Advertisement

Surgical and Radiologic Anatomy

, Volume 16, Issue 4, pp 341–347 | Cite as

Anatomic bases of the forearm compartment syndrome

  • R. Fröber
  • W Linss
Anatomic Bases Of Medical, Radiological And Surgical Techniques

Summary

One of the most common sites for the compartment syndrome (CS) is the forearm. Its compartments have been studied by injection of colored gelatin into the particular anatomical spaces. The three “pressure — measuring — points” recommended in the clinical literature to measure intracompartmental tissue pressure in equivocal diagnostic cases were used for the dye injections on the forearms of five preserved cadavers of adults. However, instead of the compartments especially affected in CS two adjacent spaces were revealed. In order to elucidate the clinical relevant spaces two additional approaches for the injection had been used. Cross-sections at 15 mm intervals of the injected forearms had been performed. Some of them are presented and schematically summarized in this article. Recent studies have suggested that there are different guidelines for description of the anatomically isolated spaces. However, especially one of these spaces seems to be responsible for the CS on the forearm. The remarkable features of this so called “deep flexor compartment” are its very restrictive envelopes, its rare fascial contacts, its impermeable seal in proximal-radial direction as well as the extremely endangered structures within the compartment. The flexor carpi ulnaris muscle is recommended to be the “primary structure” for measuring the tissue pressure as well as for surgical decompression. The article reviews the anatomical base of the CS.

Key words

Forearm compartment syndrome Fascial spaces Ischemic muscle contracture Volkmann contracture Anatomical studies 

