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Compartment syndrome after compression sclerotherapy.

Acute limb compartment syndrome is a condition in which raised pressure within a closed fascial space reduces capillary perfusion below a level necessary for tissue viability. Although it is a rare but potentially disastrous complication of orthopedic injury to the extremities, it may occur spontaneously without a history of trauma, and any insult that tends to increase resistance to flow in the capillary bed in any anatomical situation may result in a compartment syndrome. We report an extremely rare case of compartment syndrome following compression sclerotherapy.

Adult↗

Tibial plateau fracture with compartment syndrome: a complication of higher incidence in Taiwan.

BACKGROUND: Compartment syndrome after tibial plateau fracture has been described, solely as case reports in previously published articles, as a relatively rare complication. METHODS: A retrospective review of 106 patients with 107 tibial plateau fractures was undertaken from January 1996 to June 1997 at a level I trauma center, and the incidence of compartment syndrome was 10.3%. The diagnosis was based on characteristic clinical symptoms and signs of acute compartment syndrome and/or by measurement of intracompartment pressures. The treatment included fasciotomy of the 4 compartments. RESULTS: There was a high correlation between the incidence of compartment syndrome and the fracture pattern as well as the mechanism of trauma. Higher-energy traumas (Schatzker's type IV, V, and VI) were associated with a higher incidence of compartment syndrome (30.4% in type VI). CONCLUSION: The incidence of compartment syndrome after tibial plateau fracture is more common than what has been reported in the literature, especially after high-energy trauma.

Adolescent↗

Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome.

Compartment syndrome can be difficult to diagnose in a child, with delays in diagnosis leading to disastrous outcomes. Thirty-six cases of compartment syndrome in 33 pediatric patients were treated at the authors' institution from January 1, 1992, to December 31, 1997. There were 27 boys and 6 girls, with nearly equal upper and lower extremity involvement. Approximately 75% of these patients developed compartment syndrome in the setting of fracture. Pain, pallor, paresthesia, paralysis, and pulselessness were relatively unreliable signs and symptoms of compartment syndrome in these children. An increasing analgesia requirement in combination with other clinical signs, however, was a more sensitive indicator of compartment syndrome: all 10 patients with access to patient-controlled or nurse-administered analgesia during their initial evaluation demonstrated an increasing requirement for pain medication. With early diagnosis and expeditious treatment, >90% of the patients studied achieved full restoration of function.

Acute Disease↗

Venous obstruction in healthy limbs: a model for chronic compartment syndrome?

PURPOSE: Chronic exertional compartment syndrome (CECS) in the anterior tibial (AT) compartment is generally believed to be the result of reduced venous blood flow caused by restrictive compartments and increased intramuscular pressures. If this is so, then restricting venous flow in the muscles of healthy subjects during exercise should mimic CECS. METHODS: This hypothesis was tested in 10 control subjects (aged 19-41 yr, five males) with and without external venous occlusion induced by a sphygmomanometer cuff fitted just below the knee and inflated to 80 mm Hg. Twenty CECS patients (20-39 yr, 16 males) were studied without external occlusion. Subjects performed intermittent, isometric maximal voluntary contractions (MVC) of the AT for 20 min (1.6-s contractions, 0.5 duty cycle). MVC, tetanic force (2 s at 50 Hz), muscle thickness (ultrasound imaging), and pain were measured during exercise and 10 min of recovery. RESULTS: Venous occlusion in the controls induced greater pain, fatigue, and increase in muscle thickness (P < 0.01). Initially the patients fatigued more slowly than the occluded controls, but at the end of exercise, the fatigue and pain were similar in these two groups. The controls showed a greater increase in muscle size (P = 0.01). Recovery was similar in all three groups, although the size of the patients' muscles recovered rather more slowly. CONCLUSION: External venous occlusion of the AT muscles in control subjects induces changes very similar to those of CECS patients, although the different time courses indicate that different processes are involved. The AT compartment of CECS patients is capable of distension.

Adult↗

[Exertional compartment syndrome].

