Acute Hand Compartment Syndromes after Closed Crush: A Reappraisal

Abstract

Severe crush to the hand is associated with a poor prognosis. The authors investigated the hypothesis that compartment syndrome complicates such injuries. From 1996 to 2000, the authors retrospectively identified 11 patients who, after sustaining a closed crush injury, developed acute hand compartment syndrome. Diagnosis was made on clinical grounds in two patients (the intracompartmental pressure was not measured) and after clinical examination plus measurement of intracompartmental pressure in nine patients. In all cases, the muscle burst out once the fascia was released from the affected compartment. Clinical clues to elicit the diagnoses were massive hand swelling and tenseness to palpation. Classic symptoms, such as excruciating pain, were absent or their intensity was attributed to the trauma event (in six patients). Classic signs such as intrinsic muscle minus position and pain on stretching were absent in six and three patients, respectively. In addition, the latter stretch test could not be properly judged in five more patients because of interference by the associated injuries. None of the patients developed contracture or sequela that could be attributed to compartment syndrome. On the basis of this experience, it was concluded that crush injury does not in itself carry a poor functional prognosis, provided that attention is paid to the often-concomitant compartment syndrome. Elevated subfascial pressure may be present despite the absence of classic signs and symptoms.

The exploded hand syndrome: a report of five industrial injury cases

“…The clinical diagnosis of compartment syndrome was based on the presence of increasing pain with passive stretch of the fingers and the presence of massive swelling/tenderness on palpation. Similar to the findings of del Piñal et al (2002), we also found that hard swelling was the most important clinical sign. We also normally perform compartment pressure measurements, but these were not done in the current study because they were not available in that particular hospital.…”

“…The main problem in these patients is the concomitant vascular injury in which hand amputation is the end-point of treatment unless revascularization is carried out. Finally, perhaps the most common industrial crush injury to the hand is the 'simple closed crush', which is associated with acute hand compartment syndrome (Del Piñal et al, 2002). Here, the impact force is relatively lower than the exploded hand syndrome and the force is not localized across the palm as seen in the balloon hand syndrome.…”

“…Here, the impact force is relatively lower than the exploded hand syndrome and the force is not localized across the palm as seen in the balloon hand syndrome. Del Piñal et al (2002) demonstrated that an excellent outcome is expected if fasciotomies of all hand compartments are performed early. Comparisons between these various crush injuries and the exploded hand syndrome are shown in Table 4.…”

Approaches to surgical treatment of deep burns of the hand burdened with subfascial hypertension syndrome

“…Дослідження виконано відповідно до принципів Гельсінської декларації. Синдром субфасціальної гіпертензії виникає внаслідок підвищення тиску всередині фаціальних футлярів, який призводить до феномену вазоконстрикції, критичного зменшення перфузії в м'язових і нервових внутрішньофасціальних структурах, для якого характерна типова клінічна тріада -набряк ураженого сегмента, біль і глибоке порушення чутливості [3,4].…”

Massive Hand Crush: The Role of a Free Muscle Flap to Obliterate the Dead Space and to Clear Deep Infection

“…Crush injuries of the hand are a common injury. In the typical case, one can expect metacarpal fractures, ragged skin flaps and an unusually high incidence of compartment syndromes (Piñal et al, 2002). “Crush to the carpus” is a much rarer, high-energy injury associated with axial wrist dislocations (Garcia-Elias et al, 1985).…”