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Free functional rectus femoris muscle transfer for restoration of extension of the foot after lower leg compartment syndrome.

In severely injured lower extremities with loss of the anterior compartment, the free functional rectus femoris musculocutaneous flap was used to restore extension of the foot and in soft-tissue reconstruction. From June 2000-July 2002, 3 patients were treated with this technique. Mean follow-up of the 3 patients was 27 months. Electromyography and the Stanmore system (recording pain, need for orthosis, ability to wear normal shoes, activity level, muscle power, active extension of the foot, and foot posture) were used to assess results of functional rectus femoris transfer. One patient had an excellent result, one patient had a good result, and one patient had a poor result, as assessed by the Stanmore system. Free functional rectus femoris transfer can obtain excellent results in treating foot-drop and soft-tissue defects due to lower leg compartment syndrome and loss of all muscles of the anterior compartment. (c)

Adolescent↗

Compartment syndrome after simple venipuncture in an anticoagulated patient.

An excessively anticoagulated 52-year-old man on chronic warfarin therapy developed a forearm compartment syndrome after venipuncture in an antecubital vein. At fasciotomy, active venous bleeding into the forearm from the venipuncture site was noted, and a large forearm hematoma was evacuated. Anticoagulated patients or those with coagulopathies are at risk for compartment syndrome after percutaneous needle punctures and should be warned of this possibility. Such individuals should be instructed to seek immediate medical attention if any signs or symptoms of this complication occur.

Anticoagulants↗

Case report: compartment syndrome after a suspected black widow spider bite.

Widow spider envenomations generally produce systemic neurologic syndromes without significant local injury. We report a patient who sustained a black widow spider bite to the left forearm and presented to the emergency department with rhabdomyolysis and compartment syndrome. We documented a decrease in symptoms and compartment pressure after administration of antivenom. No surgical intervention was performed. We believe this report to be the first documenting compartment syndrome associated with black widow spider bite.

Animals↗

Acute orbital compartment syndrome after lateral blow-out fracture effectively relieved by lateral cantholysis.

PURPOSE: To report the observation of an acute traumatic orbital compartment syndrome in an 80-year-old man. METHODS: Lateral canthotomy and cantholysis. Computed x-ray tomography. RESULTS: Unilateral proptosis, blindness, a frozen globe and a dilated pupil developed within one hour after a blunt trauma to the left orbital region. Surgery two hours later resulted in normal orbital tension and near-complete recovery of functions. An orbital hematoma was found overlying a lateral blow-out fracture. CONCLUSION: Under favorable conditions, the orbital compartment syndrome can be effectively relieved by lateral canthotomy and cantholysis. The present and previous reports suggest that two hours of orbital ischemia is near the critical time limit for recovery of full visual function.

Accidental Falls↗

[Chronic exertional anterior compartment syndrome of the leg with fascial hernia--case report and review of the literature].

18-year-old female with chronic exertional anterior compartment syndrome was described. Pain was localized on the anterior part of the leg after long distance walking or another physical activity. Disorder was confirmed by electromyography and using Compartmental Pressure Monitor System (Stryker, USA). Intracompartmental pressure was measured three times--after rest, immediately after exercises and again after 30 min. rest. During measurement each compartment was injected by 0.2 ml 0.9% NaCl. The pressure value was noted 10 seconds later. The following values were noted: resting pressure--9 mmHg (normal 0-5 mm), immediately after exercises (active dorsal flexion of the foot)--99 mmHg (normal < 30 mm), after 30 minutes rest--29 mmHg. The patient was treated operatively by subcutaneous fasciotomy of the anterior and lateral compartment of the leg. This procedure was combined with neurolysis of the neural branches within a hernia. 6 months later at follow-up examination complete disappearing of the pain was confirmed. Chronic exertional anterior compartment syndrome should be consider in diagnostics of the lower extremity pain unknown origin in young adults (sportsmen).

Adolescent↗

Acute renal failure, compartment syndrome, and systemic capillary leak syndrome complicating carbon monoxide poisoning.

