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Petrochko JM, Ullrich LA. Lateral Compartment Syndrome From Inversion Injury. Am Surg 2023; 89:3857-3858. [PMID: 37142260 DOI: 10.1177/00031348231173950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A 17-year-old male presented for the evaluation of right calf pain after an inversion ankle sprain sustained while playing soccer 24 hours prior. On exam, he exhibited swelling and tenderness to palpation over his right calf, mild first web space numbness, and compartment pressures <30 mmHg. Magnetic resonance imaging was significant for findings of lateral compartment syndrome (CS). Upon admission, his exam worsened, prompting an anterior and lateral compartment fasciotomy. Intraoperative findings were significant for lateral CS, with findings of avulsed, nonviable muscle with associated hematoma. Postoperatively the patient had mild foot drop, which improved with physical therapy. Lateral CS rarely develops from an inversion ankle sprain. This presentation of CS is unique due to its mechanism, delayed clinical presentation, and limited signs of CS. Providers should maintain a high index of suspicion for CS in patients with this injury complex and continued pain beyond 24 hours without signs of ligamentous injury.
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Affiliation(s)
- Jameson M Petrochko
- Department of General Surgery Residency, St Luke's University Health Network, Bethlehem, PA, USA
| | - Lauryn A Ullrich
- Department of General Surgery Residency, St Luke's University Health Network, Bethlehem, PA, USA
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Lamplot JD, Wang D, Weiss LJ, Baum M, Zeidler K, Mack C, Barnes RP, Warren RF, Taylor SA, Rodeo SA. Lower Extremity Compartment Syndrome in National Football League Athletes. Sports Health 2021; 13:198-202. [PMID: 33428552 DOI: 10.1177/1941738120973674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the incidence of lower extremity compartment syndrome in National Football League (NFL) athletes and report the mechanisms of injury, methods of treatment, and subsequent days missed. We review the existing literature on lower extremity compartment syndrome in athletic populations. HYPOTHESIS Lower extremity compartment syndrome occurs with a low incidence in NFL athletes, and there is a high return-to-play rate after surgical management of acute compartment syndrome. STUDY DESIGN Case series. LEVEL OF EVIDENCE Level 4. METHODS A retrospective review of recorded cases of lower extremity compartment syndrome from 2000 to 2017 was performed using the NFL Injury Surveillance System and electronic medical record system. Epidemiological data, injury mechanism, rates of surgery, and days missed due to injury were recorded. RESULTS During the study period, 22 cases of leg compartment syndrome in 21 athletes were recorded. Of these injuries, 50% occurred in games and 73% were the result of a direct impact to the leg. Concomitant tibial fracture was noted in only 2 cases (9.1%) and there was only 1 reported case of chronic exertional compartment syndrome. Surgery was documented in 15 of 22 cases (68.2%). For acute nonfracture cases, the average time missed due to injury was 24.2 days (range, 5-54 days), and all were able to return to full participation within the same season. CONCLUSION NFL athletes with acute leg compartment syndrome treated with surgery exhibited a high rate of return to play within the same season. CLINICAL RELEVANCE Although compartment syndrome is a relatively rare diagnosis among NFL players, team physicians and athletic trainers must maintain a high index of suspicion to expediently diagnose and treat this potentially limb-threatening condition.
