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Compartment Syndrome and Orthopedic Surgery: Diagnosis and Management

  • Steven B. Orr
  • Matthew R. Garner
  • Samuel A. Taylor
  • Milton T. M. Little
  • John P. Lyden
Chapter
  • 43 Downloads

Abstract

Compartment syndrome is defined as an elevation of intracompartmental pressure to a level that impairs arterial flow to muscles, nerves, and other local tissues. Compartment syndrome of the upper and lower extremities can have multiple etiologies, including traumatic, exertional, and iatrogenic in the perioperative setting. Early identification and diagnosis enabling prompt intervention is essential to providing patients the best possible outcomes. In cases of acute compartment syndrome, emergent fasciotomy is generally indicated. Delayed fasciotomies more than 24 h after onset of symptoms is not recommended as it increases morbidity and mortality; however it is often difficult to establish a time zero for onset or irreversibility. Even with timely treatment, multiple surgeries are often necessary to ensure adequate wound debridement, appropriate soft tissue coverage, and satisfactory wound closure. Long-term sequelae range from cosmetic concerns secondary to wound complications, the use of skin grafts, limb deformity, amputation, or systemic complications associated with rhabdomyolysis.

Keywords

Compartment syndrome Fasciotomy Orthopedic emergency Tourniquet Foot drop Myonecrosis Rhabdomyolysis Amputation 

