Acute hand compartment syndromes after closed crush: a reappraisal

Severe crush to the hand is associated with a poor prognosis. The authors investigated the hypothesis that compartment syndrome complicates such injuries. From 1996 to 2000, the authors retrospectively identified 11 patients who, after sustaining a closed crush injury, developed acute hand compartment syndrome. Diagnosis was made on clinical grounds in two patients (the intracompartmental pressure was not measured) and after clinical examination plus measurement of intracompartmental pressure in nine patients. In all cases, the muscle burst out once the fascia was released from the affected compartment. Clinical clues to elicit the diagnoses were massive hand swelling and tenseness to palpation. Classic symptoms, such as excruciating pain, were absent or their intensity was attributed to the trauma event (in six patients). Classic signs such as intrinsic muscle minus position and pain on stretching were absent in six and three patients, respectively. In addition, the latter stretch test could not be properly judged in five more patients because of interference by the associated injuries. None of the patients developed contracture or sequela that could be attributed to compartment syndrome. On the basis of this experience, it was concluded that crush injury does not in itself carry a poor functional prognosis, provided that attention is paid to the often-concomitant compartment syndrome. Elevated subfascial pressure may be present despite the absence of classic signs and symptoms.