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Affiliation(s)
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California
| | - Leigh J Weiss
- New York Giants Football Club, East Rutherford, New Jersey
| | - Michael Baum
- New York Giants Football Club, East Rutherford, New Jersey
| | | | | | | | - Russell F Warren
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York
| | - Samuel A Taylor
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York
| | - Scott A Rodeo
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York
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3
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Stella M, Santolini E, Sanguineti F, Felli L, Vicenti G, Bizzoca D, Santolini F. Aetiology of trauma-related acute compartment syndrome of the leg: A systematic review. Injury 2019; 50 Suppl 2:S57-S64. [PMID: 30772051 DOI: 10.1016/j.injury.2019.01.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acute compartment syndrome (ACS) is characterised by abnormal pressure inside a compartment, resulting in ischemia of muscles and nerves. Most orthopaedic surgeons, especially those who work in major trauma centres, have been or will be facing a case of ACS in their clinical activity. Fortunately, complications related to untreated compartment syndrome have become less frequent thanks to a better understanding of pathogenesis and to early recognition and prompt surgical treatment. The aim of this study is to identify the existing evidence regarding aetiology of trauma-related ACS of the leg. METHODS A systematic review of the literature was undertaken using PubMed Medline, Ovid Medline and the Cochrane library, extended by a manual search of bibliographies. Retrieved articles were eligible for inclusion if they reported data about aetiology of trauma-related compartment syndrome of the tibia. RESULTS Ninety-five studies that fulfilled the inclusion criteria were identified. By dividing the studies into three groups according to the traumatic aetiology, we were able to classify traumatic ACS as fracture related, soft tissue injury related and vascular injury related. Fracture related was the most represented group, comprising 58 papers, followed by the soft tissue injury related group which includes 44 articles and vascular injury related group with 24 papers. CONCLUSIONS Although traditionally ACS has been associated mainly with fractures of tibial diaphysis, literature demonstrates that other localisations, in particular in the proximal tibia, are associated with an increased incidence of this serious condition. The forms of ACS secondary to soft tissues injuries represent an extremely variable spectrum of lesions with an insidious tendency for late diagnosis and consequently negative outcomes. In the case of vascular injury, ACS should always be carefully considered as a priority, given the high incidence reported in the literature, as a result of primitive vascular damage or as a result of revascularisation of the limb. Knowledge of aetiology of this serious condition allows us to stratify the risk by identifying a population of patients most at risk, together with the most frequently associated traumatic injuries.
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Affiliation(s)
- Marco Stella
- Orthopaedics and Trauma Unit, Ente Ospedaliero Ospedali Galliera, Mura delle Cappuccine 14, 16148, Genoa, Italy
| | - Emmanuele Santolini
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy.
| | - Francesca Sanguineti
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | - Lamberto Felli
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | - Giovanni Vicenti
- Department of Neuroscience and Sense Organs, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - Davide Bizzoca
- Department of Neuroscience and Sense Organs, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - Federico Santolini
- Orthopaedics and Trauma Unit, Emergency Department, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
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Hiramatsu K, Yonetani Y, Kinugasa K, Nakamura N, Yamamoto K, Yoshikawa H, Hamada M. Deep peroneal nerve palsy with isolated lateral compartment syndrome secondary to peroneus longus tear: a report of two cases and a review of the literature. J Orthop Traumatol 2015; 17:181-5. [PMID: 26362782 PMCID: PMC4882295 DOI: 10.1007/s10195-015-0373-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 08/08/2015] [Indexed: 12/01/2022] Open
Abstract
Drop foot is typically caused by neurologic disease such as lumbar disc herniation, but we report two rare cases of deep peroneal nerve palsy with isolated lateral compartment syndrome secondary to peroneus longus tears. Both patients developed mild pain in the lower legs while playing sport, and were aware of drop foot. As compartment pressures were elevated, fasciotomy was performed immediately, and the tendon of the peroneus longus was completely detached from its proximal origin. The patients were able to return their original sports after 3 months, and clinical examination revealed no hypesthesia or muscle weakness in the deep peroneal nerve area at the time of last follow-up. The common peroneal nerve pierced the deep fascia and lay over the fibular neck, which formed the floor of a short tunnel (the so-called fibular tunnel), then passed the lateral compartment just behind the peroneus longus. The characteristic anatomical situation between the fibular tunnel and peroneus longus might have caused deep peroneal nerve palsy in these two cases after hematoma adjacent to the fibular tunnel increased lateral compartment pressure.
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Affiliation(s)
- Kunihiko Hiramatsu
- Department of Orthopaedic Surgery, Yao Municipal Hospital, 1-3-1, Ryugecho, Yao, Osaka, Japan.
| | - Yasukazu Yonetani
- Department of Orthopaedic Surgery, Hoshigaoka Medical Center, 4-8-1, Hoshigaoka, Hirakata, Osaka, Japan
| | - Kazutaka Kinugasa
- Department of Orthopaedic Surgery, Hoshigaoka Medical Center, 4-8-1, Hoshigaoka, Hirakata, Osaka, Japan
| | - Norimasa Nakamura
- Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan.,Center for Advanced Medical Engineering and Informatics, Osaka University, Suita, Osaka, Japan
| | - Koji Yamamoto
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara, Toyonaka, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Masayuki Hamada
- Department of Orthopaedic Surgery, Hoshigaoka Medical Center, 4-8-1, Hoshigaoka, Hirakata, Osaka, Japan
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Low-impact trauma causing acute compartment syndrome of the lower extremities. Am J Emerg Med 2013; 31:890.e3-4. [DOI: 10.1016/j.ajem.2013.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 11/18/2022] Open
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Frank RM, Hearty T, Chiampas GT, Kodros SA. Acute Bilateral Exertional Lateral Leg Compartment Syndrome with Delayed Presentation: A Case Report. JBJS Case Connect 2012; 2:e81. [PMID: 29252377 DOI: 10.2106/jbjs.cc.l.00100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rachel M Frank
- Department of Orthopaedic Surgery, Rush University Medical Center, 1600 West Harrison Street, Suite 300, Chicago, IL 60612.
