Spontaneous compartment syndrome in a patient with diabetes and statin administration: a case report

Compartment syndrome is a condition characterized by pressure increasing in the inextensible muscular compartments that leads to a decrease of capillary perfusion with consequent ischemic lesions of the logia elements. The authors report a case of an unusual compartment syndrome with spontaneous onset in a patient with type II diabetes and chronic therapy with statins (Atorvastatin). The condition was successfully treated by a fasciotomy and medical support. The importance of a correct anamnesis and a high level of suspicion is emphasized

Initial intramuscular perfusion pressure predicts early skeletal muscle function following isolated tibial fractures

<p>Abstract</p> <p>Background</p> <p>The severity of associated soft tissue trauma in complex injuries of the extremities guides fracture treatment and decisively determines patient's prognosis. Trauma-induced microvascular dysfunction and increased tissue pressure is known to trigger secondary soft tissue damage and seems to adversely affect skeletal muscle function.</p> <p>Methods</p> <p>20 patients with isolated tibial fractures were included. Blood pressure and compartment pressure (anterior and deep posterior compartment) were measured continuously up to 24 hours. Corresponding perfusion pressure was calculated. After 4 and 12 weeks isokinetic muscle peak torque and mean power of the ankle joint in dorsal and plantar flexion were measured using a Biodex dynamometer.</p> <p>Results</p> <p>A significant inverse correlation between the anterior perfusion pressure at 24 hours and deficit in dorsiflexion at 4 weeks was found for both, the peak torque (R = -0.83; p < 0.01) and the mean power (R = -0.84; p < 0.01). The posterior perfusion pressure at 24 h and the plantar flexion after 4 weeks in both, peak torque (R = -0.73, p =< 0.05) and mean power (R = -0.7, p =< 0.05) displayed a significant correlation.</p> <p>Conclusion</p> <p>The functional relationship between the decrease in intramuscular perfusion pressures and muscle performance in the early rehabilitation period indicate a causative and prognostic role of early posttraumatic microcirculatory derangements and skeletal muscle function. Therapeutic concepts aimed at effective muscle recovery, early rehabilitation, and decreased secondary tissue damage, should consider the maintenance of an adequate intramuscular perfusion pressure.</p

Absolute compartment pressure versus differential pressure for the diagnosis of compartment syndrome in tibial fractures

We studied 39 patients with 42 diaphyseal tibial fractures in whom we suspected a high risk for the development of a compartment syndrome. We measured the anterior absolute compartment pressure (ACP) every 12 h for 72 h and also recorded the differential pressure (ΔP=diastolic blood pressure−ACP). Fasciotomy of the extremity was only performed when the differential pressure was less than 30 mmHg for more than 30 min. The highest values of the ACP were recorded between 24 h and 36 h after admission. Three fractures had a differential pressure less than 30 mmHg and all were treated by fasciotomy. In three fractures the ACP was equal to or higher than 50 mmHg, of which two had a differential pressure less than 30 mmHg. The patients were followed up for a mean of 36 months (29–45). All fractures healed, and none of our patients showed any sequelae of compartment syndrome at their last review