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Schuster M, Kappenschneider T, Meyer M, Holzapfel DE. Acute compartment syndrome of the thigh after total knee arthroplasty: a case report. J Med Case Rep 2024; 18:65. [PMID: 38374059 PMCID: PMC10877870 DOI: 10.1186/s13256-024-04378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION Acute compartment syndrome of the thigh after total knee arthroplasty is a rarely described complication. After the assessment of the diagnosis, immediate surgical intervention is necessary to prevent further tissue damage. Since only a few cases have been described and because of the high complication rate, early detection is essential for ensuring patient outcomes. CASE PRESENTATION After total knee arthroplasty in a high-volume university hospital, a 57-year-old Caucasian female patient experienced strong, disproportional pain in the ventromedial thigh of the affected leg, which did not respond to an adequate adjustment in pain medication. Imaging revealed a distinct swelling of the vastus intermedius muscle. This resulted in acute compartment syndrome of the thigh, which was immediately surgically treated. Apart from receiving surgery distal from the affected compartment and continuous intake of acetylsalicylic acid, the patient had no risk factors for developing compartment syndrome. The patient's recovery was uneventful, with timely wound closure and discharge to outpatient care without significant functional limitations. CONCLUSION Acute compartment syndrome of the thigh represents a rare, but severe complication that can occur after orthopedic surgery. In our case, no triggering factors for the development of acute compartment syndrome, such as the use of a tourniquet, were detected. Even in unusual locations, compartment syndrome should be considered as a differential diagnosis. With sufficient evidence, immediate fasciotomy should be indicated.
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Affiliation(s)
- Marie Schuster
- Department of Orthopaedic Surgery, University of Regensburg, Asklepios Klinikum, Bad Abbach, Germany.
| | - Tobias Kappenschneider
- Department of Orthopaedic Surgery, University of Regensburg, Asklepios Klinikum, Bad Abbach, Germany
| | - Matthias Meyer
- Department of Orthopaedic Surgery, University of Regensburg, Asklepios Klinikum, Bad Abbach, Germany
| | - Dominik Emanuel Holzapfel
- Department of Orthopaedic Surgery, University of Regensburg, Asklepios Klinikum, Bad Abbach, Germany
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McKenna DP, McCarthy C, Higgins T. Isolated Extensor Hallucis Longus Compartment Syndrome: A Case Report. Cureus 2024; 16:e51772. [PMID: 38192525 PMCID: PMC10772309 DOI: 10.7759/cureus.51772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 01/10/2024] Open
Abstract
We present the case of an isolated extensor hallucis longus compartment syndrome following a diaphyseal fibular fracture. Our subject underwent syndesmotic fixation and experienced ongoing pain post-procedure. This was associated with an isolated loss of power in extension of the hallux. A diagnosis of an isolated extensor hallucis longus compartment syndrome followed. Our case highlights the vulnerability of this muscle belly to ischemia and reiterates the value of complete clinical examination in the postoperative patient.
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Affiliation(s)
- Daniel P McKenna
- Surgery, Royal College of Surgeons in Ireland, Dublin, IRL
- Trauma and Orthopaedics, University Hospital Kerry, Tralee, IRL
| | - Cathal McCarthy
- Trauma and Orthopaedics, University Hospital Kerry, Tralee, IRL
| | - Tony Higgins
- Trauma and Orthopaedics, University Hospital Kerry, Tralee, IRL
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Mueller JW, Mcleod CB, Rabenhorst BM. Isolated Acute Lateral Compartment Syndrome in an Adolescent Athlete: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00054. [PMID: 35703162 DOI: 10.2106/jbjs.cc.22.00088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 17-year-old adolescent boy presented with anterolateral, right leg pain and numbness of his right foot 2 days after participating in football practice. He denied a traumatic event, and radiographs were negative for fracture. His imaging and physical examination raised suspicion for acute compartment syndrome (ACS). Single-incision fasciotomy with anterior and lateral compartment release was performed. The peroneus longus muscle was detached at the musculotendinous junction. The peroneus longus was then debrided and transferred to the peroneus brevis. CONCLUSION Atraumatic ACS, although rare, is a diagnostic challenge. Prompt recognition of this atypical presentation is important for proper treatment.
