Acute compartment syndrome: How long before muscle necrosis occurs?

Abstract

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-

Acute compartment syndrome of the dorsal forearm following noncontact injury

“…4 To preserve muscle function, fasciotomy should be performed within 6 hours of injury; 5 however, even 3 hours from injury 37% of patients develop muscle necrosis. 4 Catastrophic results are virtually inevitable if fasciotomy is delayed beyond 12 hours after the injury was sustained.…”

“…[1][2][3] Early diagnosis, often done by emergency physicians, 4 can avoid limb-threatening sequelae, which include permanent neurologic deficit, muscle necrosis, ischemic contracture, infection, delayed healing of underlying fractures and rhabdomyolysis. 5 The diagnosis is typically considered in traumatic mechanisms such as a direct blow or crush injury to a compartment, particularly when these are accompanied by a fracture in the same limb.…”

Compartment Syndrome of the Lower Leg and Foot

“…While early studies stated irreversible nerve and muscle damage begin after 5 to 6 hours of ischemia [14], more recent clinical studies revealed that muscle necrosis occurs within the first 3 hours [91]. This is earlier than suggested in experimental, tourniquet-induced ischemia studies in which adenosine triphosphate levels were normalized 15 minutes after a 3-hour tourniquet application [36].…”

Correction

“…1 I am happy to see attention being paid to an important topic and with welcome insights for prospective emergency medicine applicants.…”