Diagnosis Of Compartment Syndrome Research Articles

Case Report: Atypical acute compartment syndrome of the forearm in a child following minor trauma with consecutive osteomyelitis

IntroductionForearm compartment syndrome (CS) in children is above all a clinical diagnosis whose main cause is traumatic. However, rarer causes such as infection can alter its clinical presentation.Clinical caseAn 8-year-old boy has been seen in the emergency department complaining of severe forearm pain under a splint in a mild traumatic context. The previous radiological imaging examination three days before had not revealed any fractures. On admission, he presented with major signs of skin inflammation, loss of mobility, paresthesia and a significant biological inflammatory syndrome. The acute CS diagnosis has been made and was treated, but its atypical presentation raised a series of etiological hypotheses, in particular infectious, even if it remains rare. Complementary imaging examinations confirmed the presence of osteomyelitis of the distal radius as well as an occult Salter-Harris II fracture.DiscussionBeyond the classic “five P's of CS” -pain, paresthesia, paralysis, pallor and pulselessness-, CS's clinical presentations are multiple, especially in pediatric patients. In children, severe pain and increasing analgesic requirement must be indicators of a CS. We hypothesize that this patient sustained a nondisplaced Salter-Harris II fracture with a hematoma colonized by hematogenous osteomyelitis explaining its initial clinical presentation.ConclusionHematogenous osteomyelitis complicated by CS is rare and may be accompanied by a traumatic history. It's atypical presentation in pediatric patients requires vigilance and prompt diagnosis given the disastrous and irreversible complications.

Validation of Thermography for the Diagnosis of Compartment Syndrome in the Upper Extremities Due To Electrical Burns in Patients with Altered Alertness

Background: Compartment syndrome in the extremities is a surgical emergency that requires decompression to avoid complications, the diagnosis is made through the clinic, if there is doubt it is confirmed with the measurement of intracompartmental pressure by means of an invasive device, it is imperative for the diagnosis to measure it in patients with altered alertness. Objective: To determine the sensitivity and specificity of thermography compared to the measurement of intracompartmental pressure with the Whiteside method as a diagnosis of upper extremity compartment syndrome in patients with electrical burns with impaired alertness. Thus achieving faster, more accessible, cheaper, reliable and non-invasive detection. It can be used by the first contact physician and/or paramedics, nurses, students for timely diagnosis and treatment, reducing the rate of sequelae and complications. Material and methods: All patients with a presumptive diagnosis of compartment syndrome in the upper extremities secondary to electrical burn with altered alertness who were admitted to the Adolfo López Mateos Medical Center were included®.Results: In the present study, a sensitivity of 58% and a specificity of 100% were obtained, with a positive predictive value of 100% and a negative predictive value of 50%, as well as a prevalence of 70.58% and an incidence of 7 out of 10 patients. Conclusion: We can conclude that the study has a good specificity and when analyzing the values present we notice that it can have a good sensitivity which is altered by the amount of the sample of the patients.

Evaluation of obesity and age as a predictive factor of lower extremity compartment syndrome: A national trauma data bank analysis

BackgroundRisk factors of acute compartment syndrome (ACS) of the leg include tibial fractures followed by soft tissue injuries. MethodsData collected from the National Trauma Data Bank (NTDB) between 2017 and 2019 were analyzed for adult patients with lower extremity fractures, including proximal tibia, tibial shaft, and distal tibia. The primary outcome was a diagnosis of ACS. ResultsThere were 1052/220,868 patients with lower extremity fractures with a concomitant diagnosis of compartment syndrome. Our study has shown that patients with a BMI of ≥30 had a lower incidence of compartment syndrome when compared with patients with a BMI of 25–29 and controlled for fracture type. Increased age ≥55 in males, and females between 65 and 84, also demonstrated a decreased risk. Proximal tibial fractures (n ​= ​54,696) were significantly associated with ACS compared to midshaft (n ​= ​42,153) and distal (n ​= ​100,432), p ​< ​0.0001. ConclusionWe found that being overweight decreases risk for development of compartment syndrome in patients with lower extremity fractures. This big data study aids in establishing risk factors for development of ACS in adult trauma patients.

