Upper extremity compartment syndrome after minor trauma: an imperative for increased vigilance for a rare, but limb-threatening complication

Abstract

BackgroundCompartment syndrome of any extremity is a limb-threatening emergency requiring an emergent surgical management. Thus, ruling out compartment syndrome is often high on the list of priorities when treating high-energy injuries and fractures. However, even in the most seemingly benign injuries, this dangerous diagnosis must always remain on the differential and suspicion must remain high.Case presentation23-year-old factory worker presents after a low energy entrapment injury to his left forearm. Initial work-up and evaluation noted an isolated radial head dislocation with a normal physical motor and sensory exam. However, maintaining high suspicion for compartment syndrome despite serial normal physical exams, led objective compartment pressure measurement leading to definitive diagnosis. Emergent surgical intervention via compartment fasciotomies was performed, along with closed reduction and ligament repair. At 1 year follow-up, the patient was well-healed, back to work with full range of motion and not activity limitations.ConclusionDespite a seemingly benign injury pattern, and a relatively low energy mechanism, vigilant concern for compartment syndrome following any kind of entrapment injury should initiate serial examinations and compartment pressure measurements especially in circumstances with continued swelling and inability to perform an accurate clinical assessment due to an obtunded or medicated patient.

Brachial Artery Injury Accompanying Closed Elbow Dislocations

“…Surgeons must be vigilant for nerve injuries that are frequently associated with posterior elbow dislocations [26] . Compartment syndrome after closed elbow trauma with brachial artery injury is uncommon [27,28] , but can occur. Therefore, small-incision fasciotomies were performed prophylactically in this case.…”

An Overview of Musculoskeletal Injuries for Emergency Physicians

“…It is necessary to know the anatomy of the compartments of each limb before fasciotomy, avoiding inadequate fasciotomy which, in and of itself, will result in subsequent tissue necrosis. [42][43][44] In multiple trauma patients, irreversible tissue damage may occur at a lower compartment pressure due to generalized hypoxia. High-risk patients, especially those with closed comminuted fractures of the proximal or distal-third tibia or those with complex foot injuries, should be closely monitored.…”