Thigh compartment syndrome in urban trauma

Bullets to blame, not collisions

Lawrence M. Knab, Adel Mohamed Osman Abuzeid, Heron Rodriguez, Nabil Issa

Research output: Contribution to journalArticle

Abstract

Background: Compartment syndrome of the thigh is a surgical emergency rarely reported in the literature. The most common etiologies include blunt trauma, vascular injuries from penetrating trauma, and hematoma formation. Thigh compartment syndrome (TCS) is important as it is often associated with concomitant severe injury with mortality rates as high as 47%. This study aims to identify mechanisms of injury, clinical presentation, and outcomes associated with TCS in the urban trauma patient population. Methods: Demographic and clinical information for all patients with a diagnosis of TCS at a level 1 urban trauma center over a 10.5-y period were reviewed. Collected data included age, sex, mechanism of injury, method of diagnosis, time taken for diagnosis and management, methods of decompression, wound management, lengths of stay in the intensive care unit and hospital, amputation rate, and hospital disposition. Results: Ten patients were identified with diagnosis of TCS. The mechanism of injury was penetrating in six patients and blunt in four. The mean time from injury to diagnosis was 23.4 h. Intensive care unit and hospital lengths of stay were significantly increased among patients sustaining penetrating injuries compared with blunt injuries. Two of the six penetrating injury patients underwent an amputation. Eight of 10 patients were ambulatory on discharge. There were no mortalities. Conclusions: Among urban trauma patients, penetrating injuries of the thigh and adjacent vascular structures and the need for decompressive fasciotomy of the lower leg are the major risk factors for TCS. Clinical diagnosis and early intervention with fasciotomy remain the mainstay of treatment.

Original languageEnglish (US)
Pages (from-to)748-752
Number of pages5
JournalJournal of Surgical Research
Volume185
Issue number2
DOIs
StatePublished - Jan 1 2013

Fingerprint

Compartment Syndromes
Thigh
Wounds and Injuries
Length of Stay
Amputation
Intensive Care Units
Nonpenetrating Wounds
Mortality
Trauma Centers
Vascular System Injuries
Decompression
Hematoma
Blood Vessels
Leg

Keywords

  • Compartment syndrome
  • Penetrating injury
  • Thigh
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Thigh compartment syndrome in urban trauma : Bullets to blame, not collisions. / Knab, Lawrence M.; Abuzeid, Adel Mohamed Osman; Rodriguez, Heron; Issa, Nabil.

In: Journal of Surgical Research, Vol. 185, No. 2, 01.01.2013, p. 748-752.

Research output: Contribution to journalArticle

Knab, Lawrence M. ; Abuzeid, Adel Mohamed Osman ; Rodriguez, Heron ; Issa, Nabil. / Thigh compartment syndrome in urban trauma : Bullets to blame, not collisions. In: Journal of Surgical Research. 2013 ; Vol. 185, No. 2. pp. 748-752.
@article{95a3a05adfcb40b49cf91b21b6dcd4e6,
title = "Thigh compartment syndrome in urban trauma: Bullets to blame, not collisions",
abstract = "Background: Compartment syndrome of the thigh is a surgical emergency rarely reported in the literature. The most common etiologies include blunt trauma, vascular injuries from penetrating trauma, and hematoma formation. Thigh compartment syndrome (TCS) is important as it is often associated with concomitant severe injury with mortality rates as high as 47{\%}. This study aims to identify mechanisms of injury, clinical presentation, and outcomes associated with TCS in the urban trauma patient population. Methods: Demographic and clinical information for all patients with a diagnosis of TCS at a level 1 urban trauma center over a 10.5-y period were reviewed. Collected data included age, sex, mechanism of injury, method of diagnosis, time taken for diagnosis and management, methods of decompression, wound management, lengths of stay in the intensive care unit and hospital, amputation rate, and hospital disposition. Results: Ten patients were identified with diagnosis of TCS. The mechanism of injury was penetrating in six patients and blunt in four. The mean time from injury to diagnosis was 23.4 h. Intensive care unit and hospital lengths of stay were significantly increased among patients sustaining penetrating injuries compared with blunt injuries. Two of the six penetrating injury patients underwent an amputation. Eight of 10 patients were ambulatory on discharge. There were no mortalities. Conclusions: Among urban trauma patients, penetrating injuries of the thigh and adjacent vascular structures and the need for decompressive fasciotomy of the lower leg are the major risk factors for TCS. Clinical diagnosis and early intervention with fasciotomy remain the mainstay of treatment.",
keywords = "Compartment syndrome, Penetrating injury, Thigh, Trauma",
author = "Knab, {Lawrence M.} and Abuzeid, {Adel Mohamed Osman} and Heron Rodriguez and Nabil Issa",
year = "2013",
month = "1",
day = "1",
doi = "10.1016/j.jss.2013.07.003",
language = "English (US)",
volume = "185",
pages = "748--752",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "2",