| | - Thomas Hearty
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 1350, Chicago, IL 60611
| | - George T Chiampas
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street, Suite 200, Chicago, IL 60611
| | - Steven A Kodros
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 1350, Chicago, IL 60611
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7
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Duan X, Zhang K, Zhong G, Cen S, Huang F, Lv J, Xiang Z. Treatment of compartment syndrome of the thigh associated with acute renal failure after the Wenchuan earthquake. Orthopedics 2012; 35:e486-90. [PMID: 22495847 DOI: 10.3928/01477447-20120327-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Compartment syndrome of the thigh is a rare emergency often treated operatively. The purpose of this study was to evaluate the effects of nonoperative treatment for compartment syndrome of the thigh associated with acute renal failure after the 2008 Wenchuan earthquake. Nonoperative treatment, which primarily involves continuous renal replacement therapy, was performed in 6 patients (3 men and 3 women) who presented with compartment syndrome of the thigh associated with acute renal failure. The mean mangled extremity severity score (MESS) and laboratory data regarding renal function were analyzed before and after treatment, and the clinical outcome was evaluated at 17-month follow-up. Laboratory data regarding renal function showed improvements. All 6 patients survived with the affected lower limbs intact after nonoperative treatment. Follow-up revealed active knee range of motion and increased muscle strength, as well as a recovery of sensation. A positive linear correlation was found between MESS and the time required to achieve a reduction in swelling, as well as the time required for the recovery of sensation and knee range of motion (r>0.8; P<.05). Satisfactory clinical outcomes were obtained in patients with compartment syndrome of the thigh associated with acute renal failure.Urine alkalization, electrolyte and water balance, and continuous renal replacement therapy have played an important role in saving lives and extremities. Nonoperative treatment should be considered in the treatment of compartment syndrome of the thigh associated with acute renal failure.
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Affiliation(s)
- Xin Duan
- Department of Orthopedics, West China Hospital, Sichuan University, Sichuan, China
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8
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Kemp MA, Barnes JR, Thorpe PL, Williams JL. Avulsion of the perforating branch of the peroneal artery secondary to an ankle sprain: a cause of acute compartment syndrome in the leg. J Foot Ankle Surg 2010; 50:102-3. [PMID: 21106410 DOI: 10.1053/j.jfas.2010.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Indexed: 02/03/2023]
Abstract
In this report, we describe the case of an adult male who developed an acute compartment syndrome localized to the anterior compartment of the leg following an ankle sprain. Compartment syndrome in association with ankle sprain is unusual, and has been previously described in association with avulsion of the perforating peroneal artery. Because of the potential for severe morbidity, we feel that it is important to make foot and ankle surgeons aware of this unusual injury.
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Affiliation(s)
- Mark A Kemp
- Musgrove Park Hospital, Taunton, Somerset, UK.
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9
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Abstract
Acute compartment syndrome is a limb-threatening condition in which early diagnosis and surgical consultation for fasciotomy are required to preserve functional outcome. The diagnosis is typically considered in patients with traumatic mechanisms of injury such as a direct blow and crush to the compartment, particularly when there is a fracture in the same compartment. We report the case of a patient with acute compartment syndrome of the dorsal forearm that occurred as a result of an atypical noncontact traumatic mechanism. Establishing the diagnosis of compartment syndrome was complicated in this patient, as some of the signs and symptoms of acute compartment syndrome could have been attributed to the presence of a coexisting rupture of the extensor digitorum muscle. This report serves to remind emergency physicians that, although rare, acute compartment syndrome can result from exertional and noncontact traumatic mechanisms.
