Scientific Articles   |    
Compartment Syndrome Associated with Distal Radial Fracture and Ipsilateral Elbow Injury
Raymond W. Hwang, MD, MEng1; Pieter Bas de Witte, BSc2; David Ring, MD, PhD2
1 Department of Orthopaedic Surgery, Massachusetts General Hospital, White 535, 55 Fruit Street, Boston, MA 02114
2 Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring@partners.org
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Commercial entities (Small Bone Innovations, Smith and Nephew, Acumed, and Tornier) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Mar 01;91(3):642-645. doi: 10.2106/JBJS.H.00377
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


Background: Forearm compartment syndrome is an uncommon sequela of distal radial fractures. This investigation tested the hypothesis that the risk of forearm compartment syndrome associated with an unstable, operatively treated fracture of the distal end of the radius is higher with a concomitant injury of the ipsilateral elbow.

Methods: All patients who sustained an unstable fracture of the distal end of the radius and/or injury to the elbow (a fracture of the proximal end of the radius and/or ulna, simple elbow dislocation, elbow fracture-dislocation, or distal humeral fracture) and were operatively treated at two level-I trauma centers over a five-year period were identified from a comprehensive database. The prevalence of compartment syndrome in a cohort with an isolated distal radial fracture and a cohort with a simultaneous distal radial fracture and elbow injury were compared.

Results: Nine (15%) of fifty-nine patients who sustained a simultaneous ipsilateral distal radial fracture and elbow injury had forearm compartment syndrome develop compared with three (0.3%) of 869 patients with an isolated unstable distal radial fracture (p < 0.001, relative risk = 50). The average time from presentation to the development of compartment syndrome and subsequent fasciotomy was twenty-seven hours. Three of the nine patients with injuries to both the elbow and the wrist had a compartment syndrome develop after initial operative treatment of the injuries, requiring a return to the operating room for fasciotomy.

Conclusions: Forearm compartment syndrome is a frequent complication of simultaneous unstable injuries to the elbow and the distal end of the radius. Heightened vigilance for compartment syndrome is paramount in patients with this combination of injuries.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    Illinois - Hinsdale Orthopaedics
    Oregon - The Center - Orthopedic and Neurosurgical Care and Research
    Connecticut - Yale University School of Medicine