Abstract

MENDES, Rodolfo; PEDRO, Inês  and  SOUSA, António Rodriguez de. Síndrome compartimental do antebraço. Rev. Port. Ortop. Traum. [online]. 2014, vol.22, n.1, pp.127-134. ISSN 1646-2122.

The compartment syndrome is an orthopedic emergency which can compromise the viability of the affected limb or even cause death. This syndrome can also appear under less obvious circumstances or without a typical history. We present the case of a patient with a clinical presentation of compartment syndrome of the forearm, but without a typical history or evidence of significant trauma. A device for measuring intra-compartmental pressure was used, which was the deciding factor for performing forearm fasciotomy. Pre-op lab workup revealed renal impairment, which worsened even after surgical decompression. Despite specific medical treatment for rhabdomyolysis, the patient developed massive rhabdomyolysis and acute renal failure due to acute tubular necrosis. The patient was eventually transferred to a Critical Care Unit and afterwards to Nephrology for hemodialysis. The patient was later on discharged to the outpatient clinic without pain or paresthesias, and normal limb function. In this article, the pathological mechanism of this syndrome is discussed, as well as the consequences of not treating it. The diagnostic workup is also discussed, including the usage of compartment pressure monitoring devices, and also the medical and surgical treatment of the syndrome and its consequences, including loss of limb and acute renal failure from rhabdomyolysis, which can also cause death from multiorgan failure. The patient management is also discussed, including the timing of the decision to operate and what could have been done to prevent acute renal failure.

Keywords : Compartment syndrome; compartment pressure measurement; rhabdomyolysis; acute renal failure.

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