the fractures, the mobile wad, volar, and dorsal compartments measured 9, 9, and 8 mm Hg, respectively. The absolute pressure in the posterior arm compartment was measured multiple times in different locations ranging from 34 to 39 mm Hg. The patient's blood pressure throughout the case averaged 115/65 mm Hg. A diagnosis of posterior arm compartment syndrome was confirmed and the fascia was released. Our patient ultimately suffered 2 uncommon injuries involving the arm. She sustained a complex fracture of the distal humerus with an extension type supracondylar fracture, a separate Hahn-Steinthal capitellar fracture, and isolated posterior arm compartment syndrome. This is an unusual case that required specialized care and follow-up. Level IV.

Management of Venomous Snakebite Injury to the Extremities

Pit vipers (subfamily Crotalinae) are responsible for most venomous snakebites in the United States. The mixture of proteins with cytotoxic, proteolytic, and/or neurotoxic enzymes in snake venom varies by species. Treatment in the field consists of safe identification of the species of snake and rapid transport of the patient to the nearest health care facility. Swelling, bruising, and systemic symptoms are seen following snakebite. Most patients respond to elevation of the affected extremity and observation. Some require the administration of antivenin. Crotalidae Polyvalent Immune Fab (Ovine) (CroFab, BTG International, West Conshohocken, PA) antivenin is safe and effective for the management of local and systemic effects of envenomation. Rarely, compartment syndrome may develop in the affected limb because of edema and tissue necrosis. Close monitoring of the extremity via serial physical examination and measurement of compartment pressure is a reliable method of determining whether surgical intervention is required.

Management of peripheral arterial injury

Significant changes in the management of patients, with possible or documented injuries to peripheral arteries, have occurred over the last 20 years. Based on recent military experience, it is likely that the use of tourniquets by civilian emergency medical services systems will increase. Evaluation in the emergency center will continue to rely on a careful physical examination and measurement of an ankle-brachial index (ABI) or arterial pressure index (API). Patients without 'hard signs' of an arterial injury and an API or ABI less than 0.9 should undergo arteriography in the trauma room with a digital subtraction device, in radiology by computed tomography arteriography, which is rapidly replacing conventional arteriography, or surgeon-performed arteriography in the operating room. A temporary intraluminal arterial shunt is indicated in patients with unstable fractures in the extremity or in near-exsanguinated patients needing 'damage control'. A saphenous vein interposition graft is the conduit of choice when segmental resection of an injured artery is necessary. Measurement of postarterial repair compartment pressure is the most definitive way to determine the need for fasciotomy in an injured extremity. The care of patients with injured peripheral arteries has remained the same in some areas; however, lessons from the battlefield, new imaging technology, the safety of nonoperative management, use of temporary intraluminal shunts, and better recognition of postrepair compartment syndromes have had a significant impact on current management.

PREVENTIVE MAINTENANCE OF ISCHEMIC CONTRACTURES AT PATIENTS WITH SEVERE HAND INJURIES

Results of surgical treatment of 35 victims who had received serious blunt open and closed injuries of hand were analyzed. All injuries of hand were divided into three types, depending on mechanism and circumstances of trauma. On the basis of the data received at direct measurement of compartment pressure, indirect signs of a menacing ischemia of intrinsic muscles have been defined, and the technique of preventive maintenance of an ischemic lesion of own hand muscles were developed. High efficiency of the offered medical approaches at the expense of the maximum restoration of function of the injured extremity was proved.

Meningococcal purpura fulminans in children: I. Initial orthopedic management

Purpura fulminans is a rare and extremely severe infection, mostly due to Neisseria meningitidis frequently causing early orthopedic lesions. Few studies have reported on the initial surgical management of acute purpura fulminans. The aim of this study is to look at the predictive factors in orthopedic outcome in light of the initial surgical management in children surviving initial resuscitation. Nineteen patients referred to our institution between 1987 and 2005 were taken care of at the very beginning of the purpura fulminans. All cases were retrospectively reviewed so as to collect information on the total skin necrosis, vascular insufficiency, gangrene, and total duration of vasopressive treatment. All patients had multiorgan failure; only one never developed any skin necrosis or ischemia. Eighteen patients lost tissue, leading to 22 skin grafts, including two total skin grafts. There was only one graft failure. Thirteen patients were concerned by an amputation, representing, in total, 54 fingers, 36 toes, two transmetatarsal, and ten transtibial below-knee amputations, with a mean delay of 4weeks after onset of the disease. Necrosis seems to affect mainly the lower limbs, but there is no predictive factor that impacted on the orthopedic outcome. We did not perform any fasciotomy or compartment pressure measurement to avoid non-perfusion worsening; nonetheless, our outcome in this series is comparable to existing series in the literature. V.A.C.(®) therapy could be promising regarding the management of skin necrosis in this particular context. While suffering from general multiorgan failure, great care should be observed not to miss any additional osseous or articular infection, as some patients also develop local osteitis and osteomyelitis that are often not diagnosed. We do not advocate very early surgery during the acute phase of purpura fulminans, as it does not change the orthopedic outcome in these children. By performing amputations and skin coverage some time after the acute phase, we obtained similar results to those found in the literature.

Fasciotomy

Fasciotomy has been described in the treatment of rattlesnake-envenomation. We sought to compare the characteristics of patients undergoing fasciotomy with those where fasciotomy was discussed but not performed.A retrospective case-series constructed from a single-statewide-poison-system electronic database for cases of fasciotomy discussion or completion in rattlesnake-envenomation between January 2001 and May 2012. Age, gender, bite location, antivenom administered, compartment pressure measurements, Snakebite Severity Score (SSS) and length of hospitalization (LOS) were recorded. Comparisons were made between fasciotomy completed and where fasciotomy was only discussed.One-hundred-five cases of fasciotomy discussion or completion were identified. Fasciotomy was performed in 28 cases (27%). There was no statistically significant difference (p > 0.05) between groups in age, gender, bite site, SSS, and total number of vials of antivenom administered. Only 2 of 28 (7%) had compartment pressure measurements. Patients undergoing fasciotomy spent an additional 2 days in the hospital.Fasciotomies continue to take place, without compartment pressure measurements, and without repeat dosing of antivenom. In the absence of clear objective evidence that limb-threatening compartment syndrome occurs despite adequate antivenom administration, fasciotomy does not favorably impact morbidity and may be associated with increased costs for care following rattlesnake envenomation.