Acute Forearm Compartment Syndrome Secondary to Local Arterial Injury After Penetrating Trauma

BACKGROUND: Acute compartment syndrome (ACS) is a well-described surgical emergency that requires an immediate diagnosis and emergent operative intervention. Failure to either make the diagnosis or to implement the appropriate treatment quickly can result in severe long-term morbidity. The purpose of this article is to document evidence that penetrating trauma which results in arterial injury may cause acute forearm compartment syndrome. As a result, this mechanism should alert surgeons to the possibility of acute compartment syndrome secondary to arterial injury. METHODS: A retrospective review of all penetrating trauma patients treated at our Level 1 Trauma Center was performed within 2001 and 2005. Patients who sustained penetrating injuries to the forearm were reviewed in detail and all patients diagnosed with acute forearm compartment syndrome in this setting were included in this article. RESULTS: Five cases of ACS of the forearm secondary to a mechanism rarely described in the surgical literature were documented over five years. All cases in this series were the result of a named forearm arterial injury sustained by penetrating trauma. Every patient in this article was taken emergently to the operating room for a fasciotomy following diagnosis. CONCLUSION: This article establishes the incidence of a specific mechanism of ACS in our penetrating trauma population. As a result of these findings, a thorough evaluation of the forearm vasculature and a careful search for arterial injury is recommended at the time of fasciotomy. Securing a rapid diagnosis and executing early definitive management will result in fewer devastating long-term outcomes.