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During the current pandemic of COVID-19, a myriad of manifestations and complications has emerged and are being reported on. We are discovering patients with COVID-19 are at increased risk of acute cardiac injury, arrythmias, thromboembolic complications (pulmonary embolism and acute stroke), and secondary infection to name a few. I describe a novel case of COVID-19 in a previously healthy 33-year-old female who presented for altered mental status and proptosis. She was ultimately diagnosed with mucormycosis and orbital compartment syndrome, in addition to COVID-19. Early identification of these high morbidity conditions is key to allow for optimal treatment and improved outcomes.

Background Acute compartment syndrome (ACS) is a critical condition resulting from increased intra-compartmental pressure, causing tissue ischemia and necrosis. ACS following cardiovascular surgery is rare but catastrophic. Postoperative sedation and analgesia often obscure classic symptoms, delaying diagnosis. This underscores the importance of vigilance and early detection, particularly in high-risk scenarios such as prolonged extracorporeal circulation and femoral artery cannulation. Enhanced monitoring, including tissue oxygen saturation and transcutaneous oxygen pressure, may facilitate timely diagnosis. Case summary We report a 56-year-old male who developed ACS after valve replacement surgery involving femoral artery cannulation for cardiopulmonary bypass. Approximately 12 h postoperatively, the patient exhibited severe lower limb swelling, mottling, and diminished dorsalis pedis pulse. Laboratory findings revealed elevated myoglobin and creatine kinase levels. Diagnosis was confirmed via clinical and ultrasound evaluation, prompting emergent fasciotomy. Postoperative management included wound care, renal replacement therapy, and skin flap reconstruction. At 6 months follow-up, the patient achieved complete functional recovery of the affected limb. Conclusion ACS is a rare but severe complication of cardiovascular surgery. This case highlights the necessity for heightened vigilance, early recognition, and timely intervention to mitigate adverse outcomes. Further studies are needed to validate and establish standardized monitoring protocols and management strategies, including early use of distal perfusion techniques, to improve surgical safety and patient outcomes.

A compartment syndrome is defined as an increase in the compartmental pressure to such an extent that the viability of the tissues and organs within the compartment are threatened. The term describes a syndrome and not a disease, and as such there are many diseases and underlying pathophysiological processes that may lead to such a scenario. The aim of this review is to give a state-of-the-art overview on the current knowledge on different compartment syndromes and how they may interact. Suggested definitions are included. There are four major compartments in the human body: the head, chest, abdomen, and the extremities. Initially, the term multicompartment syndrome was suggested when more than one compartment was affected. But this led to confusion as the term multi- or multiple compartment syndromes is mostly used in relation to multiple limb trauma leading to compartment syndrome requiring fasciotomy. Only recently was the term 'polycompartment syndrome' coined to describe a condition where two or more anatomical compartments have elevated pressures. When more than one compartment is affected, an exponential detrimental effect on end-organ function to both immediate and distant organs can occur. Within each compartment, the disease leading towards a compartment syndrome can be primary or secondary. The compliance of each compartment is the key to determining the transmission of a given compartmental pressure from one compartment to another. The intra-abdominal pressure helps to explain the severe pathophysiological condition occurring in patients with cardiorenal, hepatopulmonary and hepatorenal syndromes. Initial treatment of a compartment syndrome should be focused on the primary compartment and is based on three principles: lowering of compartmental pressure, supporting organ perfusion, and optimisation and prevention of specific adverse events. Clinicians need to be aware of the existence of the polycompartment syndrome and the interactions of increased compartmental pressures between compartments.

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been increasingly recognized in the critically ill over the past decade. In the absence of consensus definitions and treatment guidelines the diagnosis and management of IAH and ACS remains variable from institution to institution. An international consensus group of multidisciplinary critical care specialists convened at the second World Congress on Abdominal Compartment Syndrome to develop practice guidelines for the diagnosis, management, and prevention of IAH and ACS. Prior to the conference the authors developed a blueprint for consensus definitions and treatment guidelines which were refined both during and after the conference. The present article is the second installment of the final report from the 2004 International ACS Consensus Definitions Conference and is endorsed by the World Society of the Abdominal Compartment Syndrome. The prevalence and etiological factors for IAH and ACS are reviewed. Evidence-based medicine treatment guidelines are presented to facilitate the diagnosis and management of IAH and ACS. Recommendations to guide future studies are proposed. These definitions, guidelines, and recommendations, based upon current best evidence and expert opinion are proposed to assist clinicians in the management of IAH and ACS as well as serve as a reference for future clinical and basic science research.