OBJECTIVES: To review the literature on chronic exertional compartment syndrome. METHODS: We searched the Medline database with use of the keys words compartment syndrome, exertional, chronic, pressure, and fasciotomy. RESULTS: Exertional compartment syndrome is characterized by pain on exertion, which recedes at rest, and by excessive increase in compartment intramuscular pressure. Intramuscular pressure measurement is the reference diagnostic tool, but it has not been standardized or evaluated. Pressure observed during the first 5 min after exertion stops is more often used in diagnosis. The first studies of noninvasive investigations (magnetic resonance imaging, thallium single-photon emission tomographic imaging, near infrared spectroscopy) revealed their inadequate diagnostic value. The pathophysiological features of exertional compartment syndrome remain unclear: increased muscle bulk, fascia thickness and stiffness, stimulation of fascial sensory stretch-receptors, poor venous return, micromuscular injuries, and small clinical myopathic abnormalities. Treatment includes decreased sport activity or fasciotomy with partial fasciectomy. Several authors have used endoscopically assisted fasciotomy, which retrospective studies have shown to be successful. Long-term outcome studies could investigate the persistence of exertional minor pain and recurrence of the compartment syndrome with this treatment. CONCLUSION: Further studies are required to understand the physiopathology, standardize the intramuscular pressure test and evaluate the pressure threshold values, evaluate noninvasive investigations and specify the long-term outcome of fasciotomy.

Chronic Disease↗

The abdominal compartment syndrome: CT findings.

OBJECTIVE: The abdominal compartment syndrome is a potentially fatal condition resulting from pathologic elevation of intraabdominal pressure. We evaluated preoperative abdominal CT scans of four patients with proven abdominal compartment syndrome to identify signs of increased intraabdominal pressure. CONCLUSION: CT findings common to all four patients included tense infiltration of the retroperitoneum out of proportion to peritoneal disease, extrinsic compression of the inferior vena cava by retroperitoneal hemorrhage or exudate, and massive abdominal distention with an increased ratio of anteroposterior-to-transverse abdominal diameter (positive round belly sign; ratio > .80; p < .001). Direct renal compression or displacement, bowel wall thickening with enhancement, and bilateral inguinal herniation were each present in two of the four patients. Radiologists should be aware of this life-threatening syndrome. In the appropriate clinical setting, CT findings of increased intraabdominal pressure should be swiftly communicated to other physicians involved in treating the patient because the abdominal compartment syndrome requires emergent surgical decompression.

Abdomen↗

Gluteal compartment syndrome following posterior cruciate ligament repair.

Compartment syndrome is a rare but important complication which may occur following injury or surgery to the lower limb. We present a case of contralateral gluteal compartment syndrome following arthroscopic posterior cruciate ligament repair. In order to gain a greater understanding of this complication, we undertook a limited study to investigate the effect of patient position on gluteal compartment pressures. Three volunteers were positioned in such a way as to recreate the intra-operative position of the patient described. Gluteal compartment pressures were calculated by placing weighing scales under each buttock and measuring the surface area over which the weight was distributed.Mean pressures exerted on the gluteal compartment of the non-operated leg were significantly higher (mean=44 mmHg) than those of the operated leg (mean=24 mmHg). The difference was significant with P<0.001. This limited study has shown that care should be taken when positioning patients on an operating table to reduce the risk of compartment syndrome. Factors that should be taken into account include mean diastolic pressure, length of operation and the surface area in contact with the operating table.

Adult↗

The use of regional anaesthesia in patients at risk of acute compartment syndrome.

A delay in the diagnosis of an acute compartment syndrome can be devastating to the patient. The increasing use of regional anaesthesia in the management of orthopaedic and trauma patients raises concerns about the potential for delay in the diagnosis of acute compartment syndrome. We undertook a postal survey to assess the usage of regional anaesthesia in patients with lower limb fractures. The study showed that regional anaesthesia is being used in patients at risk of compartment syndrome and without compartment pressure monitoring equipment being available. The anaesthetists questioned had seen cases of acute compartment syndrome being masked by regional anaesthesia. We recommend that there is an urgent need to establish joint guidelines between the orthopaedic and anaesthetic communities on the usage of regional anaesthesia in patients with lower limb fractures to reduce further morbidity from delays in the diagnosis of compartment syndrome.

Anesthesia, Conduction↗

Compartment syndrome of the upper arm.

Compartment syndromes of the upper arm are reported rarely in the literature. The diagnosis requires a high index of suspicion. As with compartment syndromes elsewhere, prompt aggressive treatment is crucial in avoiding possible crippling sequelae.

Adolescent↗

[Compartment syndrome. Definition, etiology, pathophysiology].

A compartment syndrome is a condition in which increased pressure a confined fascial space causes decreased capillary blood flow and tissue function below a level necessary for viability. There are a variety of possible etiologies, such as increased compartment content (hematoma, edema, exertion, intoxication) and decreased compartment size (constrictive dressings and casts, closure of fascial defects). The pathophysiology of compartment syndrome is based on the arteriovenous gradient theory. The high pressure within the compartment leads to a decrease in the arteriovenous gradient, to a lowering of tissue PO2 and finally to a metabolic deficit. The tolerance of increased pressure by nerve and muscle is defined by the relationship of mean arterial pressure to tissue pressure and not by absolute tissue pressure.