Early Versus Delayed Definitive Fixation Relative to Fasciotomy Closure in High-Energy Tibial Plateau Fractures With Compartment Syndrome.

To evaluate the timing of definitive fixation of tibial plateau fractures relative to fasciotomy closure with regard to alignment and articular reduction. Retrospective case series. Four Level I trauma centers. Patients with tibial plateau fractures (TPF) with ipsilateral compartment syndrome treated with fasciotomy between 2006 and 2018 met inclusion criteria. Open fractures, patients younger than 18 years, patients with missed or delayed treatment of compartment syndrome, patients with a diagnosis of compartment syndrome after surgical fixation, and patients whose plateau fracture was not treated with open reduction and internal fixation were excluded. Patients were divided into 2 groups depending on the relative timing of fixation to fasciotomy closure: early fixation (EF) was defined as fixation before or at the time of fasciotomy closure, and delayed fixation (DF) was defined as fixation after fasciotomy closure. Radiographic limb alignment (categorized as anatomic alignment (no varus/valgus), ≤5 degrees varus/valgus, or >5 degrees varus/valgus) and articular reduction (categorized as anatomic alignment with no residual gap or step-off, <2 mm, 2-5 mm, and >5 mm of articular surface step-off) were compared between early and delayed fixation groups. In addition, superficial and deep infection rates were compared between those in the EF and DF cohorts. Subgroup analysis within the EF cohort was performed to compare baseline characteristics and outcomes between those that received fixation before closure and those that underwent concurrent fixation and closure within one operative episode. A total of 131 patients met inclusion criteria for this study. Sixty-four patients (48.9%) were stratified into the delayed fixation group, and 67 patients (51.1%) were stratified into the early fixation group. In the EF cohort, 57 (85.1%) were male patients with an average age of 45.3 ± 13.6 years and an average body mass index of 31.0 ± 5.9. The DF cohort comprised primarily male patients (44, 68.8%), with an average age of 46.6 ± 13.9 years and an average body mass index of 28.4 ± 7.9. Fracture pattern distribution did not differ significantly between the early and delayed fixation cohorts ( P = 0.754 for Schatzker classification and P = 0.569 for OTA/AO classification). The relative risk of infection for the DF cohort was 2.17 (95% confidence interval, 1.04-4.54) compared with the EF cohort. Patients in the early fixation cohort were significantly more likely to have anatomic articular reduction compared with their delayed fixation counterparts (37.5% vs. 52.2%; P < 0.001). This study demonstrated higher rates of anatomic articular reduction in patients who underwent fixation of tibial plateau fractures before or at the time of fasciotomy closure for acute compartment syndrome compared with their counterparts who underwent definitive fixation for tibial plateau fracture after fasciotomy closure. The relative risk of overall infection for those who underwent fasciotomy closure after definitive fixation for tibial plateau fracture was 2.17 compared with the cohort that underwent closure before or concomitantly with definitive fixation. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Suprapatellar tibial fracture nailing is associated with lower rate for acute compartment syndrome and the need for fasciotomy compared with the infrapatellar approach

BackgroundIntramedullary tibial nailing (IMN) is the gold standard for stabilizing tibial shaft fractures. IMN can be performed through an infra- or suprapatellar approach.PurposeThe aim of this study is to compare the rate of fasciotomies for acute compartment syndrome between infra- and suprapatellar approaches.MethodsA total of 614 consecutive patients who were treated with IMN for tibial fracture between October 2007 and February 2020 were included in the study. The approach used for IMN was determined by the operating surgeon. Infrapatellar IMN was performed with the knee in deep flexion position, with or without calcaneal traction. Suprapatellar IMN was performed in straight or semiflexed position. The diagnosis of compartment syndrome was based on clinical analysis, but for some patients, a continuous compartment pressure measurement was used. The primary outcome was the rate of peri- and postoperative compartment syndrome treated with fasciotomies.ResultsThe study sample included 513 patients treated with infrapatellar IMN and 101 patients treated with suprapatellar IMN technique. The mean age of the patients was 44.7 years (infrapatellar technique) and 48.4 years (suprapatellar technique). High energy trauma was seen in 138 (27%) patients treated with infrapatellar technique and in 39 (39%) patients treated with suprapatellar technique. In the suprapatellar group (n = 101), there were no cases of peri- or postoperative compartment syndrome treated with fasciotomies. In the infrapatellar group (n = 513), the need for fasciotomies was stated in 67 patients, 31 patients (6.0%) perioperatively and in 36 patients (7.0%) postoperatively. The rate of fasciotomies (0/101 versus 67/513 cases) differed significantly (p < 0.001). There were no significant differences in the fracture morphology or patient demographics between the study groups.ConclusionsThe suprapatellar technique is recommended over the infrapatellar approach in the treatment of tibial shaft fractures. The rate of peri- and postoperative compartment syndrome and the need for fasciotomies was significantly lower with the suprapatellar technique. The major cause of increased rate of peri- or postoperative acute compartment syndrome with infrapatellar IMN technique is presumably associated with the positioning of the patient during the operation.Level of evidence3.

