Comparative study and literature review about acute compartment syndrome in the upper limb
| Author | Upper limb cases (n) | Follow-up (mon), mean (range) | Mode of injury | Type of injury | Common presentation | Associated fracture | Compartment pressure | Compartment syndrome >12 h after injury | Time injury to fasciotomy, mean (range) | Additional procedure | Wound closure | Time to motor/sensory recovery | Motor recovery | 2PD | Range of movements | Complications |
| Bae et al 3 | 17 | 26.1 (3–79) | Crush/avulsion/ clean/dog bite | Closed: 9, open injuries: 8 | Pain (88%) paresthesia (61%) paralysis (36%) | Fractures (74%) | 61%>30 mmHg <2 with <30 mmHg | 11 | 30.5 h* (range 3–144) 16 had >12 h | Skin grafting 3/17 | 12/17 delayed closure | NA | NA | NA | NA | Elbow stiffness, radial growth arrest |
| Erdös et al 10 | 5 (<12 y) 1 (15–18 y) | NA | Pedestrians struck | NA | NA | Majority of study focused towards lower limb compartment syndrome | 30%–50% (range 30–60 mmHg) | 1 | 2.5–99.0 h | Skin grafting 3 | Temporary closure with epiguard synthetic skin substitute | NA | NA | NA | NA | 4.2% permanent contractures /epiphysiolysis of distal radius |
| Grottkau et al 2 | 20 | NA | Pedestrians struck | Open: 9 Closed: 11 RR 2.2 for open | NA | FA fractures (74%) SC (15%) carpal/metcarpal (11%) comatose (14%) | NA | 40% went undiagnosed initially, one patient diagnosed after 4 d of injury | Six hands no fasciotomy | NA | NA | NA | NA | NA | NA | NA |
| Kanj et al 15 | 23 | 6 or follow-up to complete recovery | Fractures (57%), fall from height/crush injury/ hand intravenous infiltrates 4/23 | Five no fracture cases, NA data about open/close injury | Pain (83%), swelling (65%), paralysis (22%–26%), pulseless (9%) | NA | 17/23 >30 mmHg | 3/23 | 32.8 h (3.7–158.0) | NA | NA | NA | NA | NA | Excellent/fair/poor | 4% poor outcome (one had sensory deficit; one both motor and sensory deficits), 4 had stiffness with no FA rotations |
| Prasarn et al 9 | 14 | 22 (NA) | Long bone fracture | 58% iatrogenic, intravenous infiltration, gunshot, road traffic injury | Obtunded sensorium (83%) difficult in examination | Zone 2/3 of Foucher: 14/6 | NA | 2 | 9.4 h (2–24) | Contracture release/skin grafting (6.7 mon) | NA | NA | NA | NA | NA | 58% normal outcome; three amputation |
| McQueen et al 16 | 23 | NA | Distal radius (15), FA (13 mixed with adults) | Pedestrian injury, crush 59 patients (36%) and of the distal radius in 16 (9.8%) | Injury to the soft tissues without a fracture occurred in 38 patients (23.2%) | 15 | NA | NA | NA | NA | NA | NA | NA | NA | NA | |
| Mubarak and Carroll6 | 21 | NA | Motorcycle spokes wheel | SC humerus (40%), FA fractures (40%) | 20 | 12 patients (both upper and lower limbs) | SC: 2 FA: 2 (brachial artery repair) | NA | NA | NA | NA | NA | SC: 7/9 severe deformity, FA: 7/10 severe | |||
| Our study | 24 | 67.3 (59–80) | Tight oil bandage (29%) | RTA/injury (70%), closed fracture 2/24 have intravenous infiltrate | Pain (76%) mixed with other 5 Ps. Paralysis (100%) | SC humerus (20%) FA, distal radius, proximal forearm (80%) | 9 | 15 patients | 44 h (5–192) | SC: 2/24 with brachial artery repair; redo K wire: 2 | 3 delayed closure (mean 5 d) 3 skin grafting (mean 5 d) | Radial motor 12; sensory 24 wk, median motor 10.3; sensory 13 wk Ulnar–motor 12; sensory 19 wk | Radial 6; median 7.5 ulnar 8.5 mon | S4: 21 (87%) S3: 13 6.9 mm (5–10) | Full | Elbow stiffness, stiff claw hand, osteomyelitis humerus, non-union SC |
Compartmentall pressure: pressure was considered to be increased if it was either greater than 30 mmHg or if the DP was less than 30 mmHg.
DP, difference between the diastolic blood pressure and the intracompartmental pressure; FA, forearm; K wire, Kirschner wire; NA, not available; 2PD, 2-point discrimination; 5 Ps, pain, paresthesia, pallor, pulselessness and paralysis; RR, relative risk of 2.2 for developing a compartment syndrome in the forearm for an open fracture versus a closed fracture; RTA, road traffic accident; SC, supracondylar.