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Affiliation(s)
- Joshua W Mueller
- Division of Pediatric Surgery, Department of Orthopedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Muñoz Pérez DF, Medina Rojas R, Sanjuan Mar´ín JF, Rodríguez Florez RJ, Sánchez Arroyo ND. Síndrome compartimental agudo del miembro inferior: estado actual. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
El síndrome compartimental agudo del miembro inferior es una urgencia médica, que puede conllevar una importante morbilidad para el paciente y que puede tener implicaciones medicolegales para el personal médico. Afecta cerca de 3,1 por 100.000 habitantes en el mundo occidental, con predominio de hombres y jóvenes. Debido a una alteración de la perfusión tisular, por la disposición de los músculos de las extremidades en compartimientos compactos, con poca tolerancia a variaciones en la presión, puede causar isquemia, con cambios irreversibles a nivel muscular y nervioso, falla multiorgánica y la muerte, de no tratarse oportunamente.
El trauma de la extremidad inferior asociado a fractura es la principal causa del síndrome compartimental agudo. El diagnóstico puede realizarse por evaluación clínica, mediante las clásicas seis “P” de la isquemia, u de manera objetiva, al medir la presión intracompartimental con dispositivos especializados. La fasciotomía descompresiva es un procedimiento quirúrgico mediante el cual se inciden las fascias de los compartimientos musculares, permitiendo la disminución de las presiones a ese nivel, y se constituye en el único tratamiento eficaz para el síndrome compartimental agudo. Las complicaciones posquirúrgicas no son infrecuentes, siendo la perdida de la extremidad la más grave de todas. Un correcto conocimiento y aplicación de la técnica quirúrgica evitará procedimientos inadecuados, que impliquen mayor riesgo de resultados adversos.
Presentamos una revisión de los aspectos fundamentales de esta patología potencialmente catastrófica.
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Chen J, Zhang F, Chen H, Pan H. Rhabdomyolysis After the Use of Percussion Massage Gun: A Case Report. Phys Ther 2021; 101:5958507. [PMID: 33156927 PMCID: PMC7846179 DOI: 10.1093/ptj/pzaa199] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 09/10/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Percussion massage guns are commonly used by professional athletes and nonathletes worldwide for warm-up and physical recovery; however, there are no published clinical or evidence-based reports on percussion guns regarding their benefits, indications, contraindications, and even side effects. The purpose of this case report is to describe the first case of rhabdomyolysis as a severe and potentially life-threatening illness following use of a percussion gun. METHODS A young Chinese woman with untreated iron deficiency anemia presented with fatigue and pain in her thigh muscles for 3 days and tea-colored urine for 1 day, after cycling and subsequently receiving percussion gun treatment by her coach for the purpose of massage and relaxing tired muscles. Muscle tenderness and multiple hematomas were found on her thighs, and her urinalysis indicated hemoglobinuria. Her serum creatine kinase was reported as "undetectably high," a hallmark of serious muscle damage leading to a diagnosis of severe rhabdomyolysis. Aggressive intravenous fluid resuscitation, urine alkalinization via intravenous alkaline solution, assessment of urine output, and maintenance of electrolyte balance were administered during hospitalization. RESULTS The patient's clinical presentation gradually improved with the decline of creatine kinase, and she recovered well during follow-up. CONCLUSION A case of severe rhabdomyolysis after percussion massage should alert caregivers, sports professionals, and the public to suspect and recognize the potentially serious adverse effects of percussion guns and to ensure that percussion massage guns be used appropriately and safely in rehabilitation therapy, especially in individuals with an underlying disease or condition. Research is needed to examine the benefits, indications, contraindications, and adverse reactions of percussion guns.
