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A Large Database Analyses to Characterize Hand Injury Profiles of Patients with Compartment Syndrome of The Hand
Vignesh Chennupati, BE, Barite Gutama, MD, Ricardo A Torres-Guzman, MD; Shady Elmaraghi, MD
Vanderbilt University Medical Center, Nashville, TN
Introduction: Diagnosis of Hand compartment syndrome (HCS) relies on clinical evaluation with a detailed understanding of the patient's injury profile, but its clinical findings are often subtle and evolving, requiring a high index of suspicion and serial examinations. If missed or not treated within hours of injury, HCS can result in irreversible tissue damage. The literature on risk factors associated with HCS in hand injury patients is scarce, limited to case reports and small case series. This study investigates risk factors, particularly injury profiles of patients with HCS. The study aims to enhance clinical evaluation and guide evidence-based management of HCS.
Methods: Using the National Trauma Data Bank, we identified 578 patients with hand compartment syndrome diagnoses from 2017-2021. Demographic data, mechanisms of injury, fracture patterns, and surgical interventions (fasciotomy, carpal tunnel release (CTR)) were extracted. Univariate and multivariable logistic regression analyses were performed.
Results: The 578 patients included in the study were predominantly male (78%) and had a mean age of 39.5 ± 17.6 years with a mean BMI 28.1 ± 6.9 kg/m2. The most common mechanisms of injury (MOI) were crush (30.6%), motor vehicle accidents (MVAs) (19.6%), and non-GSW assault (17.1%) (Table 1). 29% of the patients (N = 167) sustained ?1 arm fracture, with metacarpal (60.5%), radius (29.9%), and ulna (28.7%) being the most common (Table 2).
Among the 578 patients, 65.7% underwent fasciotomy, 49.5% underwent CTR, and 39.4% required both. Patients with HCS who required CTR had significantly higher odds of presenting with a concurrent humerus fracture compared to those who did not undergo CTR (OR 9.52; 95% CI, 1.20-75.23;
p = 0.03). Compared to HCS patients that did not undergo fasciotomy, those that required fasciotomy were more likely to have metacarpal fractures (OR 1.83; 95% CI 1.02-3.28; p = 0.04) and a lower likelihood of fall as the MOI (OR 0.25; 95% CI 0.07-0.93;
p = 0.04).
Conclusions: Patients with HCS exhibit specific injury profiles and MOI features. The significant association between concurrent humerus fractures and the need for CTR in HCS patients may be due to high-energy proximal trauma, which can elevate wrist compartment pressures and compromise median nerve perfusion. In contrast, falls, a low-energy MOI, were less commonly associated with HCS requiring fasciotomy. However, an acute rise in hand compartment pressure-driven by local tissue inflammation, edema, or hematoma-may increase the risk of HCS in patients with metacarpal fractures.
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