Acute noncontact compartment syndrome

Although acute compartment syndrome is considered a surgical emergency, controversies exist regarding diagnosis, surgical indications, and techniques of management. Acute compartment syndrome is associated with numerous causes, including fractures, crush injuries, burns, soft tissue injuries, and vascular trauma. Prolonged positioning of an extremity has not been previously described as a cause of compartment syndrome. The authors present a case of an acute compartment syndrome occurring because of prolonged extrication after a motor vehicle accident and without direct trauma to the involved extremity.     

Acute Compartment Syndrome After Rupture of the Medial Head of Gastrocnemius in a Child

Rupture of the gastrocnemius muscle is an uncommon injury, with most cases occurring in athletes and, typically, presenting with the acute onset of focal calf pain and ecchymosis after injury. Although gastrocnemius ruptures are usually treated symptomatically with good results, we present an unusual case of a medial head of gastrocnemius muscle tear complicated by acute compartment syndrome in a 7-year-old boy whose right calf was crushed in a fall. After confirmation of the diagnosis of compartment syndrome, the patient underwent emergency fasciotomy with evacuation of hematoma, and, thereafter, he recovered unremarkably. Clinicians and surgeons need to maintain a high index of suspicion for compartment syndrome associated with gastrocnemius muscle injury, so that timely surgical decompression can be undertaken and complications related to delayed diagnosis and treatment can be avoided.     

Akutes Kompartmentsyndrom des Unterschenkels nach Kniegelenkarthroskopie

This case report describes an acute postoperative compartment syndrome of the lower leg following simple arthroscopy of the knee. The diagnostics as well as the time course of further therapeutic procedures are considered critically. Furthermore, the surgical workflow is analyzed for possible reasons. Retrospectively, an accumulation of irrigation fluid passing through a popliteal cyst into the superficial flexor compartment must be suspected. In summary, even with an optimal perioperative management the subsequent compartment syndrome due to knee arthroscopy cannot be avoided with any certainty. However, immediate causal therapy lies in the urgent dermatofasciotomy to prevent irreversible neuromuscular damage.     

Rupture of the lateral head of the gastrocnemius muscle at the musculotendinous junction mimicking a compartment syndrome

This case report documents an acute rupture of the lateral head of the gastrocnemius muscle at the myotendinous junction and a lateral dislocation of the tibialis anterior tendon with a clinical presentation consistent with a compartment syndrome, despite the intraoperative finding of a rupture of the posterior and lateral compartments. Extensive hematoma formation led to marked edema, paresthesias, muscle weakness, and severe pain in the involved leg. Surgical repair of the torn muscle and dislocated tendon and evacuation of the dissecting hematoma resulted in a well-functioning extremity. The authors emphasize the importance of prompt diagnosis of soft tissue injuries, which may place a patient at risk for a compartment syndrome. A compartment syndrome may lead to severe ischemia and irreversible tissue necrosis if intracompartmental hemorrhage of a torn muscle persists, and may require a surgical decompression. The clinical presentation, as well as adjunctive techniques in the diagnosis of a patient with a partial rupture of the gastrocnemius muscle, and a compartment syndrome, were presented.     

Pelvic compartment syndrome: a systematic review

Bilateral ureteral obstruction due to traumatic pelvic haematoma and increased pressure in the retroperitoneal space constitute an acute pelvic compartment syndrome. We systematically reviewed the available evidence concerning pelvic compartment syndrome using an online search of the MEDLINE databases OVID and PubMed. There were nine cases of pelvic compartment syndrome. A motor vehicle accident was the most frequent cause of pelvic compartment syndrome. Diagnosis was made using clinical and radiological methods in all cases. Treatment was by surgical decompression in 88% of cases. Observed complications were neurological deficits (44%), muscle atrophy (33%), and renal failure (33%). Pelvic compartment syndrome is as serious as the more common compartment syndromes, requiring high vigilance for diagnosis and surgical decompression for treatment.     

Continuous compartment pressure monitoring for tibia fractures: does it influence outcome?