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Affiliation(s)
- Jian Chen
- Department of Neurosurgery, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Fan Zhang
- Department of Diagnostic Ultrasound, Shantou Affiliated Hospital of Sun-Yat-Sen University, Shantou, Guangdong, P.R. China
| | - Haizhu Chen
- Outpatient Department, Shantou Longhu People’s Hospital, Shantou, Guangdong, P.R. China
| | - Hui Pan
- Address all correspondence to Dr Pan at:
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van Veelen NM, Fischli S, Beeres FJP, Eisenhut T, Babst R, Henzen C, Link BC. Compartment syndrome of the leg after thyroid hormone withdrawal; two cases and a systematic review of the literature. BMC Endocr Disord 2020; 20:80. [PMID: 32503586 PMCID: PMC7275613 DOI: 10.1186/s12902-020-00555-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute compartment syndrome is a rare complication of severe hypothyroidism. If the symptoms are not recognized promptly and treatment initiated immediately, there is a high risk of permanent damage. Only few other cases of compartment syndrome due to hypothyroidism have been published and the exact pathophysiological mechanism remains unknown. CASE PRESENTATIONS A 59 year old male developed acute compartment syndrome of his right lower leg after thyroid hormone withdrawal prior to radioiodine remnant ablation after total thyroidectomy for follicular thyroid cancer. He underwent emergency fasciotomy of all four compartments of the lower leg. The muscle tissue in the anterior and lateral compartment was necrotic and was therefore excised. The second patient was a 62 year old female with Hashimoto's thyroiditis, who developed acute compartment syndrome of both lower legs after thyroid hormone withdrawal due to non-compliance. Emergency fasciotomy of all four compartments of both legs was performed. The muscle tissue was viable in all compartments. CONCLUSION Although compartment syndrome due to hypothyroidism is uncommon, it is a complication physicians should be aware of. The majority of reported cases are caused by an acute withdrawal of thyroid hormones and not by undetected hypothyroidism. No previous case of compartment syndrome caused by an iatrogenic hormone withdrawal in preparation for radioactive iodine has been published. However, as shown in this report, it may be beneficial to inform patients of this rare complication prior to hormone withdrawal in preparation for remnant ablation after thyroidectomy.
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Affiliation(s)
- Nicole M van Veelen
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland.
| | - Stefan Fischli
- Department of Endocrinology and Diabetes, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Frank J P Beeres
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Timo Eisenhut
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Christoph Henzen
- Department of Endocrinology and Diabetes, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Björn-Christian Link
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland
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Mortensen SJ, Zhang D, Mohamadi A, Collins J, Weaver MJ, Nazarian A, von Keudell AG. Predicting factors of muscle necrosis in acute compartment syndrome of the lower extremity. Injury 2020; 51:522-526. [PMID: 31767373 DOI: 10.1016/j.injury.2019.11.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/15/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acute physiologic compartment syndrome (ACS) is a disorder of increased intra-compartmental pressure leading to decreased tissue perfusion and muscle necrosis. Tissue ischemia can result in irreversible muscle and nerve injury and requires urgent fasciotomy. The aim of this study was to determine the factors associated with the presence of necrotic muscle in patients undergoing leg fasciotomy. METHODS This is a retrospective cohort study of all patients undergoing fasciotomies for ACS of the leg at two level 1 trauma centers from 2000 to 2015. We found 1,028 patients who underwent leg fasciotomies. We excluded ACS at other sites than the leg, the index fasciotomy performed at an outside institution, prophylactic fasciotomy with no clinical signs of ACS, and patients with inadequate medical records. A total of 357 patients were included in the final analysis. We used bivariate analysis to assess which explanatory variables are associated with the main outcome measure, the presence of necrotic muscle at fasciotomy. We used multivariable regression analysis to determine association accounting for any confounding. RESULTS Of 357 cases of ACS of the leg, 14.6% of patients presented with an open fracture and 21.3% of patients were multiply injured. Overall, 14.3% of cases had muscle necrosis at the time of fasciotomy. Fifty-nine percent of patients with necrotic muscle required more than 3 debridements. Open fracture was the only statistically significant predictor of muscle necrosis (OR=2.8). Crush injury (OR=3.1) and soft tissue injuries (OR=2.8) were at an increased odds of necrotic muscle, but only marginally significant. CONCLUSION ACS is a potentially limb threatening condition often associated with poor outcomes, particularly when the diagnosis is delayed. Patients with open fracture have a three-fold increase in odds of necrotic muscle at the time of fasciotomy.
