Hand Compartment Syndrome

Abstract

Compartment syndrome is defined by high pressures in a closed myofascial compartment, which affects initially the muscles and later the nerves and vessels. The hand is rarely affected, but if treated suboptimally, it results to a permanent loss of function. Eleven compartments are included in the hand and wrist. Diagnosis of compartment syndrome of the hand remains challenging. Pain out of proportion of injury and excessive swelling should raise suspicion towards a compartment syndrome. Intracompartmental pressure measurement contributes to the diagnosis, but it is not always reliable. Once the diagnosis of acute compartment syndrome has been made, decompression of all compartments is mandatory, in order to achieve a good outcome. Failing to manage this emergent condition properly leads to a significant hand disability. Our chapter includes the following sections: 1. Introduction. A brief description of the hand compartment syndrome is presented. 2. Anatomy. Special considerations regarding hand compartments are presented, 3. Etiology. 4. Diagnosis. Signs and symptoms are reported, as well as guidelines of the technique of intracompartmental pressure measurement. 5. Treatment. Faciotomies’ indications and operative technique are described in details. 6. Conclusion. Appropriate figures of the clinical image and surgical decompression are presented as well.

Well leg compartment syndrome due to the lithotomy position in orthopedic surgery: a report of two cases and a review of the literature

“…[ 10 ] reported that 81% of patients undergoing fasciotomies develop long-term complications, but this should not deter surgeons from performing fasciotomies when deemed necessary. In the setting though of a delayed diagnosis, like our second case, surgical fasciotomy is no longer effective and might lead to serious complications, such as infection and limb amputation [ 11 ]. Our review suggests that the 29.4% of the patients who develop WLCS post-surgery achieved full recovery.…”

Orthotopic forelimb transplantation in a Yucatan minipig model: Anatomic and in vivo study

“…Perfusate samples from the venous outflow were drawn to measure arterial and venous perfusate gases and lactate (ADVIA 120 Hematology System, Malvern, PA). Compartment syndrome was defined as fullness of muscle compartments within closed fascial compartments (flexor and extensor), confirmed by intracompartmental pressures ≥30 mmHg measured using the Stryker® intracompartmental pressure monitor (Torlincasi et al, 2017). Forelimbs were weighed before transplantation to assess edema formation secondary to EVNLP.…”

Douleur aux membres inférieurs : banal ou fatal ?

“…Le syndrome du compartiment est une pathologie peu fréquente qui atteint 7,3 hommes et 0,7 femme par 100 000 habitants par an (22). Il se définit comme une augmentation de la pression au niveau d'une loge non extensive qui entraîne une ischémie musculaire et des dommages aux cellules nerveuses (23).…”

“…Dans 75 % des cas, la cause identifiée est une fracture à la suite d'un traumatisme. Cependant, il peut survenir en cas de lésions des tissus mous : brûlures, blessure par écrasement, lésions vasculaires, contusion, hématome majeur ou parfois relié à une reperfusion tissulaire, entre autres, à la suite d'une chirurgie vasculaire (22). Lorsque la cause n'est pas une fracture, il est important de rester à l'affût puisque le risque de développer une complication est plus élevé (24).…”