The compartment syndrome: is the intra-compartment pressure a reliable indicator for early diagnosis?

Nudel, Iftah; Dorfmann, Luis; deBotton, Gal

doi:10.1093/imammb/dqw016

Cited by 7 publications

(9 citation statements)

References 36 publications

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“…At time of assessment by the orthopedic surgeon, patients may be intubated and/or sedated and/or obtunded, and clinical evaluation of ACS (pain out of proportion with the clinical findings and exacerbated by passive muscle stretch) may be impossible to perform [9][10][11][12][13]. In addition to intra-compartmental pressure (ICP) measurement, alternative ACS predictors need to be identified [11,14,15].…”

Section: Introductionmentioning

confidence: 99%

Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial shaft fractures: a retrospective cohort study

Wuarin

Gonzalez

Zingg

et al. 2020

BMC Musculoskelet Disord

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Background: The purpose of this study was to evaluate the association between epidemiological, clinical and radiographic factors of patients with tibial shaft fractures and the occurrence of acute compartment syndrome. Methods: 270 consecutive adult patients sustaining 273 tibial shaft fractures between January 2005 and December 2009 were included in this retrospective cohort study. The outcome measure was acute compartment syndrome. Patient-related (age, sex), fracture-related (high-vs. low-energy injury, isolated trauma vs. polytrauma, closed vs. open fracture) and radiological parameters (AO/OTA classification, presence or absence of a noncontiguous tibial plateau or pilon fracture, distance from the centre of the tibial fracture to the talar dome, distance between tibial and fibular fracture if associated, and angulation, translation and over-riding of main tibial fragments) were evaluated regarding their potential association with acute compartment syndrome. Univariate analysis was performed and each covariate was adjusted for age and sex. Finally, a multivariable logistic regression model was built, and odds ratios and 95% confidence intervals were obtained. Statistical significance was defined as p < 0.05. Results: Acute compartment syndrome developed in 31 (11.4%) cases. In the multivariable regression model, four covariates remained statistically significantly associated with acute compartment syndrome: polytrauma, closed fracture, associated tibial plateau or pilon fracture and distance from the centre of the tibial fracture to the talar dome ≥15 cm. Conclusions: One radiological parameter related to the occurrence of acute compartment syndrome has been highlighted in this study, namely a longer distance from the centre of the tibial fracture to the talar dome, meaning a more proximal fracture. This observation may be useful when clinical findings are difficult to assess (doubtful clinical signs, obtunded, sedated or intubated patients). However, larger studies are mandatory to confirm and refine the prediction of acute compartment syndrome occurrence. Radiographic signs of significant displacement were not found to be correlated to acute compartment syndrome development. Finally, the higher rate of acute compartment syndrome occurring in tibial shaft fractures associated to other musculoskeletal, thoraco-abdominal or cranio-cerebral injuries must raise the level of suspicion of any surgeon managing multiply injured patients.

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Section: Introductionmentioning

confidence: 99%

Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial shaft fractures: a retrospective cohort study

Wuarin

Gonzalez

Zingg

et al. 2020

BMC Musculoskelet Disord

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“…Es menester recordar que existen variaciones entre los compartimientos medidos, a razón de que pueden existir compartimentos con una medición normal mientras otros presentar hipertensión. 17 McQueen y colaboradores establecieron que la monitorización continua de la presión durante dos horas con una presión < 30 mmHg entre la presión diastólica y la compartimental, era el mejor método de diagnóstico con una sensibilidad del 94%, 18 misma que se ha mantenido en la actualidad, aunque este método no carece de los errores antes mencionados, sumando que se necesita equipo especializado como un monitor continuo de presión y personal experimentado, mismos que usualmente son difíciles de conseguir en situaciones de desastres naturales.…”

Section: Wwwmedigraphicorgmxunclassified

Revisión del síndrome de aplastamiento: reporte de un caso

Santos-Montoya¹,

Herrera-Caballero²,

Ceballos-Sánchez³

et al. 2020

El Residente

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RESUMEN. El síndrome compartimental se define como la elevación de la presión tisular por arriba de 30 mmHg en un compartimento, aunque es más fiable la comparación de la presión tisular compartimental con la presión arterial diastólica por debajo de 30 mmHg. Esta situación comúnmente es predecesora del síndrome de aplastamiento, el cual se define como una rabdomiólisis postraumática con alteración sistémica, que principalmente está asociada con una falla renal aguda. El uso de la amputación como método para mejorar la condición clínica del paciente aún es controversial. A continuación, se presenta el caso de un paciente rescatado de los escombros de un derrumbe 24 horas posteriores al terremoto que afectó a la Ciudad de México el 19 de septiembre de 2017, y asimismo se presenta una revisión de la literatura actual.

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“…Furthermore, these signs are more often signs of arterial ischemia than ACS, and be elicited only in the fully alert patient. [6–8]…”

Section: Diagnosis Varietiesmentioning

confidence: 99%

“…Nudel et al found that ACS is not uniform about pressure distribution in the compartment. [6] The pressure adjacent to the damaged artery is substantially higher than a critical value, indicating the need for fasciotomy. However, at the same time, the pressure in regions far from the bleeding artery is substantially lower than the threshold value even after 2 hours from injury.…”

Section: Diagnosis Varietiesmentioning

confidence: 99%