Compartment Syndrome of the Upper Extremity - Our Experience

Gal Barkay 1 Amir Arami 1,2 Shay Menachem 1 Batia Yaffe 1,2
1Orthopedic Surgery, Sheba Medical Center, Tel Hashomer, Israel
2Hand Surgery, Sheba Medical Center, Tel Hashomer, Israel

Introduction: Acute extremity compartment syndrome is a surgical emergency for which timely diagnosis is essential. Although being extensively described in regards to the lower extremities, compartment syndrome involving the upper extremities has only been seldom reported. Therefore, epidemiologic factors such as incidence and cause are difficult to assess. In this study we aim to better understand the characteristics of this injury in our practice and assess patient outcomes.

Methods: We retrospectively searched our hospital`s patient registry for files from the past 10 years regarding patients that have undergone a reported and documented fasciotomy procedure in the upper extremity. Data was collected from discharge reports, surgical reports, imaging and outpatient clinic documentation.

Results: A total of 28 patients underwent surgical fasciotomy of the upper extremity. Average age was 24 (1-70) with 89%(25) males and 11%(3) females. Initial injury was fracture in 12 patients, hematoma/vascular injury in 4, gunshot wound in 3, contusion in 2, electrocution in 2, infection in 2 and elbow dislocation and snakebite in a single patient. A clinical diagnosis was made in 13 patients, instrumental diagnosis in 8 and a preventive fasciotomy was performed in 7 patients. Fasciotomy within 24 hours of injury was performed in 15 (53%) of the patients. Long term follow up presented 16 patients with functional disability or sensory deficit, 8 patients had no disability and 4 were lost to follow up.

Discussion: Surgical Fasciotomy for presumed compartment syndrome of the upper extremity is a rare but hazardous entity with high morbidity even when preformed early. Fractures were documented in less than half of the cases and a late surgical treatment was observed. Maintaining a high index of suspicion is crucial to early diagnosis and successful treatment.