title: Risk factors for compartment syndrome in traumatic brachial artery injuries: an institutional experience in 139 patients.
abstract: BACKGROUND
  The brachial artery is the most common vascular injury encountered in upper extremity trauma. If not treated promptly, it can result in compartment syndrome (CS) and long-term disability. Here, we report an institutional experience of traumatic brachial artery injuries and establish risk factors for the development of upper extremity CS in this setting.
  
  
  METHODS
  A retrospective review of 139 patients with traumatic brachial artery injury from 1985 to 2001 at a single institution. Patients were divided into two cohorts, those with evidence of CS and those without CS (NCS), for comparison.
  
  
  RESULTS
  One hundred thirty-nine patients presented with traumatic brachial artery injuries (mean age, 28.4 years). Twenty-nine patients (20.9%) were diagnosed with upper extremity CS, and 28 of these patients underwent fasciotomy on recognition of their CS. Seven patients (6.4%) in the NCS cohort underwent fasciotomy as a result of absent distal pulses on initial examination. Mean follow-up was 51.6 days. Two patients required revision of their arterial repair, and one patient underwent amputation. The risk of CS was increased in the presence of combined arterial injuries (p = 0.03), combined nerve injuries (p = 0.04), motor deficits (p < 0.0001), fractures, and increased intraoperative blood loss (p = 0.001). Multivariate logistic regression performed on these variables revealed that elevated intraoperative blood loss, combined arterial injury, and open fracture were independent risk factors for the development of CS (OR 1.12, 5.79, and 2.68, respectively).
  
  
  CONCLUSIONS
  Prompt evaluation and management of traumatic brachial artery injuries is important to prevent CS, which can lead to functional deficits. In the setting of combined arterial injury, open fracture, and significant intraoperative blood loss, prophylactic fasciotomy should be considered.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA. jokim@nmh.org
authors.forename: John Y S
authors.initials: JY
authors.lastname: Kim
authors.forename: Donald W
authors.initials: DW
authors.lastname: Buck
authors.forename: Antonio J V
authors.initials: AJ
authors.lastname: Forte
authors.forename: Vairavan S
authors.initials: VS
authors.lastname: Subramanian
authors.forename: Michael V
authors.initials: MV
authors.lastname: Birman
authors.forename: Clark F
authors.initials: CF
authors.lastname: Schierle
authors.forename: Oliver
authors.initials: O
authors.lastname: Kloeters
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Mattox
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Wall
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Epstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001916:Brachial Artery / Q000293:injuries* / Q000601:surgery*; D016009:Chi-Square Distribution; D002648:Child; D003161:Compartment Syndromes / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D034941:Upper Extremity / Q000293:injuries* / Q000601:surgery*