Anatomic location of penetrating lower-extremity trauma predicts compartment syndrome development (original) (raw)

Compartment syndrome in combined arterial and venous injuries of the lower extremity

The American journal of …, 1989

In 9 of 45 patients treated for dual vascular injuries of the lower extremity, concomitant fasciotomies were performed at the time of initial surgery for associated soft tissue injury, fracture, or prolonged ischemia. Eight other patients developed compartment syndrome requiring delayed fasciotomy. In seven of them, vein was either ligated or the repaired vein hecame occluded. In the eighth patient, peripheral venous hypertension was caused by massive swelling of the thigh. In the laboratory, compartment pressure was monitored by wick catheter in 24 hind limbs of 12 dogs subjected to experimental conditions simulating vascular injuries and their management. There was a significant increase in compartment pressure in a group that simulated arterial and venous injuries managed by arterial repair and venous outflow obstruction. Based on our study, we suggest that obstruction to venous drainage and venous hypertension are major factors in the development of compartment syndrome in dual vascular injuries of the lower extremity. C ompartment syndrome is a condition in which increased pressure within a limited space compromises the circulation, causing ischemic dysfunction and necrosis of tissues within that space. In the leg, four limited unyielding spaces are bounded by the tibia, the fibula, the interosseous membrane, and the crural fascia. There are many causes reported for the development of compartment syndrome, including reperfusion after prolonged ischemia, local soft tissue and osseous trauma, intensive use of muscle, intraarterial injection of drugs, venous obstruction, and burns [Z]. Reports of consequences of arterial and venous injuries during the Vietnam War included the suggestion of performing concomitant fasciotomy during vascular repair, especially when popliteal arterial injury is associated

Acute Compartment Syndrome after Lower Leg Fracture

European Journal of Trauma, 2004

Background: In acute situations, fasciotomy can be done prophylactically or as early therapeutic decompression, the latter being performed as soon as the first symptoms of compartment syndrome are present. Patients and Methods: Results of fasciotomy after lower leg fracture performed between 1992 and 2001 were reviewed with emphasis on the efficacy of treatment and morbidity of the procedure sec. Patients, divided into a prophylactic group (A) and a therapeutic fasciotomy group (B), were interviewed and examined, focusing on late sequelae of compartment syndrome and of the fasciotomy sec. Results: 52 patients were followed up after a median period of 40 months, 18 in group A and 34 in group B. All fractures in group A were operated within 24 h, one third of patients in group B underwent surgery later. In group A, one short foot syndrome was found. In group B, five amputations were performed for ischemic muscle necrosis, two short foot syndromes were observed, and five legs showed other late compelling signs of manifest compartment syndrome. In the 31 legs without sustained compartment syndrome, only seven had no fasciotomy-related abnormalities besides a scar; reduced endurance and swelling were most frequently found. An iatrogenic superficial peroneal nerve lesion was diagnosed in seven legs. Conclusion: Outcome after prophylactic fasciotomy seems to be superior to that after early therapeutic decompression. Though prophylactic fasciotomy is effective, its morbidity is quite high, with long-term consequences in three quarters of patients.

Current thinking about acute compartment syndrome of the lower extremity

Canadian journal of surgery. Journal canadien de chirurgie, 2010

Acute compartment syndrome of the lower extremity is a clinical condition that, although uncommon, is seen fairly regularly in modern orthopedic practice. The pathophysiology of the disorder has been extensively described and is well known to physicians who care for patients with musculoskeletal injuries. The diagnosis, however, is often difficult to make. In this article, we review the clinical risk factors of acute compartment syndrome of the lower extremity, identify the current concepts of diagnosis and discuss appropriate treatment plans. We also describe the Canadian medicolegal environment in regard to compartment syndrome of the lower extremity.

Compartment syndrome of the non-injured limb

BMJ Case Reports, 2020

Compartment syndrome is a common limb-threatening entity in trauma. However, the occurrence of the same in the non-injured limb is rare. It seems to be multifactorial in origin, with abnormal positioning being the most common cause. We present such a case of well-leg compartment syndrome which was treated by an urgent fasciotomy. We emphasise on the fact that the diagnosis of compartment syndrome is clinical and the management remains the same irrespective of whether the limb has sustained an injury or not.

