International Orthopaedics

, Volume 43, Issue 6, pp 1465–1472 | Cite as

Acute compartment syndrome in patients undergoing fasciotomy of the forearm and the leg

  • Dafang ZhangEmail author
  • Matthew Tarabochia
  • Stein J. Janssen
  • David Ring
  • Neal Chen
Original Paper



The primary objective of this study is to compare the likelihood of acute compartment syndrome in the leg versus the forearm in patients who undergo fasciotomy for a clinical diagnosis of suspected acute compartment syndrome. The secondary objective is to identify factors associated with higher likelihood of acute compartment syndrome or with the use of split-thickness skin graft in these patients.


We identified 449 patients diagnosed with suspected acute compartment syndrome of 468 legs and 119 patients diagnosed with suspected acute compartment syndrome of 119 forearms, treated with fasciotomy, from January 2000 to June 2015. Patients clinically diagnosed with suspected acute compartment syndrome were scored for likelihood of acute compartment syndrome based on muscle appearance, time to closure, neurologic deficit at final follow-up, and contracture at final follow-up.


There was no difference in likelihood of acute compartment syndrome between the leg and the forearm, with about 70% having relatively high likelihood. Forearm fasciotomy was associated with documentation of poorer muscle appearance (p = 0.01) and contracture (p < 0.001) compared with leg fasciotomy. Multivariable logistic regression analyses showed that compartment pressure measurement (p = 0.01) was associated with higher likelihood of acute compartment syndrome in legs and that male sex (p = 0.001) and non-vascular mechanism of injury (p = 0.02) were associated with split-thickness skin graft in legs.


The likelihood and severity of acute compartment syndrome are comparable in the leg and the forearm.


Acute compartment syndrome Diagnosis Forearm Leg Split-thickness skin graft 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


  1. 1.
    Prasarn ML, Ouellette EA (2011) Acute compartment syndrome of the upper extremity. J Am Acad Orthop Surg 19(1):49–58CrossRefGoogle Scholar
  2. 2.
    von Keudell AG, Weaver MJ, Appleton PT, Bae DS, Dyer GSM, Heng M, Jupiter JB, Vrahas MS (2015) Diagnosis and treatment of acute extremity compartment syndrome. Lancet 386(10000):1299–1310CrossRefGoogle Scholar
  3. 3.
    Jensen SL, Sandermann J (1997) Compartment syndrome and fasciotomy in vascular surgery. A review of 57 cases. Eur J Vasc Endovasc Surg 13(1):48–53CrossRefGoogle Scholar
  4. 4.
    Rorabeck CH (1984) The treatment of compartment syndromes of the leg. J Bone Joint Surg Br 66(1):93–97CrossRefGoogle Scholar
  5. 5.
    Al-Dadah OQ, Darrah C, Cooper A, Donell ST, Patel AD (2008) Continuous compartment pressure monitoring vs. clinical monitoring in tibial diaphyseal fractures. Injury 39(10):1204–1209CrossRefGoogle Scholar
  6. 6.
    Allen MJ, Stirling AJ, Crawshaw CV, Barnes MR (1985) Intracompartmental pressure monitoring of leg injuries. An aid to management. J Bone Joint Surg Br 67(1):53–57CrossRefGoogle Scholar
  7. 7.
    McQueen MM, Duckworth AD, Aitken SA, Court-Brown CM (2013) The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome. J Bone Joint Surg Am 95(8):673–677CrossRefGoogle Scholar
  8. 8.
    O’Toole RV, Whitney A, Merchant N, Hui E, Kim TT, Sagebien C (2009) Variation in diagnosis of compartment syndrome by surgeons treating tibial shaft fractures. J Trauma 67(4):735–741CrossRefGoogle Scholar
  9. 9.
    Cambon-Binder A, Jehanno P, Tribout L, Valenti P, Simon AL, Ilharreborde B, Mazda K (2018) Pulseless supracondylar humeral fractures in children: vascular complications in a ten year series. Int Orthop 42(4):891–899CrossRefGoogle Scholar
  10. 10.
    Ulmer T (2002) The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder? J Orthop Trauma 16(8):572–577CrossRefGoogle Scholar
  11. 11.
    Broström LA, Stark A, Svartengren G (1990) Acute compartment syndrome in forearm fractures. Acta Orthop Scand 61(1):50–53CrossRefGoogle Scholar
  12. 12.
    Elliott KG, Johnstone AJ (2003) Diagnosing acute compartment syndrome. J Bone Joint Surg Br 85(5):625–632CrossRefGoogle Scholar
  13. 13.
    Giannoudis PV, Nicolopoulos C, Dinopoulos H, Ng A, Adedapo S, Kind P (2002) The impact of lower leg compartment syndrome on health related quality of life. Injury 33(2):117–121CrossRefGoogle Scholar
  14. 14.
    Rush DS, Frame SB, Bell RM, Berg EE, Kerstein MD, Haynes JL (1989) Does open fasciotomy contribute to morbidity and mortality after acute lower extremity ischemia and revascularization? J Vasc Surg 10(3):343–350CrossRefGoogle Scholar
  15. 15.
    Hake ME, Etscheidt J, Chadayammuri VP, Kirsch JM, Mauffrey C (2017) Age and dressing type as independent predictors of post-operative infection in patients with acute compartment syndrome of the lower leg. Int Orthop 41(12):2591–2596CrossRefGoogle Scholar
  16. 16.
    McQueen MM, Gaston P, Court-Brown CM (2000) Acute compartment syndrome. Who is at risk? J Bone Joint Surg Br 82:200–203CrossRefGoogle Scholar
  17. 17.
    Shadgan B, Pereira G, Menon M, Jafari S, Darlene Reid W, O'Brien PJ (2015) Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal fractures in adults. J Orthop Traumatol 16(3):185–192CrossRefGoogle Scholar
  18. 18.
    Kalyani BS, Fisher BE, Roberts CS, Giannoudis PV (2011) Compartment syndrome of the forearm: a systematic review. J Hand Surg Am 36A:535–543CrossRefGoogle Scholar
  19. 19.
    Harris IA, Kadir A, Donald G (2006) Continuous compartment pressure monitoring for tibia fractures: does it influence outcome? J Trauma 60(6):1330–1335CrossRefGoogle Scholar
  20. 20.
    Duckworth AD, Mitchell SE, Molyneux SG, White TO, Court-Brown CM, McQueen MM (2012) Acute compartment syndrome of the forearm. J Bone Joint Surg Am 94:e63 (1–6)CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryMassachusetts General HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Department of General Surgery, OLVGAmsterdamThe Netherlands
  4. 4.Dell Medical SchoolUniversity of TexasAustinUSA

Personalised recommendations