Diagnosis Accuracy for Compartment Syndrome: A Systematic Review and Meta-Analysis.

To evaluate whether published studies support basing the diagnosis of compartment syndrome of the lower leg on clinical findings, intracompartmental pressure (ICP) monitoring, or both. A PubMed/MEDLINE, Web of Science, and Embase search of the English literature from 1966 to February 2022 was performed. This used "lower extremity" or "leg" or "tibia" and "compartment syndrome" and "pressure" as the subjects. A manual search of the bibliographies was performed and cross-referenced with those used to formulate the American Academy of Orthopaedic Surgeons clinical practice guidelines. Inclusion criteria were traumatic tibia injuries, presence of data to calculate the sensitivity, specificity, positive and negative predictive values of clinical findings and/or pressure monitoring, and the presence or absence of compartment syndrome as the outcome. A total of 2906 full articles were found, of which 63 were deemed relevant for a detailed review. Seven studies met all eligibility criteria. The likelihood ratio form of Bayes theorem was used to assess the discriminatory ability of the clinical findings and ICP monitoring as tests for compartment syndrome. The predictive value for diagnosing acute compartment syndrome was 21% and 29% for the clinical signs and ICP, respectively. When combining both, the probability reached 68%. The use of ICP monitoring may be helpful when combined with a clinical assessment to increase the sensitivity and specificity of the overall diagnosis. Previously accepted individual inference values should be revisited with new prospective studies to further characterize the statistical value of each clinical finding. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Compartment Syndrome following Intramedullary Nail Fixation in Closed Tibial Shaft Fractures.

Compartment syndrome complicating intramedullary nailing of closed tibia fractures has been described as early as the 1980s, but currently remains less described in literature compared to compartment syndrome directly following trauma. This study aims to review this potentially disabling complication and highlight the importance of timely diagnosis and management of compartment syndrome following fracture fixation, not just after fracture itself, via a review of three cases. A retrospective study of a series of three cases was conducted. The type of fracture, wait time to fixation, surgery duration, reaming, size of nail implant used, tourniquet time, and surgical technique were recorded. Time to diagnosis of compartment syndrome, compartment pressure if available, extent of muscle necrosis, reconstructive procedures performed, and post-operative complications were analysed. The three cases following high-energy trauma from road traffic accidents presented from January to May 2010. Compartment syndrome was diagnosed clinically for all cases, between one to six days post-operatively and supported by elevated compartment pressure measurements in two of the three cases. This study advocates thorough clinical monitoring and maintaining strong clinical suspicion of compartment syndrome in patients even after intramedullary nail fixation of tibial shaft fractures to achieve timely limb-salvaging intervention. While intercompartmental pressure can be used to aid in diagnosis, we do not advise using it in isolation to diagnose compartment syndrome. Tendon transfer improves functional mobility and provides a good result in patients with severe muscle damage, while skin grafting sufficient in patients with minimal muscle damage.

