Compartment syndrome after low-velocity gunshot wounds to the forearm

Between 1980 and 1988, 127 patients with 131 low-velocity gunshot wounds to the forearm were treated. In 71 extremities there was no bony injury; 60 extremities sustained fractures. The diagnosis of a compartment syndrome was based on tissue pressure measurements and/or clinical examination. A univariate analysis followed by a multivariate stepwise logistic regression was used to evaluate potential risk factors including fracture location, displacement, comminution, and the quantity of radiographically determined metallic foreign bodies in the wound. A compartment syndrome was diagnosed in 13 of the extremities (10%). Fracture location was the only significant risk factor for the development of a compartment syndrome. Low-velocity gunshot injuries to the forearm are at definite risk for the occurrence of a compartment syndrome. A high index of suspicion is necessary to prevent untoward sequelae. Patients with this injury, especially those with a proximal one-third fracture who constitute an extremely high-risk group, should be monitored closely.