Acute Thigh Compartment Syndrome due to an Occult Arterial Injury Following a Blunt Trauma

Nooh, Anas; Wang, Casey K.; Alaseem, Abdulrahman; Harvey, Edward J.; Bernstein, Mitchell

doi:10.2106/jbjs.cc.18.00506

Cited by 4 publications

(5 citation statements)

References 12 publications

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“…On the other hand, the specificity of such technique was 96%. The current AAOS CPG recommendation 2,8,10,12,13,15,16,24,41 is to use ICP as a marker for ACS. Moderate evidence also supports the use of continuous or repeated ICP monitoring with a threshold of DBP minus ICP .30 mm Hg to rule out ACS.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis Accuracy for Compartment Syndrome: A Systematic Review and Meta-Analysis

Lorange

Laverdière

Corban

et al. 2023

Journal of Orthopaedic Trauma

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Objective: To evaluate whether published studies support basing the diagnosis of compartment syndrome of the lower leg on clinical findings, intracompartmental pressure (ICP) monitoring, or both. Data Sources: A PubMed/MEDLINE, Web of Science, and Embase search of the English literature from 1966 to February 2022 was performed. This used “lower extremity” or “leg” or “tibia” and “compartment syndrome” and “pressure” as the subjects. A manual search of the bibliographies was performed and cross-referenced with those used to formulate the American Academy of Orthopaedic Surgeons clinical practice guidelines. Study Selection and Extraction: Inclusion criteria were traumatic tibia injuries, presence of data to calculate the sensitivity, specificity, positive and negative predictive values of clinical findings and/or pressure monitoring, and the presence or absence of compartment syndrome as the outcome. A total of 2906 full articles were found, of which 63 were deemed relevant for a detailed review. Seven studies met all eligibility criteria. Data Synthesis: The likelihood ratio form of Bayes theorem was used to assess the discriminatory ability of the clinical findings and ICP monitoring as tests for compartment syndrome. The predictive value for diagnosing acute compartment syndrome was 21% and 29% for the clinical signs and ICP, respectively. When combining both, the probability reached 68%. Conclusions: The use of ICP monitoring may be helpful when combined with a clinical assessment to increase the sensitivity and specificity of the overall diagnosis. Previously accepted individual inference values should be revisited with new prospective studies to further characterize the statistical value of each clinical finding. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

“…24 Conversely, elevated one-time measurements that are erroneous may lead to unnecessary fasciotomies. 15,23,41 Clinicians cannot estimate the time course of the pressure elevation. 5 In vitro comparisons of older commercially available devices for continuous versus single stick 13 have shown discrepancies.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis Accuracy for Compartment Syndrome: A Systematic Review and Meta-Analysis

Lorange

Laverdière

Corban

et al. 2023

Journal of Orthopaedic Trauma

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“…Compartment syndrome was also of concern. Nooh et al [11] described acute thigh compartment syndrome caused by an initially undiagnosed injury of a descending branch of the lateral femoral circumflex artery. Active bleeding and large hematoma in the anterior compartment were revealed through an arteriogram, and embolization was performed.…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic Shock in a Patient with a Morel-Lavallée Lesion Combined with Active Arterial Bleeding without Fracture

Lim

Cho

et al. 2021

J Trauma Inj

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A Morel-Lavallée lesion is a closed degloving injury caused by traumatic separation of the skin and subcutaneous tissue from the underlying fascia. However, since physicians tend to focus on treating the bone fracture, hemodynamic instability accompanying a Morel-Lavallée lesion can sometimes be overlooked. We report the case of a hemodynamically unstable 73-year-old man who had a Morel-Lavallée lesion of the thigh, but no femur fracture. Angiography showed active bleeding from the muscular branch of the right deep femoral artery, which was then successfully embolized.

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“…There is also a paucity of literature regarding thigh compartment syndrome as a result of blunt trauma without a fracture or any associated major vascular injury or pre-injury pathological conditions. Compartment syndrome is defined as the increased interstitial pressure within the osseofascial compartment altering the capillary perfusion, leading to a decrease in blood supply to the soft tissues such as muscles and nerves which ultimately end up with cellular anoxia, ischemia, and necrosis [ 2 ]. The most common cause of acute compartment syndrome of the thigh is fracture or crush injury [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Atraumatic etiologies include coagulopathy due to the use of low-molecular-weight heparin, warfarin, NSAIDs, or because of medical condition like cirrhosis. Major trauma leading to coagulopathy has also been documented as a cause for thigh compartment syndrome [ 2 ]. The principle of diagnosis and management of thigh compartment syndrome remain same as the compartment syndrome of upper limb and leg [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Acute Anterior Compartment Syndrome of the Thigh without a Fracture Following a Blunt Trauma – A Case Report

Islam¹,

Kar²,

Gogoi³

2022

JOCR

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Introduction: Acute compartment syndrome of the thigh is an orthopedic emergency. Compartment syndrome of the thigh without a fracture or any other associated pre-injury pathology is scantily reported in the literature. Lack of awareness and inexperience often results in a failure to diagnose it. Case report: In this article, we are presenting a rare case of acute compartment syndrome involving the anterior compartment of the thigh without any bony abnormality or a fracture in a 62-year-old male who sustained an injury to his lateral aspect of the right thigh by a fall from a height. We performed an emergency fasciotomy and decompression of the involved compartment. The patient needed a subsequent skin grafting for the wound closure. Finally, after 7 months of follow-up, an excellent clinical outcome of the affected limb has been achieved. Conclusion: Thigh compartment syndrome without a fracture or other pre-injury pathological abnormalities of the thigh is relatively rare, hence there is often a fair risk that a case will go unnoticed. Therefore, a high index of clinical suspicion and prompt treatment can protect a patient with thigh compartment syndrome from long-term disability.

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Acute Thigh Compartment Syndrome due to an Occult Arterial Injury Following a Blunt Trauma

Cited by 4 publications

References 12 publications

Diagnosis Accuracy for Compartment Syndrome: A Systematic Review and Meta-Analysis

Diagnosis Accuracy for Compartment Syndrome: A Systematic Review and Meta-Analysis

Hemorrhagic Shock in a Patient with a Morel-Lavallée Lesion Combined with Active Arterial Bleeding without Fracture

Acute Anterior Compartment Syndrome of the Thigh without a Fracture Following a Blunt Trauma – A Case Report

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