Single-center Experience with JETi Hydrodynamic Thrombectomy System for Arterial Occlusions of the Extremities

Percutaneous aspiration thrombectomy is a new modality for treating patients with acute limb ischemia (ALI). We report our experience and outcomes using the JETi hydrodynamic thrombectomy system (Abbott Vascular, Abbott Park, IL) to treat acute arterial occlusions of the extremities. This a single-center retrospective review of patients with acute occlusions of peripheral arteries or grafts treated with the JETi from September 2020 to December 2022. JETi was used either as primary intervention or as an adjunct to treat distal vessel thrombus after proximal open thrombectomy. The primary outcome for success was defined as >50% luminal opening post-intervention. Indications, limb salvage, and major adverse events were reviewed. The JETi was used in 59 procedures (56 acute lower extremity ischemia [ALEI], three acute upper extremity ischemia [AUEI]) to treat 124 arteries in 57 patients. Mean age was 62 years (range, 29-95 years), and 49% were male. The mean duration of symptoms before hospitalization was 4.8 days (range, 0 hours to 21 days) for ALEI. The primary outcome was achieved in 102 of 124 (83%) arteries by JETi alone. Additional modalities including open thrombectomy, angioplasty, and stenting were used in five arteries to achieve the primary outcome. Seventeen arteries failed to achieve primary outcome with JETi with or without an adjunct. Reasons for failure were attributed to small artery size and chronic nature of the clot. Complete luminal patency with JETi thrombectomy alone was achieved in 52 arteries (42%). Additionally, 55 arteries underwent additional procedures (angioplasty and stenting) to restore complete luminal patency, which was successfully achieved in 49 vessels (89%) (Table). Average estimated blood loss in JETi-only procedures was 335 mL and 384 mL in those who underwent adjunctive procedures to achieve the primary outcome. Complications included distal embolization (5), access site hematoma (3), and acute kidney injury (AKI) (8). Two AKIs were attributed to rhabdomyolysis with creatine phosphokinas >10,000 IU/L; none of whom needed dialysis. There was a single 30-day mortality. Six patients required major limb amputations within 30 days – two after unsuccessful recanalization and one each for severe gangrene despite restoration of in-line flow, reocclusion of a distal bypass graft, recurrent ALEI postoperative day 15 with non-viable muscle on exploration, and a delayed compartment syndrome diagnosis. Success of the JETi to remove the targeted clot was 83%. The JETi system is an efficacious and safe tool for use in the treatment of acute artery occlusion.TableJETi thromboembolectomy technical success outcomes by vessel/graft intervened uponName of artery/graftNo. of each vesselJETi >50%JETi + adjunctive >50%JETi 100%JETI + adjunctive 100%JETI 4- adjunctive 50% <X <100%Aorta000000Common iliac660150External iliac642150Common femoral440310Superficial femoralI8170313IProfunda iroris220100Popliteal20I80882Anterior tibial16111840Tibioperoneal trunk13110821Peroneal artery13100910Posterior tibial1382631Femoral-anterior tibial bypass330030Femoral-popliteal bypass55004lAxillary femoral bvpass110100Axillary200000Subclavian110100Brachial110100124101552496 Open table in a new tab

Acute Charcot neuropathy: A devastating consequence of diabetes mellitus

Abstract Introduction Acute Charcot neuropathy (ACN) is a complication of diabetes mellitus. The prevalence of ACN may be up to 13% in diabetic individuals. ACN has a complex etiology. Although it mostly affects middle of the foot, hind-foot joints, the ankle, and forefoot joints; upper limp may also be affected. Here, we present a case with ACN, whose diagnosis was hard to differentiate and manage. Clinical Case A fifty-nine-year-old female admitted to our emergency department with a complaint of pain, numbness, swelling, edema and erythema on left arm. When questioned, she had a history of type 2 diabetes for 22 years and had impaired glycemic regulation with 12.2% HbA1c level. She had all macro and micro vasculary complications of diabetes. On physical examination, her left arm was swollen, pulses were not palpabl. With a suspicion of acute thromboembolism, doppler ultrasound was performed and USG showed no arterial occlusion, but thrombosis from the basilic vein to the proximal brachial vein was seen. She initiated anticoagulant therapy with heparin. After 2 weeks, her complaints increased and pallor, coldness, and pain with passive movements on the left arm were added. She admitted to our intensive care unit with a diagnosis of compartment syndrome. She was followed in ICU with stable hemodynamics and without oxygen supplementation. She had transient acute kidney injury due to rhabdomyolysis but resolved without hemodialysis. Despite fasciotomy, myonecrosis developed on left arm and transhumeral resection was performed. After this devastating result, the patient transferred to endocrinology clinic. Intensive insulin therapy and appropriate antibiotic treatment were continued. During her stay in our clinic, she had the same complaints and physical examination findings on her left foot. Imaging studies (X-ray, bone scintigraphy) showed no osteomyelitis but acute charcot arthropathy was seen. Her glucose levels were regulated, and antibiotics completed. The physical strengthening and ROM exercises for lower extremity and oral total calorie intake was adjusted. Her HbA1c level was decreased to 6.2% without hypoglycemia and she is stable on follow-up. Conclusion ACN is a devastating complication of diabetic neuropathy with its consequences. The diagnosis may mislead clinicians to cellulitis, acute venous thrombosis, arthritis or gout. Misdiagnosis or delay in diagnosis may result in serious consequences such as infection, ulceration even amputation as in our case. A multidisciplinary approach and close monitoring of the findings may provide huge benefit for the patient.

