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Williams DW, Dyer GSM, von Keudell A, Zhang D. Characteristics and outcomes of patients who undergo fasciotomies for upper arm compartment syndrome. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2291-2296. [PMID: 36344794 DOI: 10.1007/s00590-022-03416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Describe the demographic, injury-related, treatment-related, and outcome-related characteristics of patients who undergo fasciotomies for acute upper arm compartment syndrome (ACS). METHODS From January 1, 2006, to June 30, 2015, 438 patients with a diagnosis code of upper extremity (including hand, forearm, arm, and shoulder) compartment syndrome at two tertiary care centers were identified. Of those patients, 423 were excluded for a diagnosis other than upper arm ACS or incomplete documentation. A final cohort of 15 adult patients with acute upper arm compartment syndrome treated with fasciotomy was included. The electronic medical record for patient-related variables, lab data, mechanism of injury, presence of additional injuries, and treatment-related variables were reviewed. RESULTS The mean age of our cohort was 52 years, and 73% were male. The most common mechanisms of injury were blunt trauma (20%), vascular injury (20%), oncologic resection (13%), and infection related to intravenous drug use (13%). Humerus fractures and biceps tendon ruptures were associated with 13 and 27% of the cases, respectively. More than two-thirds of the patients had elevated international normalized ratios (INR). While 27% of cases underwent fasciotomy within 6 h after injury, seven patients (47%) underwent fasciotomy more than 24 h after injury. Six patients had no major deficits, while 7 patients had long-term deficits. CONCLUSION Upper arm ACS is a potentially devastating condition that can be seen after blunt trauma, vascular injury, oncologic resection, and intravenous drug use. Clinicians should have high suspicion in cases of elevated INR and biceps tendon rupture.
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Affiliation(s)
| | - George S M Dyer
- Harvard Medical School, 25 Shattuck St, MA, 02115, Boston, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Arvind von Keudell
- Harvard Medical School, 25 Shattuck St, MA, 02115, Boston, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Rigshospitalet, Department of Orthopedic Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Dafang Zhang
- Harvard Medical School, 25 Shattuck St, MA, 02115, Boston, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
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Rodriguez J, Torres J, Salinas V, Pareja R. Compartment Syndrome of the Hand after Laparoscopic Gynecologic Surgery. J Minim Invasive Gynecol 2019; 27:220-224. [PMID: 30936029 DOI: 10.1016/j.jmig.2019.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/26/2022]
Abstract
Acute compartment syndrome of the hand is a potentially devastating and infrequent condition observed after trauma, arterial injury, or prolonged compression of the upper limb. We present the case of a patient diagnosed with compartment syndrome of the hand after laparoscopic surgery for epithelial ovarian cancer. The patient is a 42-year-old woman with incidental finding of high-grade ovarian serous carcinoma after an emergency surgery. On imaging evaluation, the patient was found to have evidence of residual retroperitoneal adenopathy and was taken to the operating room for a staging procedure by laparoscopy. In the immediate postoperative period, she developed compartment syndrome of the right hand that required multiple fasciotomies and multidisciplinary management by plastic surgery, orthopedics, and rehabilitation medicine. The patient was discharged from the hospital 7 days after laparoscopic surgery to undergo rehabilitation. Three months after surgery, she is continuing to recover, with near complete recovery of hand function. The patient has completed a total of 3 cycles of chemotherapy with carboplatin/paclitaxel. Compartment syndrome of the hand is an uncommon event, but it can generate major functional deficits and even death if it is not diagnosed and treated in a timely manner. Strict criteria for patient positioning in laparoscopy surgery may avoid or reduce this complication. To date, this is the first case reporting such complications associated with laparoscopic gynecologic surgery.
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Affiliation(s)
- Juliana Rodriguez
- Departments of Gynecologic Oncology (Drs. Rodriguez, Torres, and Pareja)
| | - Jarol Torres
- Departments of Gynecologic Oncology (Drs. Rodriguez, Torres, and Pareja)
| | - Vanessa Salinas
- Orthopedic Oncology (Dr. Salinas), Instituto Nacional de Cancerologia, Bogotá, Colombia
| | - Rene Pareja
- Departments of Gynecologic Oncology (Drs. Rodriguez, Torres, and Pareja); Clinica de Oncologia Astorga, Medellin, Colombia, Gynecologic Oncology Professor Universidad Pontificia Bolivariana, Medellin, Colombia.
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Rattan B, Misser SK. Magnetic resonance imaging in exertional compartment syndrome of the forearm: Case-based pictorial review and approach to management. SA J Radiol 2018; 22:1284. [PMID: 31754492 PMCID: PMC6837798 DOI: 10.4102/sajr.v22i1.1284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/11/2018] [Indexed: 11/16/2022] Open
Abstract
Exercise-related limb pain poses a management dilemma to the clinician. The term ‘chronic exertional compartment syndrome’ (CECS) (previously known as ‘anterior tibial syndrome’) refers to a condition characterised by exercise-induced pain in one or more muscle groups and is more commonly seen in the lower limbs. Much less has been reported about the upper limbs where the muscular compartments are variably noted to be involved. A high index of clinical suspicion should therefore be maintained to avoid missing the diagnosis. Although commonly noted in athletes, CECS can occur in any age group with any level of exercise activity. In addition, there is no age predilection and the syndrome may be bilateral. The exact prevalence is not known as many athletes modify their training methods, thus delaying or avoiding medical assistance and imaging. The pathophysiology of compartment syndrome is complex. In this review of the syndrome, we describe the cycle of intracellular events leading to CECS and the eventual destruction of muscle. There is considerable overlap with the many possible causes of limb pain. Even the most experienced clinicians experience some difficulty in making this diagnosis of CECS, but with increasing awareness of this entity and availability of good-quality magnetic resonance imaging to confirm the suspicion, upper limb CECS is being more commonly diagnosed and patients more timeously managed.