BACKGROUND: Compartment syndrome is common in acute fractures of the tibia. Early diagnosis is important, as delayed treatment leads to significant complications. Continuous compartment pressure monitoring has been recommended to prevent late diagnosis of compartment syndrome associated with tibia fractures. In this study, we aim to examine the effect of continuous compartment pressure monitoring on outcome in acute tibia fractures. METHODS: We randomized 200 consecutive acute extra-articular tibia fractures into monitored and nonmonitored groups. The monitored group received continuous compartment pressure for 36 hours and the nonmonitored group received usual postoperative observations. In alert patients, the diagnosis of compartment syndrome was made clinically. In unconscious patients, a difference between compartment pressure and diastolic blood pressure (DeltaP) of less than 30 mm Hg was the criteria for fasciotomy. Patients were assessed for late sequelae of compartment syndrome (sensory loss, muscle weakness, contracture, and toe clawing) at 6 months. RESULTS: Eighty-nine percent of patients were followed up for a minimum of 6 months or to fracture union. There were five cases of compartment syndrome in the nonmonitored group and none in the monitored group. At 6 months, the complication rates and late sequelae in both groups were not significantly different. In the monitored group, there were 18 patients with DeltaP less than 30 mm Hg, none of whom developed compartment syndrome or late sequelae. In both groups, patients with high energy or open fractures had significantly more late sequelae. CONCLUSIONS: Continuous compartment pressure monitoring is not indicated in alert patients who are adequately observed.     

Acute Compartment Syndrome of the Thigh with Sciatic Nerve Palsy after Femoral Fractures

Acute compartment syndromes of the thigh are rare and have been infrequently reported in the literature. They occur with greatest frequency in association with femoral fractures. Patients who sustained multiple trauma have an increased susceptibility to the development of compartment syndrome of the thigh, and compartment syndromes are often overlooked in these cases. A compartment syndrome in a cooperative patient can be diagnosed clinically, but it presents a special challenge if the patient is multiply injured and unable to cooperate with the physical examination. Left unrecognized, compartment syndromes of the thigh can result in permanent damage to muscle and nerve in that compartment. Early diagnosis through a high index of suspicion and measurement of intracompartmental pressure in each compartment is mandatory. Intraoperative measurement of compartment pressure is recommended in cases of impending compartment syndrome. Immediate fasciotomy is indicated to provide the optimum chance of recovery and to prevent microvascular compromise and necrosis of tissue. We present 3 cases of multiply injured patients in which sciatic nerve palsy followed fracture of the ipsilateral femur und compartment syndrome of the thigh. We found that the extent of myoneural necrosis seems to be dependent on the duration and magnitude of the elevated compartment pressure. A comprehensive review of the literature about compartment syndromes of the thigh is also presented.     

Spontaneous bilateral compartment syndrome of the legs: A case report and review of the literature

INTRODUCTIONBilateral acute compartment syndrome of the legs is a rare presentation requiring emergent surgical intervention.PRESENTATION OF CASEWe report the case of 41-year-old woman who presented with acute bilateral compartment syndrome of the legs, complicated by rhabdomyolysis and acute renal failure.DISCUSSIONThere are very few previously reported cases of bilateral compartment syndrome of the legs. In the present case, despite any clear causative factor, we suggest that the aetiology is related to inadvertent posture during sleep.CONCLUSIONThe diagnosis of acute bilateral compartment syndrome of the legs requires a high index of suspicion, particularly in the absence of obvious aetiology. A successful outcome can be achieved with early diagnosis, prompt surgical intervention and a multidisciplinary approach.     

Compartment syndrome of the thigh: an unusual complication after spinal surgery

Compartment syndrome of the thigh is an uncommon pathology, and its acute presentation after spinal surgery is rare. Because a large muscle mass is involved and systemic manifestations of crush syndrome and altered mental status are present, such abnormalities may lead to a delay in appropriate diagnosis and subsequent treatment. A 56-year-old man who was suspected of having a posterior compartment syndrome in the thigh after spinal decompression in the knee-chest position was evaluated clinically and with the use of a catheter for intracompartmental pressure measurement as a tool to help establish the diagnosis and monitor the evolution. Because of sciatic involvement and a demonstrated increase in the pressure in the posterior compartment with myoglobinuria and acute renal failure, prompt longitudinal fasciotomy was performed with excellent neurologic recovery and improvement of both clinical parameters and mental status.     

急性下肢缺血动脉再通后并发骨筋膜室综合征的诊治

目的：探讨急性下肢缺血动脉再通后并发骨筋膜室综合征的临床表现、早期诊治及预后。方法：回顾性分析2005年1月至2009年1月因急性下肢缺血在我科行动脉再通治疗后并发急性下肢骨筋膜室综合征病人的临床资料,包括发病原因、时间、治疗方式、治疗效果、骨筋膜室综合征的处理方法及预后。结果：126例病人因急性下肢缺血行动脉再通治疗,发病至再通时间平均为26h（3h至6d）,其中24例（共27条肢体）并发骨筋膜室综合征而行筋膜切开（包括3例行双侧肢体预防性切开）。21例动脉再通术后延迟切开时间平均为10（5—48）h,其中2例术中行血液透析,1例行术后血液透析。本组3例截肢,2例死亡（包括1例截肢）。结论：骨筋膜室综合征是急性下肢缺血动脉再通后的严重并发症,动脉再通后持续疼痛或疼痛加重伴局部张力升高者应高度怀疑为骨筋膜室综合征,其治疗方法是充分切开4个筋膜腔减压,同时动态监测病人电解质和肾功能指标,维持肾功能和内环境的稳定,必要时应早期进行透析。     

