A Multi-institutional Assessment of Causes, Reoperation Rates, and Mortality in Forearm Acute Compartment Syndrome

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Vascular Surgery

Background:

• Forearm acute compartment syndrome (ACS) is a surgical emergency requiring emergent fasciotomy to prevent irreversible damage.
• While trauma is the leading cause, atraumatic ACS necessitates a high index of suspicion.
• Understanding scenarios and outcomes of forearm fasciotomies is crucial for this rare diagnosis.

Purpose of the Study:

• To evaluate the scenarios and outcomes of forearm fasciotomies.
• To identify risk factors and predictors of mortality in forearm ACS.
• To assess the safety and efficacy of primary versus secondary closure techniques.

Main Methods:

• Retrospective review of patients undergoing forearm fasciotomy across two institutions from 2007 to 2022.
• Analysis of clinical outcomes, including mortality, reoperation rates, and complications.
• Comparison of outcomes between traumatic and atraumatic etiologies of ACS.

Main Results:

• Eighty-eight forearm fasciotomies were performed; trauma (48%) and arterial catheterization (13.6%) were most common.
• Mortality rate was 13.7% overall, significantly higher in atraumatic ACS (23% vs. 8%).
• Atraumatic ACS patients had more comorbidities; elevated lactate and potassium correlated with mortality.

Conclusions:

• Forearm ACS is a recognized risk of arterial catheterization.
• High mortality in forearm ACS, especially in comorbid patients, warrants careful counseling.
• Primary closure of fasciotomy sites in select cases can reduce secondary procedures.