Acute compartment syndrome of the dorsal forearm following noncontact injury

Abstract

Acute compartment syndrome is a limb-threatening condition in which early diagnosis and surgical consultation for fasciotomy are required to preserve functional outcome. The diagnosis is typically considered in patients with traumatic mechanisms of injury such as a direct blow and crush to the compartment, particularly when there is a fracture in the same compartment. We report the case of a patient with acute compartment syndrome of the dorsal forearm that occurred as a result of an atypical noncontact traumatic mechanism. Establishing the diagnosis of compartment syndrome was complicated in this patient, as some of the signs and symptoms of acute compartment syndrome could have been attributed to the presence of a coexisting rupture of the extensor digitorum muscle. This report serves to remind emergency physicians that, although rare, acute compartment syndrome can result from exertional and noncontact traumatic mechanisms.

Atypical Signs of Compartment Syndrome Caused by Pressure Injury in Forearm

“…To the extent of our knowledge, this is the first case report of forearm ACS in Korea caused by muscle rupture without an underlying fracture [1,2,9]. Though there is literature from overseas reporting similar case, this complication can still be overlooked due to the difficulty in distinguishing pain caused by ACS from that by contusion, the frequency of dermal contact burn by pressure injury, and rarity of the complication.…”

“…ACS is a surgical emergency because of the possibility of limbthreatening complications such as neurologic deficit, muscle necrosis, Volkmann ischemic contracture, infection, delayed healing of underlying fractures and rhabdomyolysis [1]. To avoid motor impairment secondary to these irreversible damages, aggressive surgical decompression via fasciotomy should be performed within six hours after an injury [5].…”

“…ACS is often accompanied by fractures in the affected limb [4]. Typically, symptoms exacerbate within a few hours after injury, making physicians strongly suspect ACS [1,2]. Herein, we report a rare case of delayed volar forearm ACS presented by a contact burn wound.…”

“…Acute compartment syndrome (ACS) is a condition in which increased pressure within a closed fascial compartment limits circulation to tissues, sometimes resulting in tissue necrosis [1]. Swift diagnosis and treatment are necessary.…”

After a punch: recurrence of compartment syndrome following minor trauma

“…Fortunately, despite a 6-day delay from the onset of symptoms to fasciotomy, the vascular compromise was not severe enough to cause tissue anoxia, as there was no gross myonecrosis on intra-op exam and no neurological sequelae. This is unusual, as a delay in over 12 h almost invariably causes long-term sequelae [ 8 ]. We suspect that this might have been due to the fact that the compartment was at least partially released with prior fasciotomy, allowing pressures to build up more gradually and hence have a less traumatic effect on enclosed muscular and neural tissue.…”