Belastungsinduziertes Kompartmentsyndrom der Peronealloge nach Bowling

A 30-year-old man presented several times with pain in the calf after twisting his foot and injuring it during bowling. It was some time before the diagnosis of acute exertion-induced compartment syndrome was made, and an immediate fasciotomy could no longer prevent necrosis of the peroneal muscles. Because of the patient's drop-foot, we performed a tibialis posterior tendon transfer, fixing it to the cuneiform bone. The sort of compartment syndrome observed after engagement in various sports is a recognised, albeit uncommon, variant of acute compartment syndrome. A high level of suspicion and observation is required to make the diagnosis when any leg pain has no definite diagnosis. Fasciotomy should be performed early.     

Acute limb compartment syndrome: a review

Acute limb compartment syndrome (LCS) is a limb-threatening and occasionally life-threatening condition caused by bleeding or edema in a closed muscle compartment surrounded by fascia and bone, which leads to muscle and nerve ischemia. Well-known causative factors are acute trauma and reperfusion after treatment for acute arterial obstruction. Untreated compartment syndrome usually leads to muscle necrosis, limb amputation, and, if severe, in large compartments, renal failure and death. Alertness, clinical suspicion of the possibility of LCS, and occasionally intracompartmental pressure (ICP) measurement are required to avoid a delay in diagnosis or missed diagnosis. Open fasciotomy, by incising both skin and fascia, is the most reliable method for adequate compartment decompression. The techniques of measuring ICP have advantages and disadvantages, whereas the pressure level that mandates fasciotomy is controversial. Increased awareness of the syndrome and the advent of measurements of ICP pressure have raised the possibility of early diagnosis and treatment. This review reports LCS, including etiology, pathophysiology, diagnosis, ICP measurement, management, and outcome.     

Neonatal Volkmann's compartment syndrome. A report of two cases

Neonatal Volkmann's compartment syndrome is a rare entity. This diagnosis may be suspected when a case presents cutaneous damage associated with poor hand and wrist function after delivery. We present two such cases of neonatal Volkmann compartment syndrome with long term clinical and x-ray follow-up. In our patients, a hand surgeon was not consulted in the perinatal period and early fasciotomy was not performed. No particular aetiology or associated cerebrovascular accident was found. A series of operations was necessary in order to improve function of the hand. Neonatal Volkmann compartment syndrome must be recognised early in order to enable further investigation of any underlying condition and to perform early surgical decompression. Long term clinical and x-ray follow-up is necessary to prevent and treat wrist deformation and finger contractures.     

ACUTE COMPARTMENT SYNDROME DUE TO CLOSED MUSCLE RUPTURE

Acute compartment syndrome has multiple causes: fractures, crush injury, vascular trauma and burns. Exertional compartment syndrome may be acute (progressive) or chronic (usually reversible). The acute form usually occurs after intensive exercise. Closed muscle rupture is an uncommon cause with few reports. We report two cases, in the peroneal compartment of the leg and the flexor compartment of the forearm, to show that a high index of suspicion, allowing prompt diagnosis and fasciotomy, will enable a full recovery without complications.     

Non-traumatic causes and the management of the open abdomen

The open abdomen is increasingly used for the treatment and prevention of abdominal compartment syndrome. The leading non-traumatic conditions that may cause abdominal compartment syndrome requiring surgical decompression include secondary peritonitis, ruptured abdominal aortic aneurysm and severe acute pancreatitis. Patients may also end up with the open abdomen when the laparotomy wound cannot be closed without tension because of excessive visceral swelling. Also, surgical complications such as laparotomy wound dehiscence, may require temporary abdominal closure techniques. In critically ill surgical patients and in situations when second-look laparotomy is mandatory the open abdomen can be utilized in a preventive manner like in damage control trauma surgery. Underlying disease and the indication for the open abdomen significantly contributes to outcome of patient with open abdomen. Non-traumatic aetiology of the open abdomen is associated with lower likelihood of primary fascial closure and higher rate of open abdomen related complications compared with traumatic aetiology. A number of temporal abdominal closure techniques have been described. Ideally, temporal abdominal closure technique should prevent the development of recurrent abdominal compartment syndrome and facilitate later primary fascia closure with low complication rate. Although fascial closure rate varies between techniques, there are few evidence-based data to support one technique over another. However, recent evolution of temporary abdominal closure techniques have decreased the number of patients with frozen abdomen and reduced the need for planned hernia management. Highest fascial closure rates have been achieved with vacuum-assisted closure systems and systems that provide continuous fascial traction.     