Coping With the Fear of Compartment Syndrome Without Compromising Analgesia: A Narrative Review.

Pain management in trauma or surgery with a high risk of developing compartment syndrome (CS) is always challenging due to fears of masking symptoms that could delay diagnosis and treatment. Regional anesthesia/analgesia (RA) can facilitate enhanced postoperative recovery and improve patient satisfaction by providing excellent postoperative analgesia. However, its consideration in surgeries with a high risk of developing CS remains controversial and contentious. Studies suggest focusing more on early diagnosis through regular vigilant monitoring with a high index of suspicion rather than discontinuing the analgesic method alone. The most consistent features in all reported cases of CS were altered sensation in the affected limb, disproportionate pain in the presence of a functional nerve block, and an escalating need for analgesics. Several extrinsic or intrinsic factors are responsible for the progressive increase in compartment pressure that can lead to vascular compromise and subsequent ischemic changes in muscles, tissues, and nerves. Measurement of intracompartmental pressure (ICP) has always been considered the gold standard for diagnosing CS. An ICP of 30 mm Hg is considered the cut-off point for fasciotomy that helps restore muscle perfusion and avoid irreversible tissue damage. The chronology of symptoms can sometimes provide clues to the severity of CS, the pathophysiology involved, and the management required. Therefore, it is necessary to look for warning signs, further investigate the causes, and make quick decisions to diagnose and treat CS and its complications on time. Any delay in the diagnosis and treatment of CS can result in high morbidity and poor outcomes. A well-integrated interprofessional team of health professionals can deliver the required complexity of care through a holistic and multidisciplinary approach. This review article highlights the symptoms, risk factors, and pathophysiology involved in CS. It can guide readers in choosing various options to diagnose, prevent, and treat CS. It also discusses the role of RA in patients or surgeries prone to developing CS.

Resolving the Conflict Between Regional Analgesia and Developing Compartment Syndrome in Below-Knee Surgeries With the High-Volume Proximal Adductor Canal (Hi-PAC) Block: A Prospective Feasibility Study.

The consideration of regional analgesia (RA) in below-knee surgeries is always a controversial topic due to the fear of masking symptoms of developing compartment syndrome (CS) in the postoperative period. Compartment syndrome (CS) has been found frequently in below-knee surgeries, particularly among tibial diaphyseal fractures. Like any other surgery, below-knee surgeries have significant postoperative pain that requires effective postoperative analgesia protocol. The analgesia quality makes a big difference when compared with or without RA. Also, the presence or absence of RA cannot prevent or promote the development of CS. Therefore, patients should not be deprived of their right to remain pain-free in the postoperative period by compromising the analgesia protocol.The pain out of proportion to the surgery or injury is a typical symptom of developing CS, which can cause increased analgesic demands postoperatively. Timely diagnosis and treatment of CS require vigilant postoperative monitoring of the warning signs by trained staff. Avoiding RA for fear of presumed masking of symptoms and delaying CS diagnosis may not be a solution instead of choosing an appropriate RA with regular postoperative monitoring for such warning symptoms. The high-volume proximal adductor canal (Hi-PAC) block has been described as a procedure-specific and motor-sparing RA technique appropriate for below-knee surgeries.In this prospective study, we evaluated the analgesic efficacy of the Hi-PAC block in below-knee surgeries. We also observed the effect of the Hi-PAC block, due to proximal and distal drug distribution, on masking the symptoms of the developing CS during postoperative monitoring.We found the Hi-PAC block to be a safer and more effective RA alternative for below-knee surgeries with an added motor-sparing benefit that facilitated early mobility and discharge. Its property of not interfering with postoperative surveillance to detect the symptoms of CS and intervene in time helps deal with the anxiety of CS in below-knee surgeries.

