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Acute compartment syndrome: How long before muscle necrosis occurs?

Published online by Cambridge University Press:  21 May 2015

Christian Vaillancourt ,
Ian Shrier ,
Alain Vandal ,
Markus Falk ,
Michel Rossignol ,
Alan Vernec  and
Dan Somogyi
Christian Vaillancourt
Affiliation:
Department of Emergency Medicine, The Ottawa Hospital, and the Ottawa Health Research Institute, University of Ottawa, Ottawa, Ont.
Ian Shrier*
Affiliation:
Centre for Clinical Epidemiology and Community Studies, SMBD–Jewish General Hospital, Montréal, Que. Department of Family Medicine, SMBD–Jewish General Hospital, Montréal, Que.
Alain Vandal
Affiliation:
Centre for Clinical Epidemiology and Community Studies, SMBD–Jewish General Hospital, Montréal, Que. Department of Mathematics and Statistics, McGill University, Montréal, Que.
Markus Falk
Affiliation:
Chief Information Officer, INOVA Q Inc., Bolzano, Italy
Michel Rossignol
Affiliation:
Centre for Clinical Epidemiology and Community Studies, SMBD–Jewish General Hospital, Montréal, Que.
Alan Vernec
Affiliation:
Department of Family Medicine, SMBD–Jewish General Hospital, Montréal, Que.
*
Department of Clinical Epidemiology and Community Studies, SMBD–Jewish General Hospital, 3755, ch. Côte Ste-Catherine, Montréal QC H3T 1E2; 514 340-4562, fax 514 340-7564, ian.shrier@mcgill.ca

Abstract

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Objectives:

Acute compartment syndrome (ACS) is a limb-threatening condition often first diagnosed by emergency physicians. Little is known about the rapidity with which permanent damage may occur. Our objective was to estimate the time to muscle necrosis in patients with ACS.

Methods:

This historical cohort analysis of all patients who had a fasciotomy for ACS was conducted in 4 large teaching hospitals. Diagnosis was confirmed clinically or by needle measurement of compartment pressure. Muscle necrosis was determined using pathology reports and surgeons’ operative protocols. We used descriptive statistics and estimated tissue survival probability using the Vertex exchange method for interval-censored data.

Results:

Between 1989 and 1997 there were 76 cases of ACS. Most cases occurred in young men (median age 32) as a result of a traumatic incident (82%). Forty-nine percent (37/76) of all patients suffered some level of muscle necrosis, and 30% (11/37) of those with necrosis lost more than 25% of the muscle belly. Necrosis occurred in 2 of 4 cases in which the patient had been operated on within 3 hours of the injury, and our exploratory survival analysis estimates that 37% (95% confidence interval, 13%-51%) of all cases of ACS may develop muscle necrosis within 3 hours of the injury.

Conclusions:

This is the largest cohort of ACS and the first clinical estimation of time to muscle necrosis ever published. Ischemia from ACS can cause muscle necrosis before the 3-hour period post-trauma that is traditionally considered safe. Further research to identify risk factors associated with the development of early necrosis is necessary.

