Compartment Syndromes

However, there are a significant number of cases, sometimes estimated as 19% of fractures, where repair does not occur in a reasonable amount of time. The problems are associated primarily with severe injury, infection, arthritis, or biochemical abnormalities. A very common cause, known as the compartment syndrome, is related to severe swelling pressure on the blood vessels that limits blood access to the muscles. In many of these cases, electrical stimulation has been shown to be effective in accelerating repair. 

Perler, B.A., Tohmer, A.G. and Bulkley, G.B. (1990). Inhibition of the compartment syndrome by the ablation of free radical-mediated reperfusion injury. Surgery 108, 40-47. 

Consider large-volume paracentesis if evidence of abdominal compartment syndrome is secondary to tense ascites... 

Wilder RP, Sethi S. Overuse injuries Tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med 2004 23 55-81. 

A 50-year-old man who was treated with ziprasidone 40 mg bd for 3 weeks had a substantial rise in creatine kinase activity without any evidence of muscle trauma, stiffness, or swelling or any signs of neuroleptic malignant syndrome (29). There was no renal insufficiency or compartment syndrome. 

Diazepam produces less sedation in cigarette smokers, and higher (not lower, as stated in SEDA-20) doses may be required for the same sedative or anxiolytic effect. Owing in part to its continued widespread use, several unusual adverse effects of diazepam continue to be reported. These include cases of urinary retention and compartment syndrome, which are not explicable by its pharmacology. On the other hand, accumulation of diazepam and attendant complications of obtundation and respiratory depression may be understood in terms of its long half-life, particularly in elderly people and medically ill patients. Caution about the intravenous use of diazepam comes from a study that showed cardiac dysrhythmias (mainly ventricular extra beats) in a quarter of oral surgery patients midazolam and lorazepam were much safer (1). 

Inadvertent injection of bacitracin ointment into the orbit can cause a postoperative orbital compartment syndrome. 

Castro E, Seeley M, Kosmorsky G, Foster JA. Orbital compartment syndrome caused by intraorbital bacitracin ointment after endoscopic sinus surgery. Am J Ophthalmol 2000 130(3) 376-8. 

Hypotension follows the intravenous injection of benzodiazepines, but is usually mild and transient (SED-11, 92) (56), except in neonates who are particularly sensitive to this effect (57). Local reactions to injected diazepam are quite common and can progress to compartment syndrome (SEDA-17, 44). In one study (58), two-thirds of the patients had some problem, and most eventually progressed to thrombophlebitis. Flunitrazepam is similar to diazepam in this regard... 

A 37-year-old man with diabetes had septicemia and compartment syndrome of the leg after acupuncture in the calf area (92). Decompression fasciotomy was performed and Gram-positive cocci were grown from the wound swab and group A streptococci from blood cultures. He required intensive care, including intravenous antibiotics, and eventually recovered. 

Shah N, King C, Tucker K, Crawford R. Infected compartment syndrome after acupuncture. Acupunct Med 2002 20(2-3) 105-6. 

Chow LT, Chow WH. Acute compartment syndrome an unusual presentation of gemfibrozil induced myositis. Med J Aust 1993 158(l) 48-9. 

Occasionally orthopedic patients have developed compartment syndrome postoperatively during epidural infusions of bupivacaine/fentanyl mixtures. However, although aggressive analgesia was blamed for the resulting disasters, there seems to have been a remarkable lack of adequate pressure area care, correct positioning, and regular review of both patients and splints (SEDA-22,136). 

For both CRVO and BRVO the pathophysiology includes the formation of thrombosis within the venule, typically at the crossing point of an arteriole and venule in the case of BRVO, and at or just posterior to the lamina cribrosa in the case of CRVO. In both instances the compartment syndrome model has been proposed whereby the vein is partially compressed by the adjacent arteriole artery within a restricted space. This can lead to turbulence of blood flow, and secondary development of thrombosis. Surgical decompression of the vein or the surrounding structures has been proposed as a therapeutic procedure for both disorders. 

A compartment syndrome model has been proposed to explain the development of CRVO. According to this model, an unyielding scleral ring at the optic disk forms the boundary of the compartment. Thrombosis of the central retinal vein may occur when vascular thickening or collagen changes in the scleral ring allow increased pressure on the central retinal vein within a confined space. 

Local effects. Within minutes of envenomation, stinging, burning pain begins. Progressive swelling, erythema, petechiae, ecchymosis, and hemorrhagic blebs may develop over the next several hours. The limb may swell to twice its nonaal size within the first few hours. Hypovolemic shock and local compartment syndrome may occur secondary to fluid and blood sequestration in injured areas. 

Su WT, Stone DH, Lamparello PJ, Rockman CB (2004) Gluteal compartment syndrome following elective unilateral internal iliac artery embolization before endovascular abdominal aortic aneurysm repair. J Vase Surg 39 672-675... 

Hurschler C., Vanderby R. Jr., Martinez D.A., et al. (1994) Mechanical and biochemical analyses of tibial compartment fascia in chronic compartment syndrome. Annals of Biomedical Engineering, 22(3), 272-9. 

Popliteal artery and the adjacent arterial branch may be perforated by wire passing or drilling during placement of internal fixation materials on the tibial side or injured during dissection of the femoral ACL stump. The key to diagnosis is the development of signs of cyanosis and compartment syndrome due to the damaged... 

Swelling following midshaft fractures is generally modest and compartment syndrome rare in children. To avoid displacement within the cast, it must be applied with minimal padding and must be well moulded. The cast index can be determined on radiographs. This is the ratio of the inside diameter of the plaster in the lateral view to the diameter on the AP view. A cast index of >0.8 is associated with a higher risk of losing position within the cast (Chess etal. 1994). 

The dislocation is described according to the direction of tibial displacement relative to the femur. Anterior dislocation is the commonest type, and is associated with disruption of the anterior cruciate ligament, the posterior joint capsule and popliteal artery damage. Posterior dislocation can also be associated with arterial injury. Rotary or posterolateral dislocation is caused by force abduction and internal rotation. On the lateral radiograph, the femoral condyle is in profile but the tibia is rotated posterolaterally and the proximal tibiofibular joint is seen in its entirety. An early complete assessment and documentation of the neurovascular status of the leg distally is vital. Also look for signs of compartment syndrome. 

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