Incidence of Compartment Syndrome of the Hand After Open Fracture
Open fractures are a recognized risk factor for compartment syndrome of the hand, though the specific incidence is not well documented in the literature.
Epidemiology and Risk Factors
Compartment syndrome in general has a reported overall incidence of 3.1 per 100,000 population 1. While the literature specifically addressing hand compartment syndrome after open fractures is limited, we can draw several important conclusions:
- Open fractures are specifically identified as a risk factor for developing acute compartment syndrome (ACS) 1
- Fractures account for 69% of all compartment syndrome cases 1
- Males have a significantly higher risk, with a male-to-female ratio of 13:1 for fracture-associated compartment syndrome 1
Mechanism and Pathophysiology
Compartment syndrome of the hand develops through similar mechanisms as in other locations:
- Increased pressure within a closed, relatively inelastic osteofascial compartment 1
- Reduced capillary and venous blood flow leading to tissue ischemia 1
- Resulting edema and release of vasoactive mediators further increasing compartment pressure 1
In open fractures specifically, the risk is heightened due to:
- Direct tissue trauma from the injury
- Potential vascular injury
- Soft tissue damage and subsequent edema
- Inflammatory response to the trauma 1
Clinical Presentation and Diagnosis
Diagnosis of hand compartment syndrome relies primarily on clinical assessment:
- Pain (spontaneous or on passive stretching) - the earliest and most reliable sign
- Tension/firmness of the compartment
- Paresthesia
- Paresis/weakness 1, 2
Late signs indicating irreversible damage include:
Compartment pressure measurements are useful diagnostic tools:
- Pressure >30 mmHg
- Differential pressure (diastolic blood pressure – compartment pressure) <30 mmHg 1
Special Considerations
Several case reports highlight important considerations regarding hand compartment syndrome:
- It can occur in patients of all ages, from children to the elderly 3
- Innocuous-appearing fractures (even distal radius fractures) can lead to hand compartment syndrome 4
- Patients with altered mental status or obtunded sensorium are at particular risk for delayed diagnosis 3
- Compartment syndrome of the hand may occur concurrently with compartment syndrome of the forearm 3, 5
Management
Early recognition and treatment are critical to prevent permanent functional impairment:
- Immediate surgical consultation is essential 2
- Fasciotomy should be performed promptly when compartment syndrome is clinically evident 2
- Carpal tunnel release and decompression of involved compartments are typically required 3
- Monitoring for reperfusion syndrome and rhabdomyolysis is important 1, 2
Outcomes
Outcomes depend largely on time to diagnosis and intervention:
- Satisfactory results can be achieved with early decompression 3
- Delayed diagnosis can lead to severe functional impairment, need for amputation, or death 3, 4
Prevention and Monitoring
For patients with open hand fractures:
- Maintain high clinical suspicion, especially in high-risk patients 2
- Regular clinical assessments (every 30 min to 1 hour) during the first 24 hours in patients with risk factors 1
- Consider compartment pressure monitoring in patients with altered mental status or when clinical assessment is difficult 1
- Be vigilant for signs of compartment syndrome in patients with risk factors such as open fractures, crush injuries, hemorrhagic injuries, and hypotension 2
While the specific incidence of hand compartment syndrome after open fractures is not precisely documented, the evidence clearly indicates it is a recognized complication that requires vigilant monitoring and prompt intervention to prevent devastating functional outcomes.