Acute compartment syndrome of the upper arm: a report of 2 cases

Compartment syndromes of the upper arm are rare clinical entities but can be a serious problem, especially in unconscious patients or those presenting with altered mental status. A high index of suspicion is needed to make an accurate diagnosis. Measuring compartment pressures is helpful, but the role of pressure measurement in the diagnosis and treatment may be secondary to the clinical examination. In patients presenting without histories of trauma, who have sustained long periods of immobilization, a suspicion of a crush syndrome should also be included during the workup of a compartment syndrome. Fasciotomy and débridement of necrotic and nonviable tissue are the treatments of choice for a patient with a compartment syndrome, but initiating medical management and providing medical stability for systemic complications resulting from a crush syndrome may be necessary prior to surgical intervention to prevent organ failure and death. Overall, prognosis is improved by early diagnosis and treatment.     

Acute compartment syndrome of the forearm following manipulation under anaesthesia for atypical wrist injury

Acute compartment syndrome of the forearm may arise from various causes. The aetiology, diagnosis and treatment have been the subject of several reviews. However, isolated wrist injury leading to acute compartment syndrome is rare. We report an unusual combination of bony and soft tissue trauma to the wrist leading to acute compartment syndrome in a young male. A combination of a high index of suspicion and prompt intervention was used to prevent the devastating sequel that could have arisen from this condition.     

Acute lumbar paraspinal compartment syndrome: a systematic review

While still a rare entity, acute lumbar paraspinal compartment syndrome has an increasing incidence. Similar to other compartment syndromes, acute lumbar paraspinal compartment syndrome is defined by raised pressure within a closed fibro‐osseous space, limiting tissue perfusion within that space. The resultant tissue ischaemia presents as acute pain, and if left untreated, it may result in permanent tissue damage. A literature search of ‘paraspinal compartment syndrome’ revealed 21 articles. The details from a case encountered by the authors are also included. A common data set was extracted, focusing on demographics, aetiology, clinical features, management and outcomes. There are 23 reported cases of acute compartment syndrome. These are typically caused by weight‐lifting exercises, but may also result from other exercises, direct trauma or non‐spinal surgery. Pain, tenderness and paraspinal paraesthesia are key clinical findings. Serum creatine kinase, magnetic resonance imaging and intracompartment pressure measurement confirm the diagnosis. Half of the reported cases have been managed with surgical fasciotomy, and these patients have all had good outcomes relative to those managed with conservative measures with or without hyperbaric oxygen therapy. These good outcomes were despite significant delays to operative intervention. The diagnostic uncertainty and subsequent delay to fasciotomy result from the rarity of this disease entity, and a high level of suspicion is recommended in the appropriate setting. This is particularly true in light of the current popularity of extreme weight lifting in non‐professional athletes. Operative intervention is strongly recommended in all cases based on the available evidence.     

Does epidural analgesia delay the diagnosis of lower limb compartment syndrome in children?

One of the cardinal symptoms of compartment syndrome is pain. A literature review was undertaken in order to assess the association of epidural analgesia and compartment syndrome in children, whether epidural analgesia delays the diagnosis, and to identify patients who might be at risk. Evidence was sought to offer recommendations in the use of epidural analgesia in patients at risk of developing compartment syndrome of the lower limb. Increasing analgesic use, increasing/breakthrough pain and pain remote to the surgical site were identified as important early warning signs of impending compartment syndrome in the lower limb of a child with a working epidural. The presence of any should trigger immediate examination of the painful site, and active management of the situation (we have proposed one clinical pathway). Avoidance of dense sensory or motor block and unnecessary sensory blockade of areas remote to the surgical site allows full assessment of the child and may prevent any delay in diagnosis of compartment syndrome. Focusing on excluding the diagnosis of compartment syndrome rather than failure of analgesic modality is vital. In the pediatric cases reviewed there was no clear evidence that the presence of an epidural had delayed the diagnosis.     

Bilateral medial foot compartment syndrome after an aerobics class: a case report

The authors present an unusual case of bilateral medial foot compartment syndrome in a healthy woman after a low-intensity aerobics exercise class. The majority of compartment syndrome cases have occurred after trauma, such as combat crush injuries and motor vehicle accidents. We wish to call attention to a rare situation in which compartment syndrome occurs in a healthy young adult after low-intensity exercise and highlight the necessity of a high clinical suspicion and a low threshold for fasciotomies to prevent irreversible muscle damage as a result of extremely high pressures. There is a paucity of cases on the clinical management and follow-up of this rare occurrence of compartment syndrome.