Secretome – A new “Cappiler” for Compartement Syndrome

Compartment Syndrome, an orthopedic emergency, is a condition of increased perfusion pressure under closed tissue. Necrosis of the nerves and muscles, namely contracture of Volkmann and systemic complications such as acute renal failure, sepsis, ARDS, will result in compartment syndrome that is not properly treated. In children, doctors must be able to diagnose compartment syndrome in order to treat it in a timely manner. The effects of mismanagement will have an impact on the future of the child. A 5-year-old boy presented a case report with complaints of worsening wounds accompanied by loss of sensation. As the patient went to alternative medicine, the patient had to be amputated because of an error in the administration of therapy (The patient came to the “dukun tulang” for 5 months ago and received inappropriate treatment). Patients have signed an agreement to follow up on treatment by single-dose intracutaneous injection of Placental Wharton Jelly Stem Cell Secretom (SC-PWJSC). Intracutaneous injection of Secretom from Placental Wharton Jelly Stem Cell after administration of a single dose of 5cc (SC-PWJSC). The patient was advised to undergo amputation and the SC-PWJSC intracutaneous injection procedure was given to the patient. There was a significant improvement in the situation after 4 weeks of intervention.

Animal models in compartment syndrome: a review of existing literature.

Objective:Extremity compartment syndrome (ECS) is a morbid condition resulting in permanent myoneural damage. Currently, the diagnosis of compartment syndrome relies on clinical symptoms and/or intracompartment pressure measurements, both of which are poor predictors of ECS. Animal models have been used to better define cellular mechanisms, diagnosis, and treatment of ECS. However, no standardized model exists. The purpose of this study was to identify existing animal research on extremity compartment syndrome to summarize the current state of the literature and to identify weaknesses that could be improved with additional research.Methods:A MEDLINE database search and reverse inclusion protocol were utilized. We included all animal models of ECS.Results:Forty-one studies were included. Dogs were the most commonly used model species, followed by pigs and rats. Most studies sought to better define the pathophysiology of compartment syndrome. Other studies evaluated experimental diagnostic modalities or potential treatments. The most common compartment syndrome model was intracompartment infusion, followed by tourniquet and intracompartment balloon models. Few models incorporated additional soft tissue or osseous injury. Only 65.9% of the reviewed studies confirmed that their model created myoneural injury similar to extremity compartment syndrome.Conclusions:Study purpose, methodology, and outcome measures varied widely across included studies. A standardized definition for animal compartment syndrome would direct more consistent research in this field. Few animal models have investigated the pathophysiologic relationship between traumatic injury and the development of compartment syndrome. A validated, clinically relevant animal model of extremity compartment syndrome would spur improvement in diagnosis and therapeutic interventions.

A medical approach to the 2020 Elazig earthquake

Objective: Besides their direct effects, earthquakes may cause death by Crush syndrome and renal factors. In this study we aimed to evaluate the medical results of 2020 Elazig earthquake. Methods: We obtained the medical data from the National Medical Rescue Team (UMKE) and hospital records. Results: There were 1063 injured, 45 victims who were pulled out from the rubble and 41 deaths due to 2020 Elazig earthquake. Of the hospitalized patients 33% were treated with Crush/ compartment syndrome diagnosis. Conclusion: Catastrophic effects and collapsing buildings due to earthquakes, threat human life. In Elazig earthquake, none of the 48 hospitalized patients required dialysis probably due to early treatment and transfer to the hospital. Renal care and treatment such as fluid replacement, dialysis are as important as traumatological services in earthquakes in terms of increasing survival.

