Journal of Musculoskeletal Trauma

Complications of Fracture: Acute Compartment Syndrome: Sung Yoon Jung, Min Bom Kim; J Korean Fract Soc 2023;36(3):103-109. Published online July 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.3.103

Abstract PDF: Acute compartment syndrome occurs when the pressure in the closed bone-myofascial muscle compartment rises above a critical level, and venous perfusion through the capillaries is blocked, resulting in microcirculation disorders. Tissue ischemia in the compartment causes irreversible damage to the muscles, nerves, and even bones, and can cause functional disorders, muscle contractures, nerve damage, and nonunion. In addition to trauma, phlebitis after injection, pseudoaneurysm due to blood vessel damage, anticoagulants (e.g., warfarin), and exercise are all known causes of acute compartment syndrome. On the other hand, it commonly occurs after a fracture, leading to serious complications if not treated appropriately. Therefore, when a fracture occurs, care must be taken to determine if acute compartment syndrome has occurred, and capillary circulation must be quickly restored through early diagnosis and decompression.

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Crush Syndrome: Traumatic Rhabdomyolysis, Reperfusion Injury: Yong-Cheol Yoon; J Korean Fract Soc 2023;36(2):62-68. Published online April 30, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.2.62

Abstract PDF: A crush injury causes damage to bones, muscles, blood vessels, nerves, and other tissues caused due to pressure. Crush syndrome is a reperfusion injury that occurs throughout the body after a crush injury and leads to traumatic rhabdomyolysis, in which muscle fibers are broken down. Owing to the decreased blood supply, inflammation, and changes in metabolic activity, fluids and electrolytes in the blood can move into tissues, causing hypovolemic shock. In addition, toxic substances resulting from cell destruction can circulate through the bloodstream, causing electrolyte imbalances, renal failure, arrhythmias, and cardiac arrest, with approximately 15% of patients with acute renal failure dying. The treatment for crush syndrome involves aggressive fluid therapy and correction of the electrolyte imbalances, while patients with acute renal failure may require dialysis. Surgical treatment may include debridement and irrigation of necrotic tissue, and fasciotomy is necessary to address compartment syndrome, a complication that may arise.

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Clinical Outcomes of Fasciotomy for Acute Compartment Syndrome: Ji Yong Park, Young Chang Kim, Ji Wan Kim; J Korean Fract Soc 2015;28(4):223-229. Published online October 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.4.223

Abstract PDF: PURPOSE
The purpose of this study is to evaluate clinical outcomes and complications after fasciotomy in acute compartment syndrome.
MATERIALS AND METHODS
Seventeen cases diagnosed as compartment syndrome and underwent fasciotomy from January 2011 to February 2015 were evaluated retrospectively. We investigated the causes and regions of acute compartment syndrome, the methods of wound management, the necessity of skin graft, and the complications including amputation and infection.
RESULTS
According to the causes of acute compartment syndrome, there were 7 fractures, 1 traumatic hematoma, 6 reperfusion injury, and 3 rhabdomyolysis. The regions of acute compartment syndrome were 3 cases of thigh, 10 cases of leg, and 3 cases of foot. One case had acute compartment syndrome involving thigh, leg, and foot. Of 17 cases, 3 cases died due to reperfusion injury and one case with severe necrosis of soft tissues underwent amputation. Among the 13 cases excluding 4 cases with death or amputation, 3 cases underwent split thickness skin graft. Shoelace technique and/or vacuum-assisted closure (VAC) was used for 9 cases, and wound closure without skin graft was achieved in all except one case, while 2 cases required skin graft among 4 cases without shoelace technique or VAC. There were 2 cases of infection.
CONCLUSION
Acute compartment syndrome caused by reperfusion injury had poor outcomes. Shoelace technique and/or VAC were useful for management of wound after fasciotomy.

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Acute Compartment Syndrome of the Thigh Caused by Contusion: 4 Cases Report: Oog Jin Shon, Gi Beom Kim, Chul Hyun Park; J Korean Fract Soc 2012;25(3):215-218. Published online July 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.3.215

Abstract PDF

Acute compartment syndrome of the thigh, which usually occurs in the anterior compartment, is a rare condition. It can have various causes including femur fractures, vessel injury, pseudoaneurysm of the femoral or popliteal artery, and use of anticoagulant. However, there have been few reports of acute compartment syndrome of the thigh without fracture caused by blunt trauma. We report 4 cases of acute compartment syndrome of the thigh without fracture caused by blunt trauma, in which three patients were treated with fasciotomy and a Vacuum-Assisted wound Closure system and the other one had a delayed diagnosis, and eventually underwent above-knee amputation.

Citations

Citations to this article as recorded by

A Clinical Case Study of Residual Symptoms after Decompression of Traumatic Compartment Syndrome
Min Jung Ji, Seong Chul Lim, Jae Soo Kim, Hyun Jong Lee, Yun Kyu Lee
The Acupuncture.2015; 32(3): 197. CrossRef
Clinical Outcomes of Fasciotomy for Acute Compartment Syndrome
Ji Yong Park, Young Chang Kim, Ji Wan Kim
Journal of the Korean Fracture Society.2015; 28(4): 223. CrossRef

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Spontaneous Intramuscular Hematoma associated with Acute Compartment Syndrome after Treatment of Low Molecular Weight Heparin: A Report of Two Cases: Keun Woo Kim, Woo Dong Nam, Kee Hyung Rhyu, Byung Ryul Cho, Yong Hoon Kim, Soo Ik Awe; J Korean Fract Soc 2006;19(1):89-92. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.89

Abstract: Low-molecular-weight heparin (LMWH) has been considered superior to unfractionated heparin in several facets such as more effective anticoagulant, more predictable bioavailability, and less bleeding complications. We report two cases of LMWH, enoxaparin-induced spontaneous intramuscular hematoma with compartment syndrome of the lower extremity in patients with cardiac problems. The patients were treated with enoxaparin (LMWH) as bridging anticoagulation before use of warfarin due to cardiac problems. At the average 3 days of enoxaparin treatment, large and painful swelling was noticed in the lower extremities without intramuscular injection or trauma. The patients were diagnosed as having compartment syndrome with large intramuscular hematoma by CT. The patients underwent immediate fasciotomy and hematoma evacuation, and recovered without any complications.

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