Keywords

compartment syndromesmusculoskeletal diseases
Type
EM Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 3 , May 2004 , pp. 147 - 154
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.Ashton, H.Effect of inflatable plastic splints on blood flow. BMJ 1966;2(527):1427–30.CrossRefGoogle ScholarPubMed
2.Reneman, RS, Slaaf, DW, Lindbom, L, Tangelder, GJ, Arfors, KE.Muscle blood flow disturbances produced by simultaneously elevated venous and total muscle tissue pressure. Microvasc Res 1980;20(3):307–18.Google Scholar
3.Shrier, I, Magder, S.Critical closing pressure and arterial resistance in an in vitro model of compartment syndrome. Med Sci Sports Exerc 1994;26(suppl):S162.CrossRefGoogle Scholar
4.Shrier, I, Magder, S.Pressure-flow relationships in in vitro model of compartment syndrome. J Appl Physiol 1995;79(1):214–21.CrossRefGoogle ScholarPubMed
5.Ruiz, E.Compartment syndromes. In: Tintinalli, JE, Kelen, GD, Stapczynski, JS, editors. Emergency medicine: a comprehensive study guide, 5th ed. New York: McGraw-Hill; 2000. p. 1838–41.Google Scholar
6.Tiwari, A, Haq, AI, Myint, F, Hamilton, G.Acute compartment syndromes. Br J Surg 2002;89(4):397–412.CrossRefGoogle ScholarPubMed
7.Matsen, FA 3rd. Compartment syndromes. Hosp Pract 1980; 15(2):113–7.CrossRefGoogle Scholar
8.Sterk, J, Schierlinger, M, Gerngross, H, Willy, C. [Intracompartmental pressure measurement in acute compartment syndrome. Results of a survey of indications, measuring technique and critical pressure value.] Unfallchirurg 2001;104(2):119–26.CrossRefGoogle Scholar
9.Gulli, B, Templeman, D.Compartment syndrome of the lower extremity. Orthop Clin North Am 1994;25(4):677–84.CrossRefGoogle ScholarPubMed
10.Hahn, M, Strauss, E, Yang, EC.Gunshot wounds to the forearm. Orthop Clin North Am 1995;26(1):85–93.CrossRefGoogle Scholar
11.Hargens, AR, Mubarak, SJ.Current concepts in the pathophysiology, evaluation, and diagnosis of compartment syndrome. Hand Clin 1998;14(3):371–83.CrossRefGoogle ScholarPubMed
12.Mabee, JR.Compartment syndrome: a complication of acute extremity trauma. J Emerg Med 1994;12(5):651–6.CrossRefGoogle ScholarPubMed
13.Matsen, FA, Winquist, RA, Krugmire, R.Diagnosis and management of compartment syndromes. J Bone Joint Surg [Am] 1980;62-A(2):286–91.CrossRefGoogle Scholar
14.McQueen, MM, Court-Brown, CM.Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br 1996;78(1):99–104.CrossRefGoogle ScholarPubMed
15.Menetrey, J, Peter, R.Syndrome de loge aigu de jambe post-traumatique. Rev Chir Orthop Reparatrice Appar Mot 1998;84(3):272–80.Google Scholar
16.Willy, C, Sterk, J, Volker, HU, Sommer, C, Weber, F, Trentz, O, Gerngross, H. [Acute compartment syndrome. Results of a clinico-experimental study of pressure and time limits for emergency fasciotomy.] Unfallchirurg 2001;104(5):381–91.CrossRefGoogle Scholar
17.Ho, K, Abu-Laban, RB.Ankle and foot. In: Marx, JA, Hockberger, RS, Walls, RM, Adams, J, editors. Rosen’s emergency medicine: concepts and clinical practice. 5th ed. St. Louis: Mosby; 2002. p. 706–37.Google Scholar
18.Cook, T, Brown, D, Roe, J.Hypokalemia, hypophosphatemia, and compartment syndrome of the leg after downhill skiing on moguls. J Emerg Med 1993;11(6):709–15.CrossRefGoogle ScholarPubMed
19.Proehl, JA.Compartment syndrome. J Emerg Nurs 1988;14(5):283–92.Google ScholarPubMed
20.Rorabeck, CH, Clarke, KM.The pathophysiology of the anterior tibial compartment syndrome: an experimental investigation. J Trauma 1978;18(5):299–304.CrossRefGoogle ScholarPubMed
21.Good, LP.Compartment syndrome. A closer look at etiology, treatment. AORN J 1992;56(5):904–11.Google Scholar
22.Perron, AD, Brady, WJ, Keats, TE.Orthopedic pitfalls in the ED: acute compartment syndrome. Am J Emerg Med 2001;19(5):413–6.CrossRefGoogle ScholarPubMed
