Upper-Extremity Compartment Syndrome: Comparison of Substance-Related Found Down and Acute Trauma Mechanisms

Abstract

Purpose: Upper-extremity compartment syndrome can result in functional deficits, loss of limb, and loss of life. Although most commonly caused by trauma, in recent years, opioid and substance-related overdose has led to a rise in patients with "found down" compartment syndrome. Our purpose was to compare clinical presentations and outcomes in patients with upper-extremity compartment syndrome caused by a substance-related found down mechanism to those caused by an acute trauma mechanism.

Methods: A retrospective chart review was performed to confirm a diagnosis of upper-extremity compartment syndrome. Inclusion criteria consisted of patients 18 years and older who underwent treatment for upper-extremity compartment syndrome from a substance-related found down or acute trauma mechanism. Patient demographics, clinical presentations, comorbidities, laboratory values, and outcomes were collected and compared between the two groups.

Results: Over the 10-year study period, 51 patients were identified and included in our final cohort. The trauma group had 24 patients, and the found down group had 27 patients. The forearm was the most affected compartment in both groups, and the found down group had more patients with multiple affected compartments. On clinical examination, muscle weakness and skin blisters were seen more in the found down group. Hemoglobin, potassium, blood urea nitrogen, and creatine kinase levels were higher in the found down group. The patients in the found down group had a higher number of surgical procedures and length of stay. The found down group had more patients with rhabdomyolysis and kidney injury requiring hemodialysis.

Conclusions: Upper-extremity compartment syndrome because of a substance-related found down mechanism most commonly affects the forearm compartment. Patients with a found down mechanism overall require more surgeries and muscle debridement in subsequent surgeries. They also have higher lengths of stay and higher rates of rhabdomyolysis and acute kidney injury requiring hemodialysis.

Type of study/level of evidence: Therapeutic IV.

Keywords: Compartment syndrome; intravenous drug use; soft tissue; trauma; upper extremity.