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10
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Rehman S, Joglekar SB. Acute isolated lateral compartment syndrome of the leg after a noncontact sports injury. Orthopedics 2009; 32:523. [PMID: 19634843 DOI: 10.3928/01477447-20090527-30] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Compartment syndrome of the leg typically affects the anterior compartment or multiple compartments and can be traumatic or exertional (chronic) in nature. Isolated lateral (peroneal) compartment syndrome of the leg is a less typical and lesser-known condition that can potentially escape diagnosis if not considered in the workup of a painful leg. This article presents a case of isolated lateral compartment syndrome of the leg without gross muscle rupture or hematoma. The patient presented 21 hours after injury while playing soccer. Isolated lateral compartment syndrome was diagnosed based on history, physical examination, and a compartment pressure measurement of 130 mm Hg. Emergent surgical decompressive fasciotomy was performed. The peroneal longus and brevis muscle tissue was not lost. Superficial peroneal nerve sensation, which was initially impaired, was recovered at 1 month postoperatively. The patient recovered and was able to participate in sports again by 2 months postoperatively.
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Affiliation(s)
- Saqib Rehman
- Department of Orthopedic Surgery, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140, USA
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11
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Lee RY, Colville JM, Schuberth JM. Acute compartment syndrome of the leg with avulsion of the peroneus longus muscle: a case report. J Foot Ankle Surg 2009; 48:365-7. [PMID: 19423039 DOI: 10.1053/j.jfas.2009.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Indexed: 02/03/2023]
Abstract
UNLABELLED A rare case of avulsion of the peroneus longus origin associated with acute lateral compartment syndrome is presented. Pain on passive stretch of the peroneus longus was not reported owing to the lack of proximal attachment of muscle. Other less reliable signs of compartment syndrome were relied on make an accurate and timely diagnosis. The surgical decompression and clinical course are presented. LEVEL OF CLINICAL EVIDENCE 4.
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Affiliation(s)
- Ryan Y Lee
- Private Practice, San Diego Podiatry Group, San Diego, CA, USA
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12
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Slabaugh M, Oldham J, Krause J. Acute isolated lateral leg compartment syndrome following a peroneus longus muscle tear. Orthopedics 2008; 31:272. [PMID: 19292237 DOI: 10.3928/01477447-20080301-37] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Acute compartment syndrome is a rare orthopedic emergency caused by orthopedic, vascular, iatrogenic, or soft tissue injury that elevates the pressure within a closed fascial space. Untreated acute compartment syndrome leads to ischemia of the muscles and nerves within the compartment with a resultant loss of motor and sensory function, death of skeletal muscle, and subsequent contracture and deformity. This article presents a case of compartment syndrome in a 33-year-old man following a peroneus longus muscle tear. The patient underwent emergent fasciotomy and decompression of the lateral compartment, and a hematoma located at the musculotendonous junction of the peroneus longus was evacuated. The patient was placed in a posterior splint with the ankle at 90 degrees and elevated. Postoperatively, the patient reported complete resolution of pain, numbness, and tingling. The patient underwent delayed skin closure on the second postoperative day and subsequently had an uneventful recovery. By 4 months postoperatively, he had resumed full activity. Knowledge of the signs and symptoms of compartment syndrome and a high index of suspicion is paramount as this injury can occur after a seemingly innocuous injury such as an ankle inversion injury.
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Affiliation(s)
- Mark Slabaugh
- 89th MSGS/SGCXO, 1050 W Perimeter Rd, Andrews AFB, MD 20762, USA
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13
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Abstract
Injury to the perforating branch of the peroneal artery has not been reported previously as a cause of acute compartment syndrome following soft-tissue injury to the ankle. We describe the case of a 23-year-old male who sustained such an injury resulting in an acute compartment syndrome. In a review of the literature, we could find only five previous cases, all of which gave rise to a false aneurysm which was detected after the acute event.
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Affiliation(s)
- N J Ward
- John Radcliffe Hospital, Oxford, UK.
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14
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Pantle HA, Chanmugam A. Case report: acute forearm compartment syndrome due to sudden, forceful supination of the hand. J Emerg Med 2007; 39:e143-6. [PMID: 17945461 DOI: 10.1016/j.jemermed.2007.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 02/13/2007] [Accepted: 03/22/2007] [Indexed: 10/20/2022]
Abstract
Acute compartment syndrome is a limb-threatening condition if not recognized and treated promptly. Appropriate management includes early fasciotomy, which often results in better functional outcomes. Although there are many causes of compartment syndrome, the common findings are significant pain, swelling, and limited range of motion. Diagnosis is usually based on physical findings in the setting of a compelling history. Before surgical intervention, the diagnosis is usually confirmed by measuring elevated compartment pressures. The patient described in this case report developed acute compartment syndrome of the forearm after his hand became trapped in machinery that applied sudden supination to the hand, and avulsed the distal portion of the left index finger. There was no direct trauma to the forearm. In this case, acute compartment syndrome was likely due to a combination of contained hemorrhage into the muscle sheath, closed muscle strain causing edema, and possibly axial traction applied to the tendons of the index finger. Acute compartment syndrome should be considered in the differential diagnosis for any patient complaining of severe pain in an extremity, even in the absence of commonly recognized mechanisms of injury.
