Acute Compartment Syndrome in the Absence of Fracture

OBJECTIVES: To determine if there are differences in demographics, referral patterns, and operative findings between patients with and without a fracture who develop an acute compartment syndrome. DESIGN: Retrospective cohort. SETTING: Orthopaedic trauma unit, university teaching hospital. METHODS: This study examines 164 cases of acute compartment syndrome over an 8-year period. Of these, 13 patients had a diagnosis of crush syndrome and are excluded from this study. The remaining 38 cases with no fracture form the basis for this study. MAIN OUTCOME MEASURES: Patient demographics, referral patterns, and operative findings were compared for the "fracture" and "no fracture" groups. RESULTS: Patients who had acute compartment syndrome in the absence of fracture were older (P < 0.05) and had significantly more comorbidities (P < 0.001) than those with a fracture. Cases without a fracture had a significantly greater mean delay to fasciotomy of 12.4 hours (P < 0.05) compared to those with a fracture. At fasciotomy, 20% of patients without a fracture had muscle necrosis requiring debridement compared to 8% for patients with a fracture (P < 0.05). CONCLUSIONS: This study demonstrates that muscle necrosis is more commonly found in acute compartment syndrome in the absence of a fracture than in those with a fracture. Referral of swollen limbs without fracture for an orthopaedic opinion should not be delayed.