Paresthesia, paresis, and especially pulselessness are usually late signs of an ACS and may indicate potentially irreversible tissue damage. Specifically, pain out of proportion to examination, pain unresponsive to analgesics, palpable tightness in the affected compartment, and pain worsening with passive stretching of the muscles in the affected compartment are the most accurate signs for early diagnosis. Pain is considered to be the main clinical symptom of a developing ACS. Classically, the presentation of ACS is described with “the 6 P’s”: pain, pallor, paresis, paresthesia, pulselessness, and poikilothermia. Given that diagnosis of ACS is best made with a high index of clinical suspicion, physical examination is paramount. The following section will further elaborate on the physical examination findings to diagnose ACS. Early compartment fasciotomy decompression allows tissues under excess pressure to expand, leading to a drop in interstitial pressure, restoration of local blood flow, clearing of toxic anaerobic metabolites, and return of normal cellular function.Ĭlinically, patients will present with varying symptoms and degrees of severity depending on the etiology of the compartment syndrome. This, in turn, leads to compromised tissue perfusion pressure, a local tissue oxygen deficit, and an ischemic insult. Interstitial tissue pressures above 30 mm Hg overwhelm capillary perfusion pressure, causing progressive blood vessel collapse. The tissue perfusion pressure equals capillary perfusion pressure minus interstitial pressure. Physiologically, a capillary perfusion pressure of approximately 25 mm Hg maintains the oxygen level needed for normal tissue metabolism, which is above the normal interstitial tissue pressure of 4 to 6 mm Hg. A systematic review of forearm compartment syndrome cases found that the most common cause of ACS of the forearm in children was a supracondylar fracture, whereas in adults the most common cause was distal radius fracture. Among other etiologies, it can also be a sequela of internal space-occupying lesions such as tumors, hematomas, abscesses, and extravasation of intravenous fluids or contrast, as well as external causes such as casts and dressings that are placed too tightly. ACS can commonly arise from any number of major traumas (especially those with crush mechanisms), fractures, and burn/electrical injuries, as well as post-surgical revascularization of ischemic limbs. In its most basic definition, acute compartment syndrome (ACS) results when there is increased pressure within a fascia-enclosed tissue space that compromises the blood flow to the tissues inside of the compartment.
Treating providers should recognize crush injury, prolonged decubitus, and infection as the most common causes of acute hand compartment syndrome.Compartment syndrome is a surgical emergency with many etiologies that share a distinct clinical picture. The surgically released compartments varied the dorsal interosseous compartments (83%), thenar compartment (75%), and hypothenar compartment (74%) were most frequently released, while the adductor pollicis compartment (43%) and Guyon canal (28%) were least frequently released.Conclusions:The demographics of acute hand compartment syndrome have evolved in the last 25 years compared with the prior literature, partly as a result of the opioid epidemic leading to a rise in “found down” compartment syndrome.
Associated hand fractures were present in 15 (28%) patients. The mechanism of injury varied widely, but the most common causative mechanisms were crush injury (25%), prolonged decubitus (17%), and infection (11%).
NUMBER OF HAND COMPARTMENTS SKIN
We reviewed the electronic medical record for patient-related variables (eg, age, sex, smoking status, diabetes mellitus), injury-related variables (eg, mechanism of injury, presence of fractures), and treatment-related variables (eg, compartments released, number of operations, use of split-thickness skin grafts, and time from injury to surgery).Results:The mean age of our cohort was 45 years, and 33 patients (62%) were men. von Keudell, Arvind Zhang, Dafangīackground:We aimed to describe the demographic, injury-related, and treatment-related characteristics of patients who undergo fasciotomies for acute hand compartment syndrome.Methods:A cohort of 53 adult patients with acute hand compartment syndrome treated with fasciotomy at 2 tertiary care referral centers over a 10-year time period from January 1, 2006, to June 30, 2015, were retrospectively identified. Surgical Demographics of Acute Hand Compartment Syndrome Surgical Demographics of Acute Hand Compartment Syndrome
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