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Affiliation(s)
| | - Shalendra K Misser
- Lake Smit and Partners Inc., Durban, South Africa.,School of Health Sciences, University of KwaZulu-Natal, South Africa
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Abstract
Acute hand compartment syndrome is a potentially devastating condition a hand surgeon may be called on to evaluate and treat. This pathophysiologic cascade of events that begins with an inciting event progresses to increased intracompartmental pressure, tissue necrosis, and resultant morbidity and potentially mortality. Many patients present with an altered sensorium, making the diagnosis challenging, requiring the clinician to rely on clinical findings and intracompartmental pressure measurements. The timing to definitive treatment with complete decompressive fasciotomies is critical to optimize patient outcomes. The goals of treatment are to prevent contracture, functional disability, and the loss of limb or life.
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Affiliation(s)
- Aaron J Rubinstein
- Department of Orthopaedic Surgery, Rutgers University, New Jersey Medical School, 140 Bergen Street, D-1610, Newark, NJ 07103, USA
| | - Irfan H Ahmed
- Department of Orthopaedic Surgery, Rutgers University, New Jersey Medical School, 140 Bergen Street, D-1610, Newark, NJ 07103, USA
| | - Michael M Vosbikian
- Department of Orthopaedic Surgery, Rutgers University, New Jersey Medical School, 140 Bergen Street, D-1610, Newark, NJ 07103, USA.
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Abstract
Hand compartment syndrome has many etiologies; untreated, it has dire functional consequences. Intracompartmental pressure exceeding capillary filling pressure causes decreased tissue perfusion resulting in progressive ischemic death of compartment contents. Clinical findings can evolve. Serial physical examinations are recommended and, if equivocal, interstitial pressure monitoring is indicated. Definitive management is emergent fasciotomies with incisions designed to decompress the involved hand compartments, which could include the thenar, hypothenar, and interosseous compartments, and the carpal tunnel. Careful wound care, edema management, splinting, and hand therapy are critical. Therapy should start early postoperatively, possibly before wound closure.
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Affiliation(s)
- Nikhil R Oak
- Department of Orthopaedic Surgery, University of California, San Diego, 200 West Arbor Drive, #8670, San Diego, CA 92103-8670, USA
| | - Reid A Abrams
- Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopaedic Surgery, University of California, San Diego, 200 West Arbor Drive, #8670, San Diego, CA 92103-8670, USA.
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Serbest S, Belhan O, Gürger M, Tosun HB. Compartment Syndrome Resulting from Carbon Monoxide Poisoning. ACTA ACUST UNITED AC 2016; 5:199-201. [PMID: 26588033 DOI: 10.1213/xaa.0000000000000211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Every year, especially in the cooler Fall and Winter months, hundreds of people die because of carbon monoxide poisoning. This occurs usually as an accident. It is a significant cause of poisoning worldwide. We present a case of compartment syndrome in both lower extremities with accompanying acute renal failure and systemic capillary leakage syndrome because of carbon monoxide poisoning.
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Affiliation(s)
- Sancar Serbest
- From the *Faculty of Medicine, Department of Orthopaedics and Traumatology, Kirikkale University, Kirikkale, Turkey; †Faculty of Medicine, Department of Orthopaedics and Traumatology, Firat University, Elaziğ, Turkey; and ‡Faculty of Medicine, Department of Orthopaedics and Traumatology, Adiyaman University, Adiyaman, Turkey
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Codding JL, Vosbikian MM, Ilyas AM. Acute compartment syndrome of the hand. J Hand Surg Am 2015; 40:1213-6; quiz 1216. [PMID: 25801580 DOI: 10.1016/j.jhsa.2015.01.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 01/30/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Jason L Codding
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
| | - Michael M Vosbikian
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Asif M Ilyas
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA
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Forearm compartment syndrome caused by reperfusion injury. Case Rep Vasc Med 2014; 2014:931410. [PMID: 25120938 PMCID: PMC4120475 DOI: 10.1155/2014/931410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/24/2014] [Accepted: 07/02/2014] [Indexed: 12/03/2022] Open
Abstract
Compartment syndrome is commonly seen following lower extremity ischemia. However, upper extremities' compartment syndrome, especially after any vascular surgical procedures, is infrequent. Herein we report a case of an acute forearm compartment syndrome that was developed after delayed brachial artery embolectomy.
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Compartment syndrome on a patient's forearm related to carbon monoxide poisoning. Am J Emerg Med 2012; 30:2104.e1-4. [DOI: 10.1016/j.ajem.2012.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 03/09/2012] [Indexed: 11/22/2022] Open
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Clinical review: Volkmann’s ischaemic contracture. Eur J Trauma Emerg Surg 2011; 38:129-37. [DOI: 10.1007/s00068-011-0079-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 01/21/2011] [Indexed: 11/26/2022]
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Abstract
Acute compartment syndrome of an extremity poses a threat to both life and limb. The usual cause in children is trauma, especially fractures and burns. Two recent cases of nontraumatic compartment syndrome of the extremities in children are presented, both owing to infection followed by myositis or fasciitis. Both cases required urgent decompression by fasciotomy, resulting in limb salvage and full recovery of neuromuscular function of the extremity. The value of prompt recognition and treatment of this condition is emphasized.
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Affiliation(s)
- Carmen Ramos
- Division of Pediatric Surgery, Children's Hospital and the Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.
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