Clinical practice guidelines for the management of acute limb compartment syndrome following trauma

ANZ Journal of Surgery, 2010

Background: Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency, and is associated with significant morbidity if not managed appropriately. There is variation in management of acute limb compartment syndrome in Australia. Methods: Clinical practice guidelines for the management of acute limb compartment syndrome following trauma were developed in accordance with Australian National Health and Medical Research Council recommendations. The guidelines were based on critically appraised literature evidence and the consensus opinion of a multidisciplinary team involved in trauma management who met in a nominal panel process. Results: Recommendations were developed for key decision nodes in the patient care pathway, including methods of diagnosis in alert and unconscious patients, appropriate assessment of compartment pressure, timing and technique of fasciotomy, fasciotomy wound management, and prevention of compartment syndrome in patients with limb injuries. The recommendations were largely consensus based in the absence of welldesigned clinical trial evidence. Conclusions: Clinical practice guidelines for the management of acute limb compartment syndrome following trauma have been developed that will support consistency in management and optimize patient health outcomes. Methods Staff from the Liverpool (Sydney) and Royal Melbourne Hospitals in Australia undertook a collaborative project to develop CPG for the

Prevalence of Acute Compartment Syndrome of Limbs: A Retrospective Study

Journal of Armed Forces Medical College, Bangladesh, 2020

Introduction: Acute compartment syndrome (ACS) is a serious and well known complication of limb trauma. This condition is an orthopaedic emergency and is associated with significant morbidity if not diagnosed promptly and treated effectively. Materials and Methods: This is a retrospective cross sectional study on the scope of compartment syndrome among patients with limbs traumas those were treated between April 2015 and November 2018 in a United Nations level-II Hospital at Kaga-Bandoro in Central African Republic leaded by Bangladesh Medical Contingent. The medical records as well as data from the orthopaedic registrars of patients with limb injuries were studied. Limb injuries considered for in-hospital treatments with or without other associated system injuries were included while patients with any form of arterial diseases or claudication were excluded. Results: A total of 320 patients met the inclusion criteria among them only 2.81% had ACS and male young adults were mostly af...

The acute compartment syndrome of the lower leg: a difficult diagnosis?

2010

Three patients, two adults and one child, developed an acute compartment syndrome of the lower leg. Due to delay in diagnosis, severe complications developed, resulting in two transfemoral amputations. In the youngest patient, the lower leg was able to be saved after extensive reconstructive surgery. In most cases, acute compartment syndrome of the lower leg is seen in combination with a fracture (40%), although other causes (minor trauma or vascular surgery) are also known. Moreover, patient history (pain out of proportion to the associated injury) and physical examination are central to the diagnosis. In some cases, however, a reliable diagnosis cannot be made clinically, as in the case of unconscious, intoxicated or intubated patients, as well as small children. Under these circumstances, intra-compartmental pressure measurement can be of great assistance. After confirmation of the diagnosis, immediate fasciotomy of all lower leg compartments should be performed. The eventual outcome of this syndrome is directly related to the time elapsed between diagnosis and definitive treatment. Although the diagnosis can be difficult, delays in treatment should be avoided at all costs. The acute compartment syndrome of the lower leg is a surgical emergency and should be dealt with immediately.

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

Patient Safety in Surgery, 2013

Background: Compartment 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 presentation: 23-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. Conclusion: Despite 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.

Management of acute limb compartment syndrome : A survey of clinical practice among orthopedics and traumatology surgeons in Turkey

2019

Aim: The aim is to conduct a survey of currently practising orthopedics and traumatology surgeons and residents in Turkey regarding their current practice and perceptions on compartment syndrome management. Materials and Methods: A structured survey was developed for the study. Diagnosis in alert and unconscious patients, clinical signs of the condition, compartment pressure measurement, optimal time frame and technique for performing a fasciotomy, and preventive measures in patients with limb injuries were assessed. Results: Due to the evaluation, most significant and earliest symptom thought to be pain in 74% and 82.2% respectively. In diagnostic approach of conscious patients, 59.6% find intense pain and intense pain with passive stretching sufficient for diagnosis. In unconscious patients, 22.6% measure intracompartment pressure in every patient and if high in first measurement, indicates emergent fasciotomy, whereas 59.5% apply emergent fasciotomy in clinical suspicion without ...

Case Report Compartment Syndrome following Open Femoral Fracture with an Isolated Femoral Vein Injury Treated with Acute Repair

2020

Acute compartment syndrome is a surgical emergency and its diagnosis is more difficult in obtunded or insensate patients. We present the case of a 34-year-old woman who sustained a Gustilo-Anderson grade III open midshaft femur fracture with an isolated femoral vein injury treated with direct repair. She developed lower leg compartment syndrome at 48 hours postoperatively, necessitating fasciotomies. She was subsequently found to have a DVT in her femoral vein at the level of the repair and was started on therapeutic anticoagulation. This case highlights the importance of recognition of isolated venous injuries in a trauma setting as a risk factor for developing compartment syndrome.