The Association between Clinical Features and Measurements of Intra-Compartmental Pressure in Diagnosis of Acute Compartment Syndrome of Closed Leg Fractures

Objective: To find the clinical features of compartment syndrome and measurement of intra-compartmental pressure (ICP) in early diagnosis of the compartment syndrome of different types of closed leg bone fractures and their association with the severity of the fracture. Methodology: This prospective study included 20 patients with unilaterally closed fractures of the tibia and/or fibular fracture that presented to Shar Hospital, Sulaimaniyah City, Northern Iraq, from October 1st, 2018, to July 1st, 2020. Sociodemographic information with date and mechanism of injury, severity, side, and site of a fractured leg, and fracture's type according to Oestern and Tscherne classification of the close fracture were obtained. ICP was measured in the broken leg and normal leg at the time of admission to the emergency ward for patients using the needle-infusion technique (Whiteside's technique).Results: All patients were followed clinically by looking at features of the compartment for three days before the definitive treatment was established. We found that 8 out of 20 patients were complaining of severe, unusual pain (paresthesia) during follow-up. Acute compartment syndrome (ACS) was diagnosed in 1 (55-year-old man) out of 8 patients whose clinical features of compartment syndrome built up and with the differential pressure (∆p) of &lt;30 mmHg. The cause of his fracture was a road traffic accident (RTA), and he underwent a fasciotomy. At the same time, the rest of the patients had no features of the compartment.Conclusions: We revealed a significant clinical correlation between the measurement of ICP and early detection and diagnosis of the post-traumatic ACS of the leg, and the measurement of ICP was valuable in the diagnosis of ACS and as a criterion for decompression. Also, this study shows a positive correlation between the type of fracture according to the Oestern and Tscherne classification and the increase in the measurement of the ICP.

Unlikely recovery in a delayed diagnosis of compartment syndrome.

Compartment syndrome (CS) is defined as a pathologic elevation of hydrostatic pressure within a closed compartment of muscle leading to the development of ischemia and myonecrosis.[1][1] Causes of CS include trauma, infection, and neurogenic or musculoskeletal conditions; among these, trauma is most

600 Bilateral Upper Limb Compartment Syndrome After Massive Postpartum Haemorrhage

Abstract Case Summary Upper limb compartment syndrome (ULCS) is an uncommon limb-threatening emergency occurring as a result of increased interstitial pressure within osteofascial compartments. The overwhelming majority of causes occur in one limb, with frequent causes including fractures, reperfusion injury and burns. We report the unusual case of bilateral upper limb CS in a previously well 35-year-old female secondary to massive resuscitation following postpartum haemorrhage. The patient received 7 litres of blood products and 4 litres of crystalloid over a period of 8 hours. One hour postoperatively both hands became painful and swollen. Symptoms worsened over the following hour: both forearms were tense to palpate with demonstrable pain on passive extension of bilateral wrists and digits of the left hand, and capillary refill to all digits was brisk. Creatinine kinase was measured at 4,600U/L and bilateral forearm and left-hand fasciotomies were performed. The presence of bulging muscles in both forearms and the left hand confirmed the diagnosis of compartment syndrome, and perfusion was restored to all digits after release of the compartments. The patient later underwent split thickness skin grafting to both forearms and left-hand fasciotomy wounds. After 5 weeks of hand therapy, she regained good function of both hands. Bilateral ULCS is extremely uncommon but has been reported secondary to massive resuscitation, particularly in trauma patients, and we suspect that this was the cause in our patient.

Tibial shaft fractures - to monitor or not? a multi-centre 2 year comparative study assessing the diagnosis of compartment syndrome in patients with tibial diaphyseal fractures