23.Giannoudis, PV, Nicolopoulos, C, Dinopoulos, H, Ng, A, Adedapo, S, Kind, P.The impact of lower leg compartment syndrome on health related quality of life. Injury 2002;33(2):117–21.CrossRefGoogle ScholarPubMed
24.Vaillancourt, C, Shrier, I, Falk, M, Rossignol, M, Vernec, A, Somogyi, D.Quantifying delays in the recognition and management of acute compartment syndrome. Can J Emerg Med 2001;3(1):26–30.CrossRefGoogle ScholarPubMed
25.Haljamae, H, Enger, E.Human skeletal muscle energy metabolism during and after complete tourniquet ischemia. Ann Surg 1975;182(1):9–14.CrossRefGoogle ScholarPubMed
26.Heppenstall, RB, Scott, R, Sapega, A, Park, YS, Chance, B.A comparative study of the tolerance of skeletal muscle to ischemia. Tourniquet application compared with acute compartment syndrome. J Bone Joint Surg [Am] 1986;68(6):820–8.CrossRefGoogle ScholarPubMed
27.Miller, SH, Price, G, Buck, D, Kennedy, TJ, Graham WP 3rd, Davis, TS.Effects of tourniquet ischemia and postischemic edema on muscle metabolism. J Hand Surg [Am] 1979;4(6):547–55.CrossRefGoogle ScholarPubMed
28.Sapega, AA, Heppenstall, RB, Chance, B, Park, YS, Sokolow, D.Optimizing tourniquet application and release times in extremity surgery. A biochemical and ultrastructural study. J Bone Joint Surg [Am] 1985;67(2):303–14.CrossRefGoogle ScholarPubMed
29.Day, LJ, Bovill, EG, Trafton, PG.Orthopedics. In: Way, LW, editor. Current surgical diagnosis & treatment. 9th ed. Norwalk: Lange; 1991. p. 1038.Google Scholar
30.Quinn, RH, Ruby, ST.Compartment syndrome after elective revascularization for chronic ischemia. A case report and review of the literature. Arch Surg 1992;127(7):865–6.Google ScholarPubMed
31.Hoffmeyer, P, Cox, JN, Fritschy, D.Ultrastructural modifications of muscle in three types of compartment syndrome. Int Orthop 1987;11(1):53–9.CrossRefGoogle ScholarPubMed
32.Böhning, D, Schlattman, P, Dietz, E.Interval censored data: a note on the nonparametric maximum likelihood estimator of the distribution function. Biometrika 1996;83:462–6.CrossRefGoogle Scholar
33.Banerjee, M, Wellner, J.Likelihood ratio tests for monotone functions. Ann Stat 2001;29(6):1699–731.CrossRefGoogle Scholar
34.Owen, A.Empirical likelyhood ratio confidence intervals for a single functional. Biometrika 1988;75:237–49.CrossRefGoogle Scholar
35.Turnbull, BW.The empirical distribution function with arbitrarily grouped, censored and truncated data. J R Stat Soc 1976;Series B(38):290–5.Google Scholar
36.Brugger, H, Falk, M, Adler-Kastner, L. [Avalanche emergency. New aspects of the pathophysiology and therapy of buried avalanche victims.] Wien Klin Wochenschr 1997;109(5):145–59.Google Scholar
37.Falk, M, Brugger, H, Adler-Kastner, L.Avalanche survival chances. Nature 1994;368(6466):21.Google Scholar
38.Lindsey, J, Ryan, L.Tutorial in biostatistics methods for interval-censored data. Stat Med 1998;17:219–38.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
39.Styf, J, Wiger, P.Abnormally increased intramuscular pressure in human legs: comparison of two experimental models. J Trauma 1998;45(1):133–9.CrossRefGoogle ScholarPubMed
40.Scott, DJ, Allen, MJ, Bell, PR, McShane, M, Barnes, MR.Does oedema following lower limb revascularisation cause compartment syndromes? Ann R Coll Surg Engl 1988;70(6):372–6.Google ScholarPubMed
41.Hurschler, C, Vanderby, R Jr, Martinez, DA.Mechanical and biochemical analysis of tibial compartment fascia in chronic compartment syndrome. Ann Biomed Engin 1994;22:272–9.CrossRefGoogle ScholarPubMed
42.Turnipseed, WD, Hurschler, C, Vanderby, R Jr.The effects of elevated compartment pressure on tibial arteriovenous flow and relationship of mechanical and biochemical characteristics of fascia to genesis of chronic anterior compartment syndrome. J Vasc Surg 1995;21(5):810–6; discussion 6–7.CrossRefGoogle ScholarPubMed