References

  1. 1.
    McQueen MM. Acute compartment syndrome. In: Fractures in adults. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 689.Google Scholar
  2. 2.
    Sava J, Moelleken A, Waxman K. Cardiac arrest caused by reperfusion injury after lumbar paraspinal compartment syndrome. J Trauma. 1999;46:196–7.CrossRefGoogle Scholar
  3. 3.
    Carr D, Gilbertson L, Frymoyer J, Krag M, Pope M. Lumbar paraspinal compartment syndrome. A case report with physiologic and anatomic studies. Spine (Phila Pa 1976). 1985;10:816–20.CrossRefGoogle Scholar
  4. 4.
    Ferreira J, Galle C, Aminian A, et al. Lumbar paraspinal rhabdomyolysis and compartment syndrome after abdominal aortic aneurysm repair. J Vasc Surg. 2003;37:198–201.CrossRefGoogle Scholar
  5. 5.
    Minnema BJ, Neligan PC, Quraishi NA, Fehlings MG, Prakash S. A case of occult compartment syndrome and nonresolving rhabdomyolysis. J Gen Intern Med. 2008;23:871–4.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Paryavi E, Jobin CM, Ludwig SC, Zahiri H, Cushman J. Acute exertional lumbar paraspinal compartment syndrome. Spine (Phila Pa 1976). 2010;35:E1529–33.CrossRefGoogle Scholar
  7. 7.
    Whitesides TE, Haney TC, Morimoto K, Harada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res. 1975;113:43–51.CrossRefGoogle Scholar
  8. 8.
    Heckman MM, Whitesides TE Jr, Grewe SR, Rooks MD. Compartment pressure in association with closed tibial fractures. The relationship between tissue pressure, compartment, and the distance from the site of the fracture. J Bone Joint Surg Am. 1994;76:1285–92.CrossRefGoogle Scholar
  9. 9.
    Matava MJ, Whitesides TE Jr, Seiler JG 3rd, Hewan-Lowe K, Hutton WC. Determination of the compartment pressure threshold of muscle ischemia in a canine model. J Trauma. 1994;37:50–8.CrossRefGoogle Scholar
  10. 10.
    McQueen MM, Christie J, Court-Brown CM. Compartment pressures after intramedullary nailing of the tibia. J Bone Joint Surg Br. 1990;72:395–7.CrossRefGoogle Scholar
  11. 11.
    White TO, Howell GE, Will EM, Court-Brown CM, McQueen MM. Elevated intramuscular compartment pressures do not influence outcome after tibial fracture. J Trauma. 2003;55:1133–8.CrossRefGoogle Scholar
  12. 12.
    Ovre S, Hvaal K, Holm I, Stromsoe K, Nordsletten L, Skjeldal S. Compartment pressure in nailed tibial fractures. A threshold of 30 mmHg for decompression gives 29% fasciotomies. Arch Orthop Trauma Surg. 1998;118:29–31.CrossRefGoogle Scholar
  13. 13.
    McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg Br. 2000;82:200–3.CrossRefGoogle Scholar
  14. 14.
    Shadgan B, Pereira G, Menon M, Jafari S, Darlene Reid W, O’Brien PJ. Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal fractures in adults. J Orthop Traumatol. 2015;16(3):185–92.CrossRefGoogle Scholar
  15. 15.
    McQuillan WM, Nolan B. Ischaemia complicating injury. A report of thirty-seven cases. J Bone Joint Surg Br. 1968;50:482–92.CrossRefGoogle Scholar
  16. 16.
    Matsen FA 3rd, Clawson DK. The deep posterior compartmental syndrome of the leg. J Bone Joint Surg Am. 1975;57:34–9.CrossRefGoogle Scholar
  17. 17.
    Rorabeck CH, Macnab L. Anterior tibial-compartment syndrome complicating fractures of the shaft of the tibia. J Bone Joint Surg Am. 1976;58:549–50.CrossRefGoogle Scholar
  18. 18.
    Rorabeck CH. The treatment of compartment syndromes of the leg. J Bone Joint Surg Br. 1984;66:93–7.CrossRefGoogle Scholar
  19. 19.
    Bhattacharyya T. The medical-legal aspects of compartment syndrome. J Bone Joint Surg Am. 2004;86-A:864.CrossRefGoogle Scholar
  20. 20.
    Bae DS, Kadiyala RK, Waters PM. Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome. J Pediatr Orthop. 2001;21(5):680–8.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Heckman MM, Whitesides TE Jr, Grewe SR, Judd RL, Miller M, Lawrence JH 3rd. Histologic determination of the ischemic threshold of muscle in the canine compartment syndrome model. J Orthop Trauma. 1993;7:199–210.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Cathcart CC, Shuler MS, Freedman BA, Reno LR, Budsberg SC. Correlation of near-infrared spectroscopy and direct pressure monitoring in an acute porcine compartmental syndrome model. J Orthop Trauma. 2014;28(6):365–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Odland RM, Schmidt AH. Compartment syndrome ultrafiltration catheters: report of a clinical pilot study of a novel method for managing patients at risk of compartment syndrome. J Orthop Trauma. 2011;25(6):358–65.CrossRefGoogle Scholar
  24. 24.
    Harvey EJ, Sanders DW, Shuler MS, Lawendy A, Cole AL, AlQahtani SM, et al. What’s new in acute compartment syndrome? J Orthop Trauma. 2012;26(12):699–702.CrossRefGoogle Scholar
  25. 25.
    Hyder N. Compartment syndrome in tibial shaft fracture missed because of a local nerve block. J Bone Joint Surg Br. 1996;78:499.CrossRefGoogle Scholar
  26. 26.
    Garner MR, Taylor SA, Gausden E, Lyden JP. Compartment syndrome: diagnosis, management, and unique concerns in the twenty-first century. HSS J. 2014;10(2):143–52.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Shuler FD. Physicians’ ability to manually detect isolated elevations in leg intracompartmental pressure. J Bone Joint Surg Am. 2010;92:361.CrossRefGoogle Scholar
  28. 28.
    Cascio BM. Documentation of acute compartment syndrome at an academic health-care center. J Bone Joint Surg Am. 2005;87:346.CrossRefGoogle Scholar
  29. 29.
    Murphy JB. Myositis. JAMA. 1914;63:1249.CrossRefGoogle Scholar
  30. 30.
    Sassoon A, Riehl J, Rich A, Langford J, Haidukewych G, Pearl G, et al. Muscle viability revisited: are we removing normal muscle? A critical evaluation of dogmatic debridement. J Orthop Trauma. 2016;30(1):17–21.CrossRefGoogle Scholar
  31. 31.
    Twaddle BC, Amendola A. Compartment syndromes. In: Skeletal trauma. 4th ed. St. Louis: Saunders Company; 2008. p. 359.Google Scholar
  32. 32.
    Fulkerson E, Razi A, Tejwani N. Review: acute compartment syndrome of the foot. Foot Ankle Int. 2003;24:180–7.CrossRefGoogle Scholar
