High Risk of Rhabdomyolysis and Acute Kidney Injury After Traumatic Limb Compartment Syndrome

Tsai, Wei Hsuan; Huang, Shih Tsai; Liu, Wen‐Chung; Chen, Lee Wei; Yang, Kuo Chung; Hsu, Kuei‐Chang; Lin, Cheng Ta; Ho, Yen Yi

doi:10.1097/sap.0000000000000460

Cited by 17 publications

(12 citation statements)

References 26 publications

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“…AKI following rhabdomyolysis in the setting of acute traumatic lower extremity CS has been reported to be near 40%. [ 10 ] The incidence of AKI following CS in the trauma group was 2.4%. Rhabdomyolysis could have contributed to the onset of this complication but prolonged impaired renal perfusion from hypovolemia and aortic cross-clamping and hypotension played significant roles in the 3 patients reported.…”

Section: Discussionmentioning

confidence: 99%

Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

Lollo

Grabinsky

2016

Int J Crit Illn Inj Sci

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Background:Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy.Methods:Retrospective chart analysis for patients with a discharge diagnosis of CS was performed. Physical demographics, employment status, activity at time of injury, injury severity score, fracture types, pain scores, hours to fasciotomy, iCP, serum creatine kinase levels, wound treatment regimen, length of hospital stay, and discharge facility were collected. Lower extremity neurologic examination, pain scores, orthopedic complications, and employment status at 30 days and 12 months after discharge were noted.Results:One hundred twenty-four patients were enrolled in this study. One hundred and eight patients were assessed at 12 months. Eighty-one percent were male. Motorized vehicles caused 51% of injuries in males. Forty-one percent of injuries were tibia fractures. Acute kidney injury occurred in 2.4%. Mean peak serum creatine kinase levels were 58,600 units/ml. Gauze dressing was used in 78.9% of nonfracture patients and negative pressure wound vacuum therapy in 78.2% of fracture patients. About 21.6% of patients with CS had prior surgery. Nearly 12.9% of patients required leg amputation. Around 81.8% of amputees were male. Sixty-seven percent of amputees had associated vascular injuries. Foot numbness occurred in 20.5% of patients and drop foot palsy in 18.2%. Osteomyelitis developed in 10.2% of patients and fracture nonunion in 6.8%. About 14.7% of patients underwent further orthopedic surgery. At long-term follow-up, 10.2% of patients reported moderate lower extremity pain and 69.2% had returned to work.Conclusion:Escalation in leg pain and changes in sensation are the cardinal signs for CS rather than reliance on assessing for firm compartments and pressures. The severity of nerve injury worsens with the delay in performing fasciotomy. Standardized diagnostic protocols and wound treatment strategies will result in improved outcomes from this complication.

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Section: Discussionmentioning

confidence: 99%

Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

Lollo

Grabinsky

2016

Int J Crit Illn Inj Sci

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“…The rate of rhabdomyolysis after acute compartment syndrome has been reported as 44.2%. 44 Of the patients that develop rhabdomyolysis, 14.4% to 39.1% develop acute kidney injury (AKI). 44 45 Risk factors for rhabdomyolysis include patients using drugs and alcohol and presenting with pulselessness in the affected extremity.…”

Section: Complications/outcomesmentioning

confidence: 99%

“… 44 Of the patients that develop rhabdomyolysis, 14.4% to 39.1% develop acute kidney injury (AKI). 44 45 Risk factors for rhabdomyolysis include patients using drugs and alcohol and presenting with pulselessness in the affected extremity. 44 Of the patients who develop traumatic compartment syndrome-related AKI, the need for dialysis is high, in one series documented at 44.4%.…”

Section: Complications/outcomesmentioning

confidence: 99%

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Lower extremity compartment syndrome

Cone

Inaba

2017

Trauma Surg Acute Care Open

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Lower extremity compartment syndrome is a devastating complication if not rapidly diagnosed and properly managed. The classic symptoms of compartment syndrome can be deceiving as they occur late. Any concern for compartment syndrome based on mechanism, or the presence of pain in the affected extremity, should prompt a compartment pressure check. Both absolute compartment pressures above 30 mm Hg and a pressure differential of less than 30 mm Hg are used to make the diagnosis. The treatment goal is first to save the patient’s life and second to salvage the affected limb. Fasciotomy is the only accepted treatment of compartment syndrome and should be performed quickly after the diagnosis is made. Outcomes after fasciotomy are best when there is no delay in treatment.

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“…The edema caused by muscle necrosis could lead to an increase in compartment content resulting in compartment syndrome [13]. However rhabdomyolysis is also a common complication of compartment syndrome [14]. It is therefore impossible to determine whether the compartment syndrome in patients with hypothyroidism is caused by rhabdomyolysis or whether, analogue to compartment syndrome after trauma [14], rhabdomyolysis is a complication of compartment syndrome.…”

Section: Discussionmentioning

confidence: 99%

Compartment syndrome of the leg after thyroid hormone withdrawal; two cases and a systematic review of the literature

et al. 2020

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Background: Acute compartment syndrome is a rare complication of severe hypothyroidism. If the symptoms are not recognized promptly and treatment initiated immediately, there is a high risk of permanent damage. Only few other cases of compartment syndrome due to hypothyroidism have been published and the exact pathophysiological mechanism remains unknown. Case presentations: A 59 year old male developed acute compartment syndrome of his right lower leg after thyroid hormone withdrawal prior to radioiodine remnant ablation after total thyroidectomy for follicular thyroid cancer. He underwent emergency fasciotomy of all four compartments of the lower leg. The muscle tissue in the anterior and lateral compartment was necrotic and was therefore excised. The second patient was a 62 year old female with Hashimoto's thyroiditis, who developed acute compartment syndrome of both lower legs after thyroid hormone withdrawal due to non-compliance. Emergency fasciotomy of all four compartments of both legs was performed. The muscle tissue was viable in all compartments. Conclusion: Although compartment syndrome due to hypothyroidism is uncommon, it is a complication physicians should be aware of. The majority of reported cases are caused by an acute withdrawal of thyroid hormones and not by undetected hypothyroidism. No previous case of compartment syndrome caused by an iatrogenic hormone withdrawal in preparation for radioactive iodine has been published. However, as shown in this report, it may be beneficial to inform patients of this rare complication prior to hormone withdrawal in preparation for remnant ablation after thyroidectomy.

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High Risk of Rhabdomyolysis and Acute Kidney Injury After Traumatic Limb Compartment Syndrome

Cited by 17 publications

References 26 publications

Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

Lower extremity compartment syndrome

Compartment syndrome of the leg after thyroid hormone withdrawal; two cases and a systematic review of the literature

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