Spontaneous compartment syndrome of the forearm – case report
Authors:
K. Edelmann 1,3; P. Meluzinová 1; V. Kunc 1,2
Authors‘ workplace:
Klinika úrazové chirurgie Fakulty zdravotnických studií Univerzity J. E. Purkyně v Ústí nad Labem a Krajské, zdravotní a. s. – Masarykovy nemocnice v Ústí nad Labem
1; Ústav anatomie, 2. lékařská fakulta Univerzity Karlovy, Praha
2; Fakulta zdravotnických studií Univerzity J. E. Purkyně v Ústí nad Labem
3
Published in:
Rozhl. Chir., 2021, roč. 100, č. 8, s. 403-408.
Category:
Case Report
doi:
https://doi.org/10.33699/PIS.2021.100.8.403–408
Overview
Introduction: Acute compartment syndrome is a serious complication of trauma and pathological disorders. Non-traumatic acute compartment syndrome is very rare and has no coherence with trauma. The case report demonstrates diagnostics difficulties and the treatment strategy.
Case report: We present a 36-year-old man with acute onset of pain after manual labor with a shovel. He had been treated with anticoagulation therapy due to a heart valve replacement. Blood clotting test showed prolongation of prothrombin time of more than four times due to iatrogenic bleeding disorder. Symptoms were considered consistent with the diagnosis of tendovaginitis, however the worsening of the symptoms was underestimated. Four days after the onset of the first symptoms, the acute compartment syndrome developed and urgent fasciotomy of the forearm and hand was performed. The convalescence lasted 10 months with restoration of the function and range of motion of the hand. The patient was able to fully self-service and manually work with a light load. The permanent consequence remained a limitation of the hand grip strength and paresthesia and neuropathic pain due to median nerve impairment.
Conclusion: Spontaneous compartment syndrome of the upper extremity is a rare but very dangerous entity requiring thorough understanding. It should be considered in the case of non-traumatic limb pain that does not respond to analgesics in patients receiving systemic anticoagulation. Only early diagnosis and immediate fasciotomy can prevent catastrophic permanent consequences.
Keywords:
acute compartment syndrome − spontaneous compartment syndrome − upper extremity
Sources
1. Volkmann R. Die ischämischen Muskellähmungen und Kontrakturen. Zentralbl Chir. 1881;8(51):801−803.
2. Papachristos IV, Giannoudis PV. Unusual presentation of compartment syndrome. In: Mauffrey C, Hak D, Martin III M. (eds) Compartment syndrome. Cham, Springer 2019. doi:10.1007/978-3-030-22331-1_15.
3. Ogrodnik J, Oliver JD, Forte AJ, et al. Clinical case of acute non-traumatic hand compartment syndrome and systematic review for the upper extremity. Hand (NY) 2019;19. doi:10.1177/1558944719856106.
4. Saiz AM Jr, Wellman AC, Stwalley D, et al. The incidence and risk factors associated with the need for fasciotomy in tibia and forearm fractures: An analysis of the National Trauma Data Bank. J Orthop Trauma 2020;34(5):e154−e158. doi:10.1097/ BOT.0000000000001702.
5. Balogh ZJ, Butcher NE. Compartment syndromes from head to toe. Crit Care Med. 2010;38(9 Suppl):445−451. doi:10.1097/ CCM.0b013e3181ec5d09.
6. Gallagher E, Ruiter T. Spontaneous arterial hemorrhage of the hand resulting in compartment syndrome. Eplasty 2014;15:ic44.
7. Janzig HMJ. Epidemiology, etiology, pathophysiology and diagnosis of the acute compartment syndrome of the extremity. Eu J Traum Emer Surg. 2007;33:576−583. doi:10.1007/s00068- 007-7151-0.
8. Kalyani BS, Fisher BE, Roberts CS, et al. Compartment syndrome of the forearm: a systematic review. J Hand Surg Am. 2011;36(3):535−543. doi:10.1016/j. jhsa.2010.12.007.
9. Krass V, Procházka V, Kužma J, et al. Kompartment syndrom v traumatologii končetin, použití podtlakové terapie. Úraz Chir. 2013;21(2):38−43.
10. Mahdi H, Gough S, Gill KK, et al. Acute spontaneous compartment syndrome in recent onset type 1 diabetes. Emerg Med J. 2007;24(7):507–508. doi:10.1136/ emj.2007.046425.
11. Zimmerman DC, Kapoor T, Elfond M, et al. Spontaneous compartment syndrome of the arm in a patient receiving anticoagulation therapy. J Emerg Med. 2013;44(1):e53−e16. doi:10.1016/j. jemermed.2011.09.031.
12. Neth MR. Acute hand pain resulting in spontaneous thenar compartment syndrome. Am J Emerg Med. 2019;37(3):561.e3−561.e4. doi:10.1016/j. ajem.2018.11.035.
13. Chang KS, Su YJ. Coma blister in nontraumatic rhabdomyolysis. Am J Emerg Med. 2016;34(7):1324.e1−1324.e2. doi:10.1016/j.ajem.2015.12.003.
14. Griffiths D, Jones DH. Spontaneous compartment syndrome in a patient on long-term anticoagulation. J Hand Surg Br. 1993;18(1):41−42. doi:10.1016/0266- 7681(93)90193-j.
15. Bekmez S, Beken S, Mermerkaya MU. Acute forearm compartment syndrome in a newborn caused by reperfusion after spontaneous axillary artery thrombosis. J Pediatr Orthop. B 2015;24(6):552−555. doi:10.1097/ BPB.0000000000000216.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2021 Issue 8
Most read in this issue
- Calcaneal fractures – current trends and pitfalls
- Acute and chronic Achilles tendon ruptures – current diagnostic and therapeutic options
- Spontaneous compartment syndrome of the forearm – case report
- Femoral shaft healing disorder − biomechanics and biology − case report