The Pathophysiology of the Anterior Tibial Compartment Syndrome

Rorabeck, Cecil H.; Clarke, Kevin

doi:10.1097/00005373-197805000-00001

Cited by 117 publications

(44 citation statements)

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“…6 Scientists have different opinions on the pressure criteria for diagnosis of ACS [9][10][11][12][13][14][15] but absolute pressures of 30 to 40 mm Hg are generally accepted. 5,6,8,16,17 The only effective therapy for ACS is decompression of the affected compartments by a fasciotomy, 9,12,13,15,[18][19][20] and if this treatment is delayed, muscle necrosis and permanent disability may result. 9,13,19,[21][22][23] In a previous series of ACS cases presenting to the ED, the median injury-to-operation time interval was greater than 9 hours, suggesting that delays may be the rule rather than the exception.…”

Section: Introductionmentioning

confidence: 99%

Acute compartment syndrome: How long before muscle necrosis occurs?

Vaillancourt

Shrier

Vandal

et al. 2004

CJEM

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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. RÉSUMÉObjectifs : Le syndrome de loge aigu est une atteinte menaçant l'intégrité des membres qui est souvent diagnostiqué par les médecins d'urgence. On sait peu de choses au sujet de la rapidité à laquelle des lésions permanentes peuvent subvenir. Notre objectif était d'estimer le délai d'instal-

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Section: Introductionmentioning

confidence: 99%

Acute compartment syndrome: How long before muscle necrosis occurs?

Vaillancourt

Shrier

Vandal

et al. 2004

CJEM

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“…9 Chronic exertional compartment syndrome differs in presentation and time course from that seen in trauma, but the eventual sequelae can be the same. Nonoperative management using stretching and activity modification has been found to have poor results.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Compartment Release for Chronic Exertional Compartment Syndrome

Knight

Daniels

Robertson

2013

Arthroscopy Techniques

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Exertional compartment syndrome of the leg is a condition that can cause chronic debilitating pain in active persons during a variety of aerobic activities. Nonoperative treatments using stretching protocols and activity modifications are often unsuccessful, and thus several operative strategies have been used to treat this condition. A novel technique for endoscopically assisted fasciotomy for chronic exertional compartment syndrome is described. By use of a small laterally based incision and an arthroscope, polydioxanone sutures are passed percutaneously along the anterior and lateral compartments with the Spectrum suture-shuttling device (ConMed Linvatec, Largo, FL). These sutures are used to retract the skin and subcutaneous tissues over the respective compartments. This method allows excellent visualization of the intercompartmental septum, the superficial peroneal nerve, and all perforating vessels. The anterior and lateral compartments can be safely and completely released with this minimally invasive approach. The patient is allowed to return to full activity at 6 weeks postoperatively, because of the decreased soft-tissue disruption.

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“…[1][2][3][4][5][6][7] If left untreated, CS may lead to tissue necrosis and permanent functional impairment. 4,[8][9][10] The clinical sequelae of CS, first described by Richard von Volkmann in 1875, relates irreversible contractures of the hand to an ischemic process in the forearm; von Volkmann put forward the idea that the pathophysiology of the contracture is caused by arterial insufficiency combined with venous stasis.…”

Section: Discussionmentioning

confidence: 99%