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Affiliation(s)
- Sharri J Mortensen
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
| | - Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Amin Mohamadi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jamie Collins
- Orthopedic and Arthritis Center for Outcome Research, Brigham and Women's Hospital, Boston, MA, United States
| | - Michael J Weaver
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, United States
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, United States; Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
| | - Arvind G von Keudell
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, United States
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Current Approach to the Evaluation and Management of Acute Compartment Syndrome in Pediatric Patients. Pediatr Emerg Care 2019; 35:432-437. [PMID: 31157749 DOI: 10.1097/pec.0000000000001855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Acute compartment syndrome is an emergent condition caused by increased pressure within a closed compartment. The most common etiology is fractures, but there a number of atraumatic causes cited in the literature. Acute compartment syndrome occurs most frequently in the anterior compartment of the lower leg, followed by the volar forearm. Patients may present with severe pain, pain with passive stretch, swelling, paresthesias, numbness, weakness, decreased pulses, and delayed capillary refill. No finding in isolation can exclude the diagnosis. Direct measurement of the intracompartmental pressure is the most important diagnostic test. Treatment involves removal of compressive dressings and surgical consultation for emergent fasciotomy.
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Long B, Koyfman A, Gottlieb M. Evaluation and Management of Acute Compartment Syndrome in the Emergency Department. J Emerg Med 2019; 56:386-397. [DOI: 10.1016/j.jemermed.2018.12.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/17/2018] [Accepted: 12/08/2018] [Indexed: 12/30/2022]
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Nilsson A, Alkner B, Wetterlöv P, Wetterstad S, Palm L, Schilcher J. Low compartment pressure and myoglobin levels in tibial fractures with suspected acute compartment syndrome. BMC Musculoskelet Disord 2019; 20:15. [PMID: 30611244 PMCID: PMC6320587 DOI: 10.1186/s12891-018-2394-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The intense ischemic pain of acute compartment syndrome can be difficult to discriminate from the pain related to an associated fracture. Lacking objective measures, the decision to perform fasciotomy is often only based on clinical findings and performed at a low threshold. Biomarkers of muscle cell damage might help to identify and monitor patients at risk. In patients with fractures, however, markers of muscle cell damage could be elevated because of other reasons associated with the trauma, which would make interpretation difficult. In a review of all patients who underwent emergency fasciotomy in our health care district we aimed to investigate the decision-making process and specifically the use of biomarkers in patients with and without fractures. METHODS In the southeast health care region of Sweden 79 patients (60 men) with fractures (median age 26 years) and 42 patients (34 men) without associated fractures (median age 44 years) were treated with emergency fasciotomy of the lower leg between 2007 and 2016. Differences in clinical findings, p-myoglobin and p-creatine phosphokinase as well as pressure measurements were investigated. RESULTS P-myoglobin was analyzed preoperatively in 20% of all cases and p-creatine phosphokinase in 8%. Preoperative levels of p-myoglobin were lower in patients with fractures (median 1065 μg/L, range 200-3700 μg/L) compared with those without fractures (median 7450 μg/L, range 29-31,000 μg/L), p < 0.05. Preoperative intracompartmental pressure was lower in the fracture group (median 45 mmHg, range 25-90 mmHg) compared with those without fractures (median 83 mmHg, range 18-130 mmHg), p < 0.05. CONCLUSIONS Biomarkers are seldom used in the context of acute fasciotomy of the lower leg. Contrary to our expectations, preoperative levels of p-myoglobin and intracompartmental pressures were lower in fracture patients. These findings support differences in the underlying pathomechanism between the groups and indicate that biomarkers of muscle cell necrosis might play a more important role in the diagnosis of acute compartment syndrome than previously thought.
