What Factors Are Associated With Acute Compartment Syndrome After Gunshot Injuries to the Upper Extremity?

Area of Science:

• Trauma Surgery
• Orthopedic Surgery
• Emergency Medicine

Background:

• Firearm-related injuries are a significant cause of morbidity and mortality in the U.S.
• Acute compartment syndrome (ACS) is a severe complication of extremity injuries, particularly in the forearm.
• Existing research on ACS in gunshot wounds has variable findings, often from military data or including diverse injury types.

Purpose of the Study:

• To determine the proportion of patients with upper extremity gunshot wounds (GSWs) who develop ACS.
• To identify patient- and injury-related factors associated with ACS development after GSWs.
• To assess postoperative complications linked to ACS in GSW patients.

Main Methods:

• Retrospective review of 731 patients with upper extremity GSWs treated at a Level 1 trauma center (May 2018-Jan 2023).
• Data collected from electronic medical records and trauma databases, including demographics, injury characteristics, and outcomes.
• Univariate analysis used to identify factors associated with ACS development.

Main Results:

• 2% (12 of 731) of patients developed ACS; all surgically treated patients underwent forearm fasciotomy.
• Vascular injury was the only factor significantly associated with ACS development (OR 47; p < 0.001).
• Patients with ACS had a higher risk of persistent postoperative neurologic deficits (50% vs. non-ACS patients; OR 4.25; p = 0.01).

Conclusions:

• The incidence of ACS following upper extremity GSWs in this cohort was 2%.
• Vascular injury is a strong independent predictor of ACS development after GSWs.
• High suspicion for ACS and close monitoring are warranted in these patients due to severe outcomes, with emphasis on discharge precautions.