Compartment Syndromes↗

Acute compartment syndrome of the arm.

Compartment syndrome of the arm, although uncommon, may result in significant disability if the diagnosis is missed. A high index of suspicion is needed, particularly in those patients at high risk, especially intoxicated or comatose patients. This article discusses the relevant anatomy, pathogenesis, diagnosis, prognosis, and complications of this syndrome.

Arm↗

Compartment syndrome complicating metastatic malignant melanoma.

Compartment syndrome is well documented in the literature. Neoplasia as a cause is a rare. We report a patient with known metastatic malignant melanoma presenting with a compartment syndrome of the arm caused by a relatively slow growing, non-invasive metastatic deposit. This was excised and the patient made an uneventful recovery.

Compartment Syndromes↗

Reduced perception of pain in schizophrenia: its relevance to the clinical diagnosis of compartment syndrome.

An atypical presentation of compartment syndrome is reported in a chronic schizophrenic patient with a closed upper tibial fracture. The features of this case and a review of the literature pertaining to pain perception in this group of patients are presented to raise clinical awareness of this combination of disorders, which may lead to delayed treatment of a surgical emergency, consequent on lack of development of classic symptoms in these patients. We suggest continuous intracompartmental pressure monitoring, even in awake schizophrenic patients with injuries at risk of compartment syndrome.

Compartment Syndromes↗

Compartment syndrome. A dorsal pedal presentation.

Compartment syndrome presents an emergency situation to the surgeon. Inordinate delay in performing a fasciotomy poses potential loss of limb or irreversible neuromuscular damage. Recognizing those injuries that may cause a compartment syndrome and careful monitoring of the at-risk patient during the early post-traumatic period are mandatory.

Adult↗

Compartment syndrome following prolonged pelvic surgery.

Compartment syndrome is a rare but serious complication of prolonged pelvic surgery. Prompted by two recent cases the authors studied the effect of limb angulation and elevation on Doppler ankle artery pressure and compartment pressure in ten normal subjects. Mean ankle pressure when supine was 130.5 (95 per cent confidence interval (c.i.) 124.5-136.5) mmHg and fell to 77.2 (95 per cent c.i. 64.6-89.8) mmHg in the Lloyd-Davies position with 10 degrees of head-down tilt. Reversing table tilt to bring the ankle elevation to 0 degrees in Lloyd-Davies supports restored mean ankle pressure to 114.3 (95 per cent c.i. 105.5-122.9) mmHg (P < 0.001). Placing the lower limb in calf supports was found to increase the mean intracompartmental pressure from 3.0 (95 per cent c.i. 1.2-4.8) mmHg to 11.6 (95 per cent c.i. 9.1-14.1) mmHg. Reversing table tilt significantly restores limb perfusion in patients undergoing prolonged pelvic surgery with the legs elevated and may protect against subsequent compartment syndrome.

Adult↗

Functional outcome after acute compartment syndrome of the thigh.

BACKGROUND: Acute compartment syndrome of the thigh is an uncommon condition that is associated with a high rate of morbidity. Because of its rarity, limited information is available on the long-term functional outcome for patients with this condition and the factors that affect the clinical result. METHODS: Eighteen patients with acute compartment syndrome of the thigh were evaluated at an average of sixty-two months after treatment. Functional outcome was evaluated by means of physical examination, isokinetic thigh-muscle testing, and validated functional outcome scores. RESULTS: Long-term functional deficits were present in eight patients, and only five patients had full recovery of thigh-muscle strength. The persistent dysfunction was reflected in worse overall functional outcome scores. High injury severity scores, ipsilateral femoral fracture, prolonged intervals to decompression, the presence of myonecrosis at the time of fasciotomy, and an age of more than thirty years were associated with increased long-term functional deficits, persistent thigh-muscle weakness, and worse functional outcome scores. CONCLUSIONS: Acute compartment syndrome of the thigh is often associated with considerable long-term morbidity. Several factors can affect the functional outcome, and knowledge of these factors can help in the development of a more effective clinical management strategy to reduce long-term morbidity.

Acute Disease↗

[Compartment syndrome of the foot].

The compartment syndrome of the foot is a rare and unrecognized entity. The most common etiology is post traumatic. Some years ago the diagnostic was suspected when the after-effects appear. Since fifteen years many authors have precised the anatomy, the diagnostic and the treatment of the compartment syndrome of the foot. Consequently the morbidity of this Pathology has diminished. In fact, because of the severity of associated injuries of the foot, after-effects are not rare and responsible for late disability.

Compartment Syndromes↗