CASE REPORT: Five Indian labourers sharing one room were found lying on the floor unconscious. A coal fire had been lit to provide heat during the cold night and was still burning inside the room. Two of the men were pronounced dead at the scene. The other three were transferred to the hospital in critical condition. This paper contains the case reports of the three patients who were transferred to the hospital. One of the patients died 60 h after admission. The other two patients were successfully treated and released. The three patients developed severe rhabdomyolysis complicated by compartment syndrome. The patient who died developed compartment syndrome in three extremities. Two patients required blood transfusion due to very severe hemolysis. The hemolysis in the third patient was less severe and did not require blood transfusion. Two patients developed anuric acute renal failure due to acute tubular necrosis as shown by renal biopsy. Two patients developed the full blown picture of systemic capillary leak syndrome. Gross and microscopic examination of specimens taken at autopsy showed extensive necrosis of all skeletal muscles, myocardial necrosis and acute tubular necrosis affecting both kidneys.

Acute Disease↗

Measurement of tissue hardness: can this be a method of diagnosing compartment syndrome noninvasively in children?

In order to assess the feasibility of using the measurement of tissue hardness as a method of diagnosing compartment syndrome noninvasively in children, a simple hand-held device to measure tissue hardness was fabricated. The relationship between hardness and compartmental pressure was studied in an experimental model and in three fresh amputated lower limbs. Normal tissue hardness of the forearm was measured in 189 children and 20 adults to identify the factors that influence normal tissue hardness. The reproducibility of measurement of tissue hardness was assessed on the experimental model, on the amputated limbs and in normal individuals. Experimental data from this study suggest that there is a nonlinear relationship between intracompartmental pressure and tissue hardness. The study also shows that tissue hardness can be measured reproducibly in the forearm of children with the device. Several factors influence tissue hardness such as the age of the child, the site of measurement on the limb, the hand dominance and active muscle contraction. These factors may affect the specificity of this measure as a screening tool for diagnosing compartment syndrome. Further refinement of the measuring device and well designed clinical trials are needed to establish whether compartmental syndrome can be diagnosed reliably by measuring tissue hardness noninvasively.

Adolescent↗

Thermodiffusion for the quantification of tissue perfusion in skeletal muscle--clinical evaluation in standardized traumatological procedures with tourniquet and potential application in the diagnosis of compartment syndrome.

The quantification of tissue perfusion in different parenchymal organs like liver, kidney, and brain by means of thermodiffusion has recently been validated experimentally and was introduced into clinical practice. Traumatology and plastic surgery deal as well with issues of microcirculation. Therefore, it was the aim of this study to validate thermodiffusion for use in skeletal muscle. Eighteen patients were studied during knee arthroscopic procedures that utilized a tourniquet. A thermodiffusion probe was inserted in the tibialis anterior muscle of the side under treatment. Measurement started before the initiation of limb ischemia (by tourniquet) and continued throughout the procedure until tissue perfusion returned to normal values postoperatively. Furthermore, an example of clinical applicability of this technique is given by monitoring muscle tissue perfusion in 3 patients with imminent compartment syndrome. Preoperative values of muscle tissue perfusion in the patients undergoing arthroscopic procedures were 17.74 +/- 4.27 ml/min 100 g. After initiation of tourniquet perfusion quickly decreased to 3.59 +/- 3.53 ml/min 100 g. Upon reperfusion tissue perfusion increased to values above normal for a few minutes and then returned to preischemic values of 20.86 +/- 7.01 ml/min 100 g. There was no significant difference between pre- and postoperative values (P=0.154) but tissue perfusion during tourniquet was significantly reduced (P=0.0001). In 3 patients presenting with the clinical signs of imminent compartment syndrome, thermodiffusion measurement was applied and showed microcirculatory impairment of different degrees. Fasciotomy was followed by a prompt increase of muscle microcirculation to levels slightly above normal. In summary, valid and stable measurements of tissue perfusion in skeletal muscle by means of thermodiffusion are possible under clinical circumstances. Thermodiffusion allows for on-line monitoring of muscle microcirculation, e.g., in compartment syndrome. The clinical potential of thermodiffusion measurements in trauma surgery needs further prospective evaluation.

Adult↗

Chronic compartment syndrome caused by aberrant fascia in an aerobic walker.

The following is a case presentation of a 36-yr-old female athlete who presented with the symptoms and signs of chronic anterior compartment syndrome. Pre-exercise and post-exercise tissue pressure measurements revealed increased compartment pressures in both of her anterior leg compartments. Aberrant fascial bands overlying and compressing the anterior compartments were discovered at the time of surgery. Fasciotomies led to complete recovery and return to previous levels of athletic activity. This is the first report of aberrant fascia as a cause of chronic anterior compartment syndrome.

Adult↗

Compartment syndrome secondary to prolonged intraosseous infusion.

Intraosseous infusions are a valuable means of establishing intravascular access in pediatric emergencies. We report a case of compartment syndrome from prolonged intraosseous infusion (53 hours). We postulate that chemical irritation from medications, infections, the tenuous nature of intraosseous infusions, and the use of infusion pumps may all play a role in the development of compartment syndrome. We recommend that, when possible, intraosseous lines be used only temporarily until more permanent vascular access is established, that lines that do not flow with gravity be removed, and that drugs known to cause chemical burns be used with caution. In addition, the use of x-ray and hourly measurement of leg circumference may help to determine whether a line is still in place. Also, given the changing circumstances and technology under which intraosseous infusions are used, new prospective studies of their complications are needed.

Compartment Syndromes↗

Thoracic compartment syndrome.

Presented is a case of a thoracic gunshot wound resulting in descending thoracic aortic and biventricular cardiac injuries. Successful management of these wounds allowed the development of an unusual and previously undescribed complication of thoracic trauma--thoracic compartment syndrome. The clinical features, therapy, and potential sequelae of thoracic compartment syndrome are presented with a review of the literature.

Adolescent↗

Compartment syndrome as a presentation of non-Hodgkin's lymphoma.

An 80-year-old woman sustained an injury to her left leg and presented having a compartment syndrome. Biopsy at the time of fasciotomy revealed lymphoma infiltrating the muscles of the left leg. We conclude that tumors may present as compartment syndrome and should be included with the differential diagnosis.

Aged↗

Vibratory sensory testing in acute compartment syndromes: a clinical and experimental study.

Invasive and noninvasive diagnostic testing was correlated in 11 patients with acute compartmental syndromes of the forearm. The excellent correlation between diminished perception of vibration and increasing compartmental pressure suggested that 256 cycle per second (cps) vibratory stimuli may be useful clinically in determining the appropriate time for surgical intervention in the acute compartmental syndrome. In 12 adult male volunteers, elevated compartment pressures were created in the anterior tibial compartment of the leg. A decrease in perception to 256 cycle per second (cps) vibratory stimulus was the earliest sensory abnormality to occur with elevated tissue compartment pressures. Analysis of variance showed significantly that 256-cps vibration was the most reliable and earliest sensory modality to change at pressures of 35 to 40 mmHg. These clinical and experimental findings support the use of the 256-cps tuning fork as a noninvasive diagnostic test in the evaluation of the patient with suspected acute compartment syndrome.

Adult↗

[Acute compartment syndrome--a clinical follow-up study].

BACKGROUND: The aim of this study has been to examine patients from 1985 to 1997 with acute compartment syndrome in the leg. We wanted to assess motor function, sensibility and aesthetic sequelae. MATERIAL AND METHODS: During this period, a total of 48 patients were treated by fasciotomy. 29 of these were examined in the follow-up study, after a mean follow-up time of 6.7 years. RESULTS: One of the patients had amputated his leg, two had extirpated necrotic muscle tissue. Another 20 patients had sequelae like drop-foot, claw toes, reduced dorsal flexion of the foot, loss of ability to walk on tiptoe, and limping. 14 patients had loss of sensibility beyond the scar area, and 24 patients had moderate or serious aesthetic sequelae. INTERPRETATION: The high number of patients in this study with sequelae from acute compartment syndrome may indicate an unacceptable delay in diagnosis and treatment.

Acute Disease↗

Peroneal nerve palsy and compartment syndrome in bilateral femoral fractures.

Four patients with bilateral femoral shaft fractures sustained 4 peroneal nerve palsies and 2 compartment syndromes during supine intramedullary nailings of their fractures. In each case, the compartment syndrome or common peroneal nerve palsy or both developed in the leg that was placed initially in the calf-supported leg holder during intramedullary rodding of the contralateral femur. Three of 4 patients had near to full recovery of motor strength postoperatively. The authors recommend that a leg with a fractured femur not be positioned in a calf-supported leg holder.

Adolescent↗

Compartment syndrome following forearm fracture in children.

Six cases of acute compartment syndrome of the forearm following displaced fractures of the distal radius and ulna are presented. In children the diagnosis can be difficult to make, and can be helped by the use of compartment pressure measurements. Children with this type of fracture are at risk of developing this complication, and careful observation and assessment following injury is recommended. The use of early decompression has given better results in this younger age group than that reported in adults.

Acute Disease↗