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Affiliation(s)
- Hardin A Pantle
- Department of Emergency Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA
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15
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Riede U, Schmid MR, Romero J. Conservative treatment of an acute compartment syndrome of the thigh. Arch Orthop Trauma Surg 2007; 127:269-75. [PMID: 16896742 DOI: 10.1007/s00402-006-0199-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Indexed: 11/24/2022]
Abstract
Compartment syndromes of the thigh after blunt trauma without any fracture are rare. Most surgeons recommend operative treatment. There are different rules for compartment syndromes of the thigh in young athletes after blunt trauma compared to compartment syndromes at other locations [(1) the large volume of the quadriceps muscle, (2) its relatively elastic fascia, (3) the direct proximal contact to the hip muscles which allows extravasation of fluid out of the compartment)]. We present a case of conservative treatment of elevated intra-compartmental pressure (ICP) of the anterior thigh after blunt trauma and the follow-up until return to sport. Conservative treatment of a compartment syndrome of the thigh after blunt trauma in a young patient without fracture or vascular damage was successful without short-term sequelae. Recovery of muscle strength is delayed but return to sport is possible. Depending on the severity the diagnosis and follow-up with ICP measurements and MRI is necessary. There is a very good chance for excellent outcome without any risk of surgery. However, a long healing time is possible.
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Affiliation(s)
- U Riede
- Orthopaedic Surgery, University Hospital Balgrist, Zurich, Switzerland.
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16
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Cheng LY, Niedfeldt MW, Lachacz J, Raasch WG. Acute, isolated lateral compartment syndrome after ankle inversion injury. Clin J Sport Med 2007; 17:151-2. [PMID: 17414486 DOI: 10.1097/jsm.0b013e31803202a5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Leon Y Cheng
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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17
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Seel EH, Wijesinghe LD, O'Connor D. Experimental evaluation of the effect of raised pressure in a single compartment in the lower leg on neighbouring compartments using fresh above knee amputated legs-a study of interstitial pressures with two case reports. Injury 2005; 36:1113-20. [PMID: 16055127 DOI: 10.1016/j.injury.2004.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 11/04/2004] [Accepted: 11/11/2004] [Indexed: 02/02/2023]
Abstract
STUDY DESIGN Experimental evaluation of intracompartmental pressures in a fresh above knee amputated human leg. OBJECTIVES To determine what effect raised pressure in one compartment of the lower leg had upon its neighbour. SUMMARY OF BACKGROUND DATA There has been no previous reports of isolated compartment pathology, following low velocity trauma, causing a compartment syndrome in all four compartments of the lower leg. METHODS Immediately after leg amputation, the intracompartmental pressure in the deep posterior compartment was artificially raised to 100 mmHg with infused 0.9% sodium chloride solution. The resultant pressure changes in remaining compartments were recorded over 30 min. RESULTS Five legs were evaluated. After 30 min, the mean maximum intracompartmental pressure increase found in the superficial posterior, anterior and peroneal compartments was 78.4 mmHg (range 65-94 mmHg), 25.2 mmHg (range 14-31 mmHg) and 24.8 mmHg (range 15-31 mmHg), respectively. CONCLUSIONS This experimental data and case reports show that a compartment in which there is raised pressure may exert external pressure on a neighbouring compartment that can result in physiological changes to induce a compartment syndrome within that neighbour. The importance of assessing all compartments within a limb segment, even when associated with low velocity trauma, remains paramount.
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Affiliation(s)
- Edward H Seel
- Department of Orthopaedics and Trauma, Royal Bournemouth Hospital, Dorset, UK.
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19
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Gabisan GG, Gentile DR. Acute peroneal compartment syndrome following ankle inversion injury: a case report. Am J Sports Med 2004; 32:1059-61. [PMID: 15150059 DOI: 10.1177/0363546503261726] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Glenn G Gabisan
- Monmouth Medical Center, 300 2nd Avenue, Long Branch, NJ 07740, USA.
