Arterial injury associated with acute compartment syndrome of the thigh following blunt trauma.
BACKGROUND
Acute compartment syndrome of the thigh is a rare condition, and the basic causes of high pressure within a muscle compartment have been considered to be intramuscular haematoma and soft-tissue oedema. However, the importance of arterial injury has not been well recognized.


METHODS
Among 3658 blunt trauma patients admitted to our Level 1 Trauma Centre between 1994 and 2001, there were eight patients (nine thighs) who had undergone emergency fasciotomy and these were the subjects of the present study. Arteriography of the proximal lower limb had been performed after the fasciotomy in patients with prolonged hypotension and persistent bleeding from the fasciotomy wound.


RESULTS
All the patients had sustained high-energy trauma, systemic hypotension and local trauma to the proximal lower limb. Among them, four (five thighs) had undergone arteriography and four (four thighs) were confirmed as having sustained arterial injuries. In those patients with definitive arterial injuries, the time from injury to the onset of the compartment syndrome was less than 5 h.


CONCLUSIONS
Acute compartment syndrome of the thigh in blunt trauma patients may be the result of associated arterial injuries. It is suggested that patients with local trauma to the proximal lower limb who exhibit an acute compartment syndrome together with haemodynamic instability should undergo arteriography soon after fasciotomy.
Suzuki
Takashi
T
Critical Care and Emergency Center, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara City 228-8555, Japan. taku@mars.dti.ne.jp
Moirmura
Naoto
N
Kawai
Kousei
K
Sugiyama
Mitsugi
M
D000208:Acute Disease; D000328:Adult; D001158:Arteries / Q000293:injuries; D003161:Compartment Syndromes / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D000071938:Fasciotomy; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005264:Femoral Fractures / Q000150:complications / Q000000981:diagnostic imaging; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D013848:Thigh / Q000098:blood supply / Q000293:injuries* / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery