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PubMed2000

Utility of near-infrared spectroscopy in the diagnosis of lower extremity compartment syndrome.

OBJECTIVE: To determine the utility of near-infrared spectroscopy in the diagnosis of lower extremity compartment syndrome (CS). METHODS: Nine patients with CS confirmed by physical examination and elevated compartment pressures (64 +/- 17 mm Hg) were evaluated before and after fasciotomy. Control readings were also performed on 33 surgical patients who had no evidence of CS. The deltoid muscle was used as a reference value. RESULTS: The deltoid muscle oxygen saturation (StO2) readings revealed a mean = 84 +/- 17% prefasciotomy and mean = 83 +/- 12% postfasciotomy in the CS group. The control group had a mean StO2 of 83 +/- 11%. In the CS group, the leg compartment with the highest pressure had a StO2 mean = 56 +/- 27% before fasciotomy. This value was statistically significantly lower (p < 0.05) than either the postfasciotomy mean StO2 in that compartment (82 +/- 16%) or the values found in matched control patients with no evidence of CS (87 +/- 7%). CONCLUSION: Near-infrared spectroscopy-derived StO2 values in the lower extremities of trauma patients with CS were diminished relative to the control patients and usually normalized after fasciotomy. Near-infrared spectroscopy evaluation may offer a rapid, noninvasive method of assessing extremities at risk for CS.

Adult↗
PubMed2006

Treatment of abdominal compartment syndrome with subcutaneous anterior abdominal fasciotomy in severe acute pancreatitis.

BACKGROUND: Managing the abdominal compartment syndrome associated with severe acute pancreatitis by the open abdomen method is associated with considerable morbidity and resource utilization. METHODS: A technique of subcutaneous anterior abdominal fasciotomy is described for the first time in two patients with severe acute pancreatitis. RESULTS: Following the procedure, the intra-abdominal pressure decreased from 30 mmHg immediately to 23 mmHg and to a sustained level of 12-14 mmHg in the first patient, and from 35 mmHg immediately to 23 mmHg and to a sustained level of 14-19 mmHg in the second patient. CONCLUSIONS: The subcutaneous anterior abdominal fasciotomy is a promising method for safe and effective abdominal decompression with sustained effect and avoiding the morbidity associated with the alternative open abdomen techniques.

Abdominal Wall↗
PubMed2001

[Abdominal compartment syndrome].

French physicians dealing with abdominal emergencies are not very familiar with the abdominal compartment syndrome (ACS). Increased abdominal pressure has deleterious consequences on local (intestine, liver, kidney) circulation, leading to death in the absence of correct treatment. Abdominal trauma and ruptured aortic aneurism are the main causes of ACS. Clinical presentation may be misleading: respiratory failure, oliguria or circulatory symptoms are often predominant. Abdominal palpation is inefficient for evaluating intra-abdominal pressure (IAP); only measurement of cystic pressure allows precise evaluation of IAP. Abdominal decompression is the treatment of choice. It must be performed as soon as IAP exceeds 25 mmHg. The procedure may be risky with a high incidence of severe complications when ischaemic territories are reperfused. Recent data underline the importance of compensation of hypovolemia before decompression. Abdominal closure may necessitate various techniques (aponevrotomy, Bogota bags, etc.). At any rate, IAP must remain low at the end of the procedure. In case of suspicion of ACS, early measurement of IAP is mandatory. If pressure is over 25 mmHg, a decompressive procedure must be initiated.

Abdominal Injuries↗
PubMed1986

Exertional tibialis posterior compartment syndrome.

Preexercise, exercise, and postexercise pressure measurements were performed simultaneously in the tibialis posterior muscle and the deep posterior compartment, to establish a diagnosis of exertional tibialis posterior compartment syndrome. The tibialis posterior muscle occupies its own fascial compartment and therefore should be decompressed at the time of deep posterior compartment fasciotomy.

Catheterization↗
PubMed1998

Treatment of chronic exertional anterior compartment syndrome with massage: a pilot study.

OBJECTIVE: To determine the effect of massage on anterior chronic exertional compartment syndrome (CECS) with respect to symptoms, intracompartmental pressures, and work output of the anterior compartment in dorsiflexion. DESIGN: One group-repeated measures design. SETTING: A private sports medicine clinic in Melbourne, Australia. PARTICIPANTS: Seven athletes (six men and one woman), aged between 21 and 29 years, were selected on the basis of clinical suspicion for anterior CECS. Historical questionnaire and examination were followed by intracompartmental pressure testing of the anterior compartment. Study exclusion criteria were history of a bleeding diathesis and previous treatment consisting of compartment fasciotomy or massage. All athletes completed the study. INTERVENTIONS: A 5-week course of massage consisting of two sessions in the first week and one session per week thereafter, for a total of six treatments. Between each session, a twice-daily standard stretching program involving both anterior and posterior compartments was performed. MAIN OUTCOME MEASURES: Postexercise anterior compartment pressures (mm Hg) before and after treatment, work output (J) in dorsiflexion to pain onset before and after treatment, self-reported symptoms before and after treatment. RESULTS: There was no significant difference in the 3-minute postexercise compartment pressures after the treatment. There was a significant (p = 0.016) increase, however, in work performed in dorsiflexion to pain onset following the massage course. CONCLUSIONS: Intermittent massage combined with specific stretching should be considered in the treatment of anterior CECS.

Adult↗
PubMed2000

Acute compartment syndrome following revisional arthroplasty of the forefoot: the dangers of ankle-block.

A case of acute compartment syndrome of the forefoot after revisional arthroplasty of the forefoot is presented. Shortening of the compartments due to bony resection and extensive dissection due to previous scarring may have predisposed to the pathological condition. Prompt decompression based on clinical grounds prevented any long term sequelae. Allowance must be made for the concomitant use of local anaesthetic procedures which may obscure the clinical picture.

Acute Disease↗
PubMed1992

Compartment syndrome after elective revascularization for chronic ischemia. A case report and review of the literature.

Compartment syndrome is a rare but serious complication of vascular reconstruction. It most commonly occurs following revascularization of an acutely ischemic extremity. This case of compartmental syndrome following bypass surgery for chronic arterial insufficiency is therefore exceedingly unusual. A review of the literature reveals only a few cases with similar presentation. The diagnosis can usually be made on the basis of clinical manifestations combined with compartmental pressure measurement. A timely, four-compartment fasciotomy can avert serious complications with minimal morbidity. Late recognition and treatment of this complication, as well as inadequate decompression, can lead to loss of limb.

Chronic Disease↗
PubMed1999

[The compartment syndrome in injuries of the lower extremity in children].

A total of 22 patients with suspected compartment syndrome in the lower extremity were treated over the period of the last ten years at the Paediatric Traumatological Centre in Brno. CS was confirmed in 15 cases of these patients and incisions of intrafascial areas were performed in the course of treatment, 13 times on the middle leg and twice on the thigh. A conservative procedure was selected in 6 cases when diagnosis was not clearly confirmed: twice on the foot and 4 times on the middle leg. In diagnostics and treatment we definitely prefer permanent monitoring of intrafascial pressures and performance of adequate fasciotomies. Therapeutic results revealed to be good in implementing a correct procedure. Prevention of the iatrogenic ratio of this serious syndrome caused particularly by late assessment of diagnosis is important.

Child↗
PubMed1994

Spontaneous tibial compartment syndrome: case report.

We report the case of an obese 34-year-old woman who spontaneously developed compartment syndrome in her right calf. The patient was treated with four-compartment fasciotomy and debridement of necrotic tissue. Four months after treatment she was ambulating without the use of aids and had full range of motion and muscle strength.

Adult↗
PubMed2001

Chronic anterior compartment syndrome and deep peroneal nerve function.

OBJECTIVE: We hypothesized that athletes with chronic anterior exertional compartment syndrome (CAECS) would demonstrate an impairment in deep peroneal nerve function, as determined by electrodiagnostic studies or neuromuscular examination, either at baseline as compared with control athletes or after exercise. DESIGN: Prospective, controlled study comparing athletes with CAECS to asymptomatic athletes. SETTING: Outpatient, academic practice. PARTICIPANTS: Ten athletes with CAECS were recruited sequentially over 1 year from an outpatient academic practice; diagnosis was confirmed by history, physical examination, and compartment pressure testing. Ten similarly aged control athletes were recruited from the surrounding facility. INTERVENTION: Repetitive dorsiflexion exercise to the point of typical symptoms (CAECS subjects) or fatigue (control subjects). MAIN OUTCOME MEASURES: Deep peroneal nerve conduction study velocity and amplitude; neuromuscular examination in the deep and superficial peroneal distributions. RESULTS: Control subjects demonstrated a significant increase in peroneal motor amplitudes postexercise as compared with preexercise (6.3 +/- 2.2 mV preexercise to 8.2 +/- 3.1 mV postexercise; p = 0.033), but the CAECS subjects did not (8.8 +/- 2.6 to 8.9 +/- 2.1; p = 0.89). At baseline and postexercise, the subjects with CAECS demonstrated decreased vibratory sensation compared with the controls (p = 0.030 at baseline and 0.045 postexercise). CONCLUSIONS: Athletes with CAECS demonstrate a decreased postexercise potentiation of the peroneal motor amplitude and a mild impairment in vibratory sensation; these findings may contribute to their sense of poor foot and ankle control. Further study is necessary before the absence of postexercise potentiation of the peroneal motor amplitude may be considered a diagnostic sign of CAECS.

Adolescent↗
PubMedDate not supplied

Concurrent compartment syndromes of the foot and leg.

We reviewed the case summaries of eight patients who developed concurrent compartment syndromes of the foot and leg after trauma. Patients with multiple fractures of the lower extremities, particularly the tibia, femur, and foot, may develop this disorder. The obvious causes of the concurrent syndromes, concurrent fractures and generalized limb ischemia, were seen only in two patients. The communication between the compartments of the foot and leg may be an additional causative factor. Delayed fasciotomy resulted in muscle necrosis and/or tibial nerve dysfunction. Suspected cases should have the diagnosis established by catheterization of the involved compartments. Prompt fasciotomies of the foot and leg should be performed if the pressures are significantly elevated.

Adolescent↗
PubMed1996

Bilateral chronic compartment syndrome in the forearm and the hand.

We report two cases of bilateral chronic exertional compartment syndrome (CCS) in the forearm and hand. Measurement of the intramuscular pressure was useful for diagnosis. These two cases illustrate that bilateral CCS should be suspected in patients complaining of bilateral exercise-induced pain in the anconeus muscle, the forearms, the thenar and hypothenar regions and in the first dorsal interosseous muscle. Fasciotomy relieved the pain in both cases.

Adult↗
PubMed1989

Transient compartment syndrome of the forearm resulting from venous congestion from a tourniquet.

A case of transient compartment syndrome of the forearm resulting from faulty tourniquet function is described. The patient was followed with serial compartmental pressure measurements. Signs and symptoms subsided within a few hours of limb elevation. Thus, conservative care in the early stages may be therapeutic. Early recognition of tourniquet malfunction, systematic assessment of the source of engorgement, and prompt correction can avoid this post-operative complication.

Compartment Syndromes↗
PubMed1983

Intramuscular pressure, muscle blood flow, and skeletal muscle metabolism in chronic anterior tibial compartment syndrome.

One hundred eight patients with lower leg pain of unknown cause underwent intramuscular pressure measurements by the wick technique. Fifteen patients (14%) were found to have a chronic anterior tibial compartment syndrome. In these patients the intramuscular pressure was significantly increased at rest and during and after exercise as compared with normal subjects. The pressure increase after exercise was long-lasting (40 minutes). Biopsies of the anterior tibial muscles showed increased water content, which may explain the elevated pressures. Muscle blood flow during exercise as measured by the xenon-133 clearance technique was decreased, and muscle lactate concentration was increased in the anterior tibial muscles. Fasciotomy relieved pain and normalized intramuscular pressure, muscle blood flow, and skeletal muscle metabolism.

Adolescent↗
PubMed2004

Rhabdomyolysis and compartment syndrome with coadministration of risperidone and simvastatin.

We report a case of rhabdomyolysis and acute compartment syndrome of the lower extremity in a schizophrenic patient taking risperidone following the addition of simvastatin to treat hyperlipidemia. We suspect that disrupted drug metabolism, resulting from interactions with cytochrome P450 enzymes, rapidly elevated drug plasma levels, which then led to muscle toxicity. Clinicians who pharmacologically treat medical comorbidities in patients receiving atypical antipsychotics must be proactive in anticipating potential drug-drug interactions.

Acute Disease↗