  33. 33.
    Rorabeck CH, Clarke KM. The pathophysiology of the anterior tibial compartment syndrome: an experimental investigation. J Trauma Acute Care Surg. 1978;18(5):299–304.CrossRefGoogle Scholar
  34. 34.
    Rollins DL, Bernhard VM, Towne JB. Fasciotomy: an appraisal of controversial issues. Arch Surg. 1981;116:1474–81.CrossRefGoogle Scholar
  35. 35.
    Sheridan GW, Matsen FA 3rd. Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg Am. 1976;58:112–5.CrossRefGoogle Scholar
  36. 36.
    Reis ND, Michaelson M. Crush injury to the lower limbs. Treatment of the local injury. J Bone Joint Surg Am. 1986;68:414.CrossRefGoogle Scholar
  37. 37.
    Finkelstein JA, Hunter GA, Hu RW. Lower limb compartment syndrome: course after delayed fasciotomy. J Trauma. 1996;40:342–4.CrossRefGoogle Scholar
  38. 38.
    Ritenour AE, Dorlac WC, Fang R, Woods T, Jenkins DH, Flaherty SF, et al. Complications after fasciotomy revision and delayed compartment release in combat patients. J Trauma. 2008;64:S153–61. Discussion S161–2.CrossRefGoogle Scholar
  39. 39.
    Flynn JM. Acute traumatic compartment syndrome of the leg in children: diagnosis and outcome. J Bone Joint Surg Am. 2011;93:937.CrossRefGoogle Scholar
  40. 40.
    Kanj WW, Gunderson MA, Carrigan RB, Sankar WN. Acute compartment syndrome of the upper extremity in children: diagnosis, management, and outcomes. J Child Orthop. 2013;7(3):225–33.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Lasanianos NG, Kanakaris NK, Roberts CS, Giannoudis PV. Compartment syndrome following lower limb arthroplasty: a review. Open Orthop J. 2011;5:181–92.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Henson JT, Roberts CS, Giannoudis PV. Gluteal compartment syndrome. Acta Orthop Belg. 2009;75:147–52.PubMedGoogle Scholar
  43. 43.
    Tornetta P 3rd, French BG. Compartment pressures during nonreamed tibial nailing without traction. J Orthop Trauma. 1997;11:24–7.CrossRefGoogle Scholar
  44. 44.
    Nassif JM, Gorczyca JT, Cole JK, Pugh KJ, Pienkowski D. Effect of acute reamed versus unreamed intramedullary nailing on compartment pressure when treating closed tibial shaft fractures: a randomized prospective study. J Orthop Trauma. 2000;14:554–8.CrossRefGoogle Scholar
  45. 45.
    Wilgis EF. Observations on the effects of tourniquet ischemia. J Bone Joint Surg Am. 1971;53:1343–6.CrossRefGoogle Scholar
  46. 46.
    Ward CM. Oedema of the hand after fasciectomy with or without tourniquet. Hand. 1976;8:179–85.CrossRefGoogle Scholar
  47. 47.
    Macfarlane MG, Spooner SJ. Chemical changes in muscle during and after ischaemia. Br J Exp Pathol. 1946;27:339–48.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Wakai A, Winter DC, Street JT, Redmond PH. Pneumatic tourniquets in extremity surgery. J Am Acad Orthop Surg. 2001;9:345–51.CrossRefGoogle Scholar
  49. 49.
    Townsend HS, Goodman SB, Schurman DJ, Hackel A, Brock-Utne JG. Tourniquet release: systemic and metabolic effects. Acta Anaesthesiol Scand. 1996;40:1234–7.CrossRefGoogle Scholar
  50. 50.
    Carlson DA, Dobozi WR, Rabin S. Peroneal nerve palsy and compartment syndrome in bilateral femoral fractures. Clin Orthop Relat Res. 1995;(320):115–8.Google Scholar
  51. 51.
    Cascio BM, Buchowski JM, Frassica FJ. Well-limb compartment syndrome after prolonged lateral decubitus positioning. A report of two cases. J Bone Joint Surg Am. 2004;86-A:2038–40.CrossRefGoogle Scholar
  52. 52.
    Anglen J, Banovetz J. Compartment syndrome in the well leg resulting from fracture-table positioning. Clin Orthop Relat Res. 1994;(301):239–42.Google Scholar
  53. 53.
    Mathews PV, Perry JJ, Murray PC. Compartment syndrome of the well leg as a result of the hemilithotomy position: a report of two cases and review of literature. J Orthop Trauma. 2001;15:580–3.CrossRefGoogle Scholar
  54. 54.
    Danner R, Partanen K, Partanen J, Kettunen K. Iatrogenic compartment syndrome, a follow-up of four cases caused by elastic bandage. Clin Neurol Neurosurg. 1989;91:37–43.CrossRefGoogle Scholar
  55. 55.
    Hinderland MD, Ng A, Paden MH, Stone PA. Lateral leg compartment syndrome caused by ill-fitting compression stocking placed for deep vein thrombosis prophylaxis during surgery: a case report. J Foot Ankle Surg. 2011;50:616–9.CrossRefGoogle Scholar
  56. 56.
    Talbot SG, Rogers GF. Pediatric compartment syndrome caused by intravenous infiltration. Ann Plast Surg. 2011;67:531–3.CrossRefGoogle Scholar
  57. 57.
    Roberts CS, Gorczyca JT, Ring D, Pugh KJ. Diagnosis and treatment of less common compartment syndromes of the upper and lower extremities: current evidence and best practices. Instr Course Lect. 2011;60:43–50.PubMedGoogle Scholar
  58. 58.
    Ojike NI, Roberts CS, Giannoudis PV. Foot compartment syndrome: a systematic review of the literature. Acta Orthop Belg. 2009;75:573–80.PubMedGoogle Scholar
  59. 59.
    Derman PB, Iyer S, Garner M, Orr S, Felix KJ, Goldberg A, et al. An initiative to standardize the identification of and acute response to postoperative lower-extremity neurological deficits: effects on provider knowledge, confidence, and communication skills. J Bone Joint Surg Am. 2016;98(23):e105.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Steven B. Orr
    • 1
  • Matthew R. Garner
    • 2
    • 3
  • Samuel A. Taylor
    • 4
  • Milton T. M. Little
    • 5
  • John P. Lyden
    • 4
  1. 1.New York University Langone Orthopedic Hospital, Department of Orthopedic Surgery, Division of Hand SurgeryNew YorkUSA
  2. 2.Milton S. Hershey Medical Center, Department of Orthopedic TraumaHersheyUSA
  3. 3.Pennsylvania State University College of Medicine, Department of Orthopedics and RehabilitationHersheyUSA
  4. 4.Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell MedicineNew YorkUSA
  5. 5.Orthopedic Trauma Surgery, Cedars-Sinai Medical Center, Department of Orthopedic SurgeryLos AngelesUSA

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