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Ehlinger M, Schneider L, Lefebvre Y, Jacquot X, Cognet JM, Simon P. Syndrome de loge d’effort de jambe antéro-latéral isolé, aigu et bilatéral. ACTA ACUST UNITED AC 2004; 90:165-70. [PMID: 15107707 DOI: 10.1016/s0035-1040(04)70041-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute compartment syndrome of the leg is generally a consequence of trauma. Exercise-induced acute compartment syndrome of the leg is an exceptional clinical entity observed in the context of a chronic compartment syndrome or as an isolated acute syndrome subsequent to an intense effort. Our patient was a young athlete with no history of exercise-induced leg pain. Following a soccer game, he developed an acute leg syndrome involving the anterolateral compartment of both legs. The diagnosis was not suggested by the patient's history (no notion of chronic compartment syndrome) nor the natural history of the condition but was retained on the basis of the clinical presentation and course then confirmed by intramuscular pressure measurements. Emergency treatment by fasciotomy under general anesthesia in the operating room led to cure with no sequela. The fasciotomy was closed on day 9 with simple skin sutures. Surgeons should be aware that acute exercise-induced compartment syndrome (with the risk of severe functional consequences) may be the cause of unexplained intense leg pain. The diagnosis is established on the basis of clinical findings and measurement of intramuscular pressures. Pain is the cardinal sign, sometimes associated with sensorial deficit. The compartment is hard and painful at palpation. Passive stretching exacerbates the pain. Compartment pressure is required for certain diagnosis, most Authors accepting > 30mmHg as a positive test. Emergency fasciotomy is required.
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Affiliation(s)
- M Ehlinger
- Département d'Orthopédie et Traumatologie, CHU de Hautepierre, avenue Molière, 67098 Strasbourg Cedex
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22
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Abstract
BACKGROUND Acute compartment syndrome is both a limb- and life-threatening emergency that requires prompt treatment. To avoid a delay in diagnosis requires vigilance and, if necessary, intracompartmental pressure measurement. This review encompasses both limb and abdominal compartment syndrome, including aetiology, diagnosis, treatment and outcome. METHODS A Pubmed and Cochrane database search was performed. Other articles were cross-referenced. RESULTS AND CONCLUSION Diagnosis of limb compartment syndrome is based on clinical vigilance and repeated examination. Many techniques exist for tissue pressure measurement but they are indicated only in doubtful cases, the unconscious or obtunded patient, and children. However, monitoring of pressure has no harmful effect and may allow early fasciotomy, although the intracompartmental pressure threshold for such an undertaking is still unclear. Abdominal compartment syndrome requires measurement of intra-abdominal pressure because clinical diagnosis is difficult. Treatment is by abdominal decompression and secondary closure. Both types of compartment syndrome require prompt treatment to avoid significant sequelae.
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Affiliation(s)
- A Tiwari
- University Department of Surgery, Royal Free Hospital, Pond Street, London NW3 2QG, UK
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Abstract
Although acute compartment syndrome is considered a surgical emergency, controversies exist regarding diagnosis, surgical indications, and techniques of management. Acute compartment syndrome is associated with numerous causes, including fractures, crush injuries, burns, soft tissue injuries, and vascular trauma. Prolonged positioning of an extremity has not been previously described as a cause of compartment syndrome. The authors present a case of an acute compartment syndrome occurring because of prolonged extrication after a motor vehicle accident and without direct trauma to the involved extremity.
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Affiliation(s)
- K Mallik
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville 22908, USA
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24
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Abstract
Acute compartment syndrome in athletes, although rare, is a limb threatening condition which warrants emergency treatment. The case of a footballer with acute compartment syndrome of the left lower leg, without any preceding direct trauma to the calf, is reported. To our knowledge this is the only description of acute atraumatic compartment syndrome secondary to rupture of one of the heads of gastrocnemius.
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Affiliation(s)
- P N Mohanna
- Department of Orthopaedics, Royal Free Hospital, London, United Kingdom
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25
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Williams P, Shenolikar A, Roberts RC, Davies RM. Acute non-traumatic compartment syndrome related to soft tissue injury. Injury 1996; 27:507-8. [PMID: 8977839 DOI: 10.1016/0020-1383(96)00070-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- P Williams
- Department of Orthopaedics, Morriston Hospital, Swansea, Wales, UK
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26
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Abstract
A review of compartment syndrome, both acute and chronic, is presented. The pathophysiology, anatomy, diagnosis, and treatment are presented in relation to a unique case report. The case is one of acute exertional compartment syndrome of the medial foot treated by fasciotomy. This condition is uncommon in both its nature and location.
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Affiliation(s)
- D K Blacklidge
- Department of Surgery, Hutzel Hospital, Detroit, Michigan, USA
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