AimsThe aim of this study was to compare the outcome in patients who did and did not undergo continuous compartment pressure monitoring (CCPM) following a tibial diaphyseal fracture. Patients and methodsWe performed a retrospective cohort study of 287 patients with an acute tibial diaphyseal fractures who presented to three centres over a two-year period. Demographic data, diagnosis, management, wound closure, complications, and subsequent surgeries were recorded. The primary outcome measure was the rate of short-term complications. Secondary outcomes were time to fasciotomy and split-skin grafting rates. ResultsOf the 287 patients in the study cohort, 171 patients underwent CCPM (monitored group; MG) and 116 did not (non-monitored group; NMG). There were 21 patients who developed ACS and underwent fasciotomy, with comparable rates in both groups (n=13 in the MG vs n=8 in NMG; p=0.82). There was no difference in the rate of complications between groups (all p>0.05). The mean time from admission to fasciotomy was 22.1hrs, with a mean time of 19.8hrs in the MG and 25.8hrs in the NMG (mean difference, 6hrs; p=0.301). One patient in the NMG required a below-knee amputation. There was a trend towards a reduced requirement for split-skin grafting post decompression in the MG (15% vs 50%; p=0.14). ConclusionThis study found no difference in the short-term complication rates in those patients that underwent CCPM and those that did not following a fracture of the tibial diaphysis. CCPM does appear to be safe with no increase in the rate of fasciotomies performed. There was a trend towards a reduced time to fasciotomy and a reduced rate of split skin grafting for wound closure with CCPM. Level of evidenceLevel III (Diagnostic: Retrospective cohort study)

Resection of Anterior and Lateral Muscle Compartments Does Not Preclude Limb Salvage and Functions.

Fasciotomy with resection of nonviable muscle is often necessary when there is a delay in compartment syndrome (CS) diagnosis after revascularization. The reported rate of major amputation following missed CS or delayed fasciotomy ranges from 12% to 35%. Herein, the authors present a series of critically ill patients who experienced delayed CS diagnosis and required complete resection of the anterior and/or lateral compartments but still achieved limb salvage and function. A retrospective chart review identified five patients from April 2018 to April 2019 within a single institution who met the inclusion criteria. Patient charts were reviewed for demographic data, risk factors, time to diagnosis following revascularization, muscle compartments resected, operative and wound care details, and functional outcome at follow-up. All of the patients developed CS of the lower extremity following revascularization secondary to acute limb ischemia and required two-incision, four-compartment fasciotomies. Further, they all required serial operative debridements to achieve limb salvage; however, there were no major amputations, and all of the patients were walking at follow-up. Delay in CS diagnosis can have devastating consequences, resulting in major amputation. In cases where myonecrosis is isolated to two or fewer compartments, complete compartment muscle resection can be safely performed, and limb preservation and function can be maintained with aggressive wound management and physical therapy.

Identifying risk factors for missed compartment syndrome in patients with tibia shaft fractures: An analysis of the national trauma data bank.

Acute compartment syndrome (CS) is a common complication of tibia shaft fractures (TSFs), and occurs when the pressure inside a myofascial compartment rises and impairs tissue perfusion. If treatment is delayed due to a missed diagnosis, amputation or permanent loss of function can result. This study aims to determine the incidence, clinical associations, and risk factors for missed CS following surgical stabilization of tibia shaft fractures (TSFs) using data from the National Trauma Data Bank (NTDB). NTDB data files from 2007 to 2016 were accessed to collect information on patients undergoing surgical fixation of TSFs. Patients with an Injury Severity Score (ISS) > 15 or inferred Gustilo-Anderson IIIB/IIIC fractures were excluded to create a more homogenous sample of lower-grade TSFs. Compartment syndrome that was originally missed leading to late intervention was the main outcome under investigation. Bivariate tests were used to assess the relationships between missed CS and the preoperative variables. If a variable and a complication had an association with a P≤0.2, it was included in a multivariate logistic regression model. A total of 184,612 patients met our inclusion criteria, and 1,269 patients (0.76%) had a missed CS diagnosis. Bivariate analysis demonstrated that male gender had a significant positive association with a missed CS diagnosis, while older age had a significant negative association (odds ratio [OR]=2.17, 0.99; P < 0.001). Multivariate analysis revealed that male gender was the most significant independent risk factor for a missed diagnosis of compartment syndrome (OR=1.84, P < 0.00001), followed by alcoholism, penetrating trauma, and smoking (OR=1.51, 1.46, 1.43; P < 0.02). The only significant protective factor was open fracture (OR=0.70, P < 0.0001). Our research identified several significant risk factors for missed CS after TSF, as well as positive and negative associations. Male gender, age, and lifestyle choices such as alcohol use and smoking conferred increased risks. These variables may assist physicians in identifying at-risk patients who may benefit from increased monitoring, and potentially prevent the high morbidity associated with this condition.