Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture.
The case of a fifty-year-old man who suffered an isolated, associated, both-column fracture of the left acetabulum is presented. He underwent an uncomplicated open reduction and internal fixation through an ilioinguinal approach. A follow-up computed tomographic scan was performed postoperatively, which documented intraarticular fragments. Hip arthroscopy was performed to remove the fragments. During the procedure, arthroscopic fluid extravasated through the fracture site under pump pressure and resulted in an intraabdominal compartment syndrome that presented as cardiopulmonary arrest. An emergent exploratory laparotomy was performed to release the fluid and resume blood flow. Despite prolonged asystole, the patient survived without neurologic sequelae. The literature on compartment syndrome secondary to arthroscopic procedures is reviewed. Because of this previously unreported potentially lethal complication, we do not advocate hip arthroscopic procedures for acute or healing acetabular fractures.
Bartlett
C S
CS
Orthopaedic Trauma Service, The Hospital for Special Surgery, New York, New York 10021, USA.
DiFelice
G S
GS
Buly
R L
RL
Quinn
T J
TJ
Green
D S
DS
Helfet
D L
DL
D000077:Acetabulum / Q000293:injuries*; D001182:Arthroscopy / Q000009:adverse effects*; D004724:Endoscopy / Q000009:adverse effects*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications* / Q000601:surgery; D050723:Fractures, Bone / Q000150:complications*; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology*; D006617:Hip Dislocation / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007594:Joint Loose Bodies / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D011859:Radiography