Sat., 10/6/12 Upper Extremity Injuries, PAPER #92, 11:36 am OTA-2012
Acute Compartment Syndrome of the Forearm
Andrew D. Duckworth, MBChB, BSc (Hons); Sarah E. Mitchell, MRCSEd;
Samuel G. Molyneux, MRCSEd; Timothy O. White, MD, FRCS;
Charles M. Court-Brown, MD; Margaret M. McQueen, MD;
Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh,
Edinburgh, Scotland, United Kingdom
Purpose: The aim of this study was to document our experience of acute forearm compartment syndrome, and to determine the risk factors for requiring split-skin grafting (SSG) and developing complications postfasciotomy.
Methods: We identified from our trauma database all patients who underwent fasciotomy for an acute forearm compartment syndrome over a 22-year period. Diagnosis was made using clinical signs, with compartment pressure monitoring, or a combination of the two. Demographic data, etiology, management, wound closure, complications, and subsequent surgeries were recorded. Outcome measures were the use of SSG and the development of complications following forearm fasciotomy.
Results: There were 90 patients in the study cohort with a mean age of 33 years (range, 13-81) and a significant male gender predominance (n = 82, P <0.001). A fracture of one or both of the forearm bones was seen in 62 patients (69%), with soft-tissue injuries causative in 28 (31%). The median time to fasciotomy was 12 hours (range, 2-72). A volar compartment decompression was performed most frequently (n = 89, 99%). Delayed wound closure was achieved in 38 patients (42%), with 52 (58%) requiring SSG. Risk factors for requiring SSG were younger age and a crush injury (both P <0.05). Complications occurred in 29 patients (32%) at mean follow-up of 11 months (range, 3-60). Risk factors for developing complications were a delay in fasciotomy of >6 hours (P = 0.018), with preoperative motor symptoms approaching significance (P = 0.068).
Conclusion: To our knowledge, this is the largest series in the literature of acute forearm compartment syndrome with the etiology, diagnosis, management, and complications reported in a consecutive group of patients. We have shown forearm compartment syndrome requiring fasciotomy predominantly affects males and can occur following either a fracture or soft-tissue injury. Age is an important predictor of undergoing SSG for wound closure. Complications occur in a third of patients and are associated with an increasing delay in the time to fasciotomy.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.