Documente Academic
Documente Profesional
Documente Cultură
ARTICLES
1)
2)
Mr Simon Woods BA, BMBS, MRCS, Orthopaedic Core Trainee in Yorkshire and the Humber.
Mr Ashish Soni MRCS, Dip SEM, FRCS (Orth) Orthopaedic Registrar in Yorkshire and the Humber.
Abstract
A 26 year old diabetic and epileptic man was found having a seizure due to diabetic ketoacidosis (DKA). The
seizure was estimated to persist for one hour. His seizure was controlled with a general anaesthetic in the
emergency department before he was transferred to ICU for management of his DKA. His left upper arm was
tense and swollen, and so orthopaedic input was urgently sought. Intracompartmental pressure measurements
confirmed compartment syndrome in the extensor compartment of the upper arm and he underwent emergency
fasciotomy. Two further procedures were required to achieve closure of the wound, but he recovered well.
Acute Compartment Syndrome (ACS) is a common phenomenon, but rarely found in the upper arm, possibly due
to the laxity of the fascia within the region. ACS typically results from a fracture, but can also be due to burns,
dislocation, vascular or penetrating injury, iatrogenic or crush injury. To the best of the authors knowledge there
are no previous cases of ACS in the upper arm due to prolonged seizure reported.
The principal symptom of ACS is pain disproportionate to injury. In this case pain was not a reported due to the
patient being anaesthetised. Other clinical features include firmness to palpation, loss of distal pulses, weakness,
and pain on passive stretch. Definitive diagnosis is by measurement of compartmental pressures in comparison to
diastolic blood pressure.
We recommend high clinical suspicion and urgent intervention with compartment pressure measurement,
monitoring and fasciotomy to avoid morbidity in this group of clinically challenging, obtunded patients.
Summary
Case
Syndrome
extensor
vigilance
of
and urea of 7.
of
and
the
upper
prompt
arm
decompression
result
of
prolonged
seizure
secondary to DKA.
compartments.
syndrome.
pulses
were
present.
The
patient
was
10
Spring 2015
11
or
bleeding,
intramuscular
dislocation 5,6,
haemorrhage
infection
and
following
injury7or
tendon
ruptures8,
minor
typically
in
the
Anatomy
compartment
containing
the
biceps
Discussion
Compartment Syndrome
Compartment
syndrome
the
compromises
that
arm11.
the
occurs
circulation
when
to
around
extremities
include
crush
injuries,
burns,
12
the
humerus
in
the
spiral
groove
Spring 2015
Diagnosis
fasciotomy14.
palpation,
the
decreased
pain
compartment.
on
passive
Absent
stretch
pulses,
of
essential
of
limb,
to
be
darkening
vigilant
of
to
the
the
urine,
signs
and
acute
irreversible
12
damage
to
contents
of
the
mortality.
Conclusion
Compartment
a Stryker device).
practice
and
unconscious
syndrome
difficult
patient.
with
to
the
posterior
diagnose
When
in
the
managing
an
obtunded
13
patient
of
potential
trauma
or
A: Elliott KG, Johnstone AJ. Diagnosing acute Compartment syndrome. Journal of Bone and Joint
Surgery Br 2003; 85:625
2.
D: Burton AC. On the physical equilibrium of small blood vessels. Am J Physiol 1951; 164:319
3.
B: Kostler W, Strom PC, Sudkanp NP. Acute compartment syndrome of the limb. Injury 2005;
36:992
4.
C:Patel RV, Haddad FS. Compartment syndromes. Br J Hosp Med (Lond) 2005; 66:583
5.
Ridings P, Gault D. Compartment syndrome of the arm. J Hand Surg Br. 1994: 19 (2): 147-148.
6.
Yen CY, Yeh WL, Tu YK. Inferior dislocation of the glenohumeral joint combined with
compartment syndrome of the upper arm, case report. Changgeng Yi Xue Za Zhi. 1998; 21 (3):
358-361.
7.
8.
Fung, Frey and Grossman. Rare Causes of upper arm Compartment Syndrome Following Biceps
Tendon Rupture. Orthopedics, May 2008 Volume 31, Issue 5
9.
Rafiq I, Anderson D. Acute compartment syndrome of the Upper Arm. The internet journal of
Orthopedic Surgery. 2005 Volume 3 Number 1.
10.
Leguit P, Comparment Syndrome of the Upper Arm. The Netherlands Journal of Surgery, 34-3,
1982.
11.
Diminick M, Shapiro G and Cornell C. Acute Compartment syndrome of the triceps and deltoid.
J Orthop Trauma, Vol 13, No 3, 1999
12.
13.
E: Olson SA, Glascow RR. Acute compartment syndrome in lower extremity musculoskeletal
trauma. J Am Acad Orthop Surg 2005; 13:436
14.
F: McQueen MM, court-Brown CM. Compartment monitoring in tibial fractures. The pressure
threshold for decompression. J Bone Joint Surg Br 1996; 32:183
14
Copyright of Mid Yorks Medical Journal is the property of Mid Yorkshire Hospitals and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.