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Affiliation(s)
- Abraham Nilsson
- Department of Orthopedics and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Björn Alkner
- Department of Orthopedics, Regional Hospital Eksjö, Region Jönköping County and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Patrick Wetterlöv
- Department of Orthopedics, Regional Hospital Eksjö, Region Jönköping County and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Lars Palm
- Department of Orthopedics and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jörg Schilcher
- Department of Orthopedics and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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Schellenberg M, Chong V, Cone J, Keeley J, Inaba K. Extremity compartment syndrome. Curr Probl Surg 2018; 55:256-273. [PMID: 30470346 DOI: 10.1067/j.cpsurg.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/09/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Morgan Schellenberg
- Fellow in Trauma and Surgical Critical Care LAC + USC Medical Center, Los Angeles, CA
| | - Vincent Chong
- Fellow in Trauma and Surgical Critical Care LAC + USC Medical Center, Los Angeles, CA
| | - Jennifer Cone
- Assistant Professor of Surgery Division of Trauma and Acute Care Surgery, University of Chicago Medical Center, Chicago, IL
| | - Jessica Keeley
- Fellow in Trauma and Surgical Critical Care LAC + USC Medical Center, Los Angeles, CA
| | - Kenji Inaba
- Professor of Surgery, Emergency Medicine, and Anesthesia Medical Director, Surgical Intensive Care Unit Associate Trauma Medical Director University of Southern California, Los Angeles, CA.
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Cone J, Inaba K. Lower extremity compartment syndrome. Trauma Surg Acute Care Open 2017; 2:e000094. [PMID: 29766095 PMCID: PMC5877908 DOI: 10.1136/tsaco-2017-000094] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/25/2017] [Indexed: 12/11/2022] Open
Abstract
Lower extremity compartment syndrome is a devastating complication if not rapidly diagnosed and properly managed. The classic symptoms of compartment syndrome can be deceiving as they occur late. Any concern for compartment syndrome based on mechanism, or the presence of pain in the affected extremity, should prompt a compartment pressure check. Both absolute compartment pressures above 30 mm Hg and a pressure differential of less than 30 mm Hg are used to make the diagnosis. The treatment goal is first to save the patient’s life and second to salvage the affected limb. Fasciotomy is the only accepted treatment of compartment syndrome and should be performed quickly after the diagnosis is made. Outcomes after fasciotomy are best when there is no delay in treatment.
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Affiliation(s)
- Jennifer Cone
- Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California, USA
| | - Kenji Inaba
- Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California, USA
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Lollo L, Grabinsky A. Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital. Int J Crit Illn Inj Sci 2016; 6:133-142. [PMID: 27722115 PMCID: PMC5051056 DOI: 10.4103/2229-5151.190648] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy. Methods: Retrospective chart analysis for patients with a discharge diagnosis of CS was performed. Physical demographics, employment status, activity at time of injury, injury severity score, fracture types, pain scores, hours to fasciotomy, iCP, serum creatine kinase levels, wound treatment regimen, length of hospital stay, and discharge facility were collected. Lower extremity neurologic examination, pain scores, orthopedic complications, and employment status at 30 days and 12 months after discharge were noted. Results: One hundred twenty-four patients were enrolled in this study. One hundred and eight patients were assessed at 12 months. Eighty-one percent were male. Motorized vehicles caused 51% of injuries in males. Forty-one percent of injuries were tibia fractures. Acute kidney injury occurred in 2.4%. Mean peak serum creatine kinase levels were 58,600 units/ml. Gauze dressing was used in 78.9% of nonfracture patients and negative pressure wound vacuum therapy in 78.2% of fracture patients. About 21.6% of patients with CS had prior surgery. Nearly 12.9% of patients required leg amputation. Around 81.8% of amputees were male. Sixty-seven percent of amputees had associated vascular injuries. Foot numbness occurred in 20.5% of patients and drop foot palsy in 18.2%. Osteomyelitis developed in 10.2% of patients and fracture nonunion in 6.8%. About 14.7% of patients underwent further orthopedic surgery. At long-term follow-up, 10.2% of patients reported moderate lower extremity pain and 69.2% had returned to work. Conclusion: Escalation in leg pain and changes in sensation are the cardinal signs for CS rather than reliance on assessing for firm compartments and pressures. The severity of nerve injury worsens with the delay in performing fasciotomy. Standardized diagnostic protocols and wound treatment strategies will result in improved outcomes from this complication.
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Affiliation(s)
- Loreto Lollo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Andreas Grabinsky
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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