Bases anatomiques des syndromes compartimentaux de l'avant-bras

Résumé

L'un des sites les plus courants des syndrômes canalaires est l'avant-bras. Ses compartiments ont été étudiés par injection de gélatine colorée dans les différents espaces anatomiques. La prise de pression en trois points, recommandée dans la littérature clinique pour mesurer la pression tissulaire intra-compartimentale en cas de diagnostic douteux, a été utilisée pour les injections d'avant-bras de 5 cadavres adultes embaumés. Cependant au niveau des compartiments affectés spécialement par les syndrômes canalaires, deux espaces adjacents supplémentaires ont été observés. Pour préciser ces espaces d'intérêt clinique, deux sites d'injection supplémentaires ont été utilisés. Des coupes transversales séparées par des intervalles de 15 mm ont été réalisées sur les avant-bras ainsi injectés. Certaines d'entre elles sont présentées et schématisées dans cet article. Des études récentes ont suggéré qu'il y avait différentes façons de décrire l'anatomie de ces compartiments. Cependant, l'un surtout de ces compartiments semble être incriminé dans les syndrômes canalaires de l'avant-bras. Les observations principales relatives à ce compartiment profond des mm. fléchisseurs concernent ses enveloppes peu extensibles, ses contacts limités avec le fascia antébrachial, l'absence quasi complète d'ouverture en direction proximo-radiale et les structures particulièrement vulnérables cheminant dans ce compartiment. Le m. fléchisseur ulnaire du carpe apparaît comme la structure première au niveau de laquelle est mesurée la pression tissulaire et réalisée la décompression chirurgicale. Cet article fait aussi le point des bases anatomiques des syndrômes canalaires.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Chevalley F, Livio JJ (1992) Progressive correction of an ulnar deviation of the hand following defective healing of the 2 forearm bones and probable sequellae of a Volkmann contracture. Acta Orthop Belg 58: 460–464Google Scholar
  2. 2.
    Balogh B, Wicke L (1993) Computertomographie. Atlas der Gelenke und Weichteile der Extremitäten. Fischer, Stuttgart Jena New York, pp 38–66Google Scholar
  3. 3.
    Corning HK (1909) Lehrbuch der topographischen Anatomie. Bergmann, München, pp 663–675Google Scholar
  4. 4.
    Dicke TE, Nunley JA (1993) Distal forearm fracture in children. Complications and surgical indications. Orthop Clin North Am 24: 333–340Google Scholar
  5. 5.
    Echtermeyer V, Muhr G, Oestern HJ, Tscherne H (1982) Chirurgische Behandlung des Kompartment-Syndromes. Unfallchirurg 85: 144–152Google Scholar
  6. 6.
    Echtermeyer V (1986) Das Kompartmentsyndrom. Springer, Berlin HeidelbergGoogle Scholar
  7. 7.
    Echtermeyer V (1987) Kompartmentsyndrom. In: Schweiberer L (ed) Breitners Chirurgische Operationslehre, Bd VIII. Urban & Schwarzenberg, München Wien Baltimore, p 212Google Scholar
  8. 8.
    Echtermeyer V (1991) Kompartmentsyndrom. Unfallchirurg 94: 225–230Google Scholar
  9. 9.
    Frick H, Leonhardt H, Stark D (1992) Taschenlehrbuch der gesamten Anatomie I. Thieme, Stuttgart New York, pp 242–252Google Scholar
  10. 10.
    Gelberman RH, Zakaib GS, Mubarak SJ (1978) Decompression of forearm compartment syndromes. Clin Orthop 134: 225Google Scholar
  11. 11.
    Gelberman RH, Garfin SR, Hergenroeder PT, Mubarak SJ, Menon J (1981) Compartment syndromes of the forearm. Clin Orthop 161: 252–261Google Scholar
  12. 12.
    Good LP (1992) Compartment syndrome. A closer look at etiology, treatment. AORN J 56: 904–911Google Scholar
  13. 13.
    Griffiths D, Jones DH (1993) Spontaneous compartment syndrome in a patient on long-term anticoagulation. J Hand Surg [Br] 18: 41–42Google Scholar
  14. 14.
    Hafferl A (1957) Lehrbuch der topographischen Anatomie. Springer, Berlin Göttingen Heidelberg, p 743Google Scholar
  15. 15.
    v. Hagens G, Romrell LJ, Ross MH, Tiedemann K (1991) The Visible Human Body. Lea & Febiger, Philadelphia London, pp 45–54Google Scholar
  16. 16.
    Hay FM, Allen MJ Barnes MR (1992) Acute compartment syndromes resulting from anticoagulant treatment. Br Med J 305: 1474–1475Google Scholar
  17. 17.
    Janzen DL, Connell DG, Vaisler BJ (1993) Calcific myonecrosis of the calf manifesting as an enlarging soft-tissue mass. Am J Roentgenol 160: 1072–1074Google Scholar
  18. 18.
    Kahle W, Leonhardt H, Platzer W (1991) Taschenatlas der Anatomie I. Thieme, Stuttgart New York, pp 156–167Google Scholar
  19. 19.
    Lanz U (1979) Ischämische Muskelnekrosen. Springer, Berlin Heidelberg New YorkGoogle Scholar
  20. 20.
    Lanz T v, Wachsmuth W (1972) Praktische Anatomie I. Springer, Berlin Göttingen Heidelberg, pp 139–176Google Scholar
  21. 21.
    Larsen JM, Bindiger A, Sherman R, Kuschner SH (1992) Insecticide injection injuries to both hands: a case report. J Hand Surg [Am] 17: 1073–1075Google Scholar
  22. 22.
    Leonhardt H, Tillmann B, Töndury G, Zilles K (1988) Rauber/Kopsch: Anatomie des Menschen, Bd IV. Thieme, Stuttgart New York, pp 390–391Google Scholar
  23. 23.
    Matsen FA, Winquist RA, Krugmire RB (1980) Diagnosis and management of compartmental syndromes. J Bone Joint Surg [Am] 62-A: 286Google Scholar
  24. 24.
    Mabee JR, Bostwick TL (1993) Pathophysiology and mechanisms of compartment syndrome. Orthop Rev 22: 175–181Google Scholar
  25. 25.
    McGee DL, Dalsey WC (1992) The mangled extremity. Compartment syndrome and amputations. Emerg Med Clin North Am 10: 783–800Google Scholar
  26. 26.
    Moed BR, Thorderson PK (1993) Measurement of intracompartmental pressure: a comparison of the slit catheter, sideported needle, and simple needle. J Bone Joint Surg [Am] 75-A: 232–235Google Scholar
  27. 27.
    Pernkopf E (1989) Topographische Anatomie II. Urban & Schwarzenberg, München Wien Baltimore, pp 151–152Google Scholar
  28. 28.
    Raskin KB (1993) Acute vascular injuries of the upper extremity. Hand Clin 9: 115–130Google Scholar
  29. 29.
    Reill P (1982) Folgezustände des Kompartment-Syndroms an der oberen Extremität und ihre operative Behandlung. Unfallheilkunde 85: 253–258Google Scholar
  30. 30.
    Royle SG (1992) The role of tissue pressure recording in forearm fractures in children. Injury 23: 549–552Google Scholar
  31. 31.
    Schmidt U, Tempka A, Nerlich M (1991) Das Kompartmentsyndrom am Unterarm. Unfallchirurg 94: 236–239Google Scholar
  32. 32.
    Schmit-Neuerburg KP (1988) Das Compartment-Syndrom als Traumafolge. Chirurg 59: 713–721Google Scholar
  33. 33.
    Sheridan GW, Matsen FA (1976) Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg [Am] 58-A: 112Google Scholar
  34. 34.
    Sneyd JR, Lau W, McLaren ID (1993) Forearm compartment syndrome following intravenous infusion with a manual “bulb” pump. Anesth Analg 76: 1160–1161Google Scholar
  35. 35.
    Sobotta J (1993) Atlas der Anatomie des Menschen I. Urban & Schwarzenberg, München Wien Baltimore, pp 236–253Google Scholar
  36. 36.
    Szyszkowitz R, Reschauer R (1982) Ätiologie, Pathophysiologie und Lokalisation des Kompartment-Syndroms. Unfallheilkunde 85: 126–132Google Scholar
  37. 37.
    Testut L, Jacob O (1906) Traite d'Anatomie Topographique. Octave Doin, Paris, pp 712–713Google Scholar
  38. 38.
    Van der Zypen E (1983) Das Kompartmentsyndrom — Eine anatomische Studie. Helv Chir Acta 50: 683–696Google Scholar
  39. 39.
    Whitesides TE, Haney TC, Morimoto K, Harada H (1975) Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop 113: 43Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • R. Fröber
    • 1
  • W Linss
    • 1
  1. 1.Institute of Anatomy IFriedrich Schiller University JenaJenaGermany

Personalised recommendations