}

TY - JOUR

T1 - Thigh compartment syndrome in urban trauma

T2 - Bullets to blame, not collisions

AU - Knab, Lawrence M.

AU - Abuzeid, Adel Mohamed Osman

AU - Rodriguez, Heron

AU - Issa, Nabil

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Background: Compartment syndrome of the thigh is a surgical emergency rarely reported in the literature. The most common etiologies include blunt trauma, vascular injuries from penetrating trauma, and hematoma formation. Thigh compartment syndrome (TCS) is important as it is often associated with concomitant severe injury with mortality rates as high as 47%. This study aims to identify mechanisms of injury, clinical presentation, and outcomes associated with TCS in the urban trauma patient population. Methods: Demographic and clinical information for all patients with a diagnosis of TCS at a level 1 urban trauma center over a 10.5-y period were reviewed. Collected data included age, sex, mechanism of injury, method of diagnosis, time taken for diagnosis and management, methods of decompression, wound management, lengths of stay in the intensive care unit and hospital, amputation rate, and hospital disposition. Results: Ten patients were identified with diagnosis of TCS. The mechanism of injury was penetrating in six patients and blunt in four. The mean time from injury to diagnosis was 23.4 h. Intensive care unit and hospital lengths of stay were significantly increased among patients sustaining penetrating injuries compared with blunt injuries. Two of the six penetrating injury patients underwent an amputation. Eight of 10 patients were ambulatory on discharge. There were no mortalities. Conclusions: Among urban trauma patients, penetrating injuries of the thigh and adjacent vascular structures and the need for decompressive fasciotomy of the lower leg are the major risk factors for TCS. Clinical diagnosis and early intervention with fasciotomy remain the mainstay of treatment.

AB - Background: Compartment syndrome of the thigh is a surgical emergency rarely reported in the literature. The most common etiologies include blunt trauma, vascular injuries from penetrating trauma, and hematoma formation. Thigh compartment syndrome (TCS) is important as it is often associated with concomitant severe injury with mortality rates as high as 47%. This study aims to identify mechanisms of injury, clinical presentation, and outcomes associated with TCS in the urban trauma patient population. Methods: Demographic and clinical information for all patients with a diagnosis of TCS at a level 1 urban trauma center over a 10.5-y period were reviewed. Collected data included age, sex, mechanism of injury, method of diagnosis, time taken for diagnosis and management, methods of decompression, wound management, lengths of stay in the intensive care unit and hospital, amputation rate, and hospital disposition. Results: Ten patients were identified with diagnosis of TCS. The mechanism of injury was penetrating in six patients and blunt in four. The mean time from injury to diagnosis was 23.4 h. Intensive care unit and hospital lengths of stay were significantly increased among patients sustaining penetrating injuries compared with blunt injuries. Two of the six penetrating injury patients underwent an amputation. Eight of 10 patients were ambulatory on discharge. There were no mortalities. Conclusions: Among urban trauma patients, penetrating injuries of the thigh and adjacent vascular structures and the need for decompressive fasciotomy of the lower leg are the major risk factors for TCS. Clinical diagnosis and early intervention with fasciotomy remain the mainstay of treatment.

KW - Compartment syndrome

KW - Penetrating injury

KW - Thigh

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=84891717073&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84891717073&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2013.07.003

DO - 10.1016/j.jss.2013.07.003

M3 - Article

VL - 185

SP - 748

EP - 752

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 2

ER -