Purpose To investigate distributions and identify possible differences in intramuscular pressure (IMP) values at 1 min post-exercise between the four muscle compartments of the lower leg, in patients with exertional leg pain with or without chronic exertional compartment syndrome (CECS). Methods A consecutive series of patients seeking orthopaedic consultation for exertional leg pain underwent IMP measurements between 2009 and 2018. The diagnosis of CECS was confirmed ( n  = 442) or ruled out ( n  = 422), based on the patient’s history, clinical examination, and IMP measurements. Results The median (range) 1 min post-exercise IMP values in affected compartments in the patients diagnosed with CECS were 33 (25–53) mmHg (deep posterior), 35 (27–54) mmHg (superficial posterior), 40 (26–106) mmHg (lateral), and 47 (24–120) mmHg (anterior). In patients with no CECS, the median (range) 1 min post-exercise IMP values in the compartments were 12 (2–28) mmHg (deep posterior), 12 (2–27) mmHg (superficial posterior), 14 (2–26) mmHg (lateral), and 18 (4–34) mmHg (anterior). The IMP was significantly lower in the lateral and both posterior compartments than in the anterior compartment in both patients diagnosed with CECS and patients without CECS. Conclusion The study demonstrates significantly lower IMP values in the posterior and lateral compartments compared to the anterior compartments. These findings suggest a lowering of the IMP 1 min post-exercise cut-off value for diagnosing CECS in the lateral and both posterior compartments, which may lead to improved treatment of patients with suspected CECS in the lower leg. Level of evidence Level II.

Risk factors of acute compartment syndrome (ACS) of the leg include tibial fractures followed by soft tissue injuries. Data collected from the National Trauma Data Bank (NTDB) between 2017 and 2019 were analyzed for adult patients with lower extremity fractures, including proximal tibia, tibial shaft, and distal tibia. The primary outcome was a diagnosis of ACS. There were 1052/220,868 patients with lower extremity fractures with a concomitant diagnosis of compartment syndrome. Our study has shown that patients with a BMI of ≥30 had a lower incidence of compartment syndrome when compared with patients with a BMI of 25–29 and controlled for fracture type. Increased age ≥55 in males, and females between 65 and 84, also demonstrated a decreased risk. Proximal tibial fractures (n ​= ​54,696) were significantly associated with ACS compared to midshaft (n ​= ​42,153) and distal (n ​= ​100,432), p ​< ​0.0001. We found that being overweight decreases risk for development of compartment syndrome in patients with lower extremity fractures. This big data study aids in establishing risk factors for development of ACS in adult trauma patients. •Adult males are more commonly affected by acute compartment syndrome of the lower extremity based on big data analysis of the National Trauma Data Bank.•There is a decreased risk association of compartment syndrome in lower extremity factors associated with BMI ≥30. The decreased risk association of developing compartment syndrome is more apparent in obese females.•Proximal tibial fractures in adults were significantly associated with acute compartment syndrome compared to midshaft and distal tibia.

A 34-year-old female athlete experienced pain, tightness, and sensation changes in her lower legs and feet when reaching approximately 1 mile (1.6 km) of her run. After a wick catheter test, an orthopaedic surgeon diagnosed her with chronic exertional compartment syndrome (CECS) and declared her eligible to undergo fasciotomy surgery. A forefoot gait is theorized to delay the symptom onset of CECS and decrease the amount of discomfort the runner experiences. The patient opted for a 6-week gait retraining program to try to alleviate her symptoms nonsurgically. The purpose of our report is to provide information about the contributing factors of CECS and to determine if gait retraining is an effective alternative to invasive surgery. After 6 weeks of gait retraining, the patient was able to run without experiencing any CECS symptoms. Also, her compartment pressures were reduced, leading the surgeon to no longer recommend fasciotomy.

Purpose Acute compartment syndrome (ACS) remains a devastating complication of orthopaedic trauma. The tibial diaphysis is especially implicated in the development of ACS, both at the time of injury and after operative management. Identification of risk factors for ACS for these distinct scenarios has been investigated in a large cohort of patients. Methods This is a retrospective cohort study of all adults (age 18 years and older) presenting to a level 1 trauma centre with a diaphyseal tibia fracture. ACS was determined by a combination of clinical signs and symptoms and compartmental pressure monitoring. Potential risk factors were subject to univariate analysis with significant variables undergoing binary logistic regression analysis. Results 1147 tibial diaphyseal fractures over a twelve year period were studied. Age, multifragmented fracture pattern, male gender, high energy mechanism and intra- articular extension all showed a statistically significant association for ACS. Increasing body mass index (BMI) and treatment with an intramedullary nail favoured development of ACS post-operatively. Conclusion Risk factors for the development of ACS specifically in tibial diaphyseal fractures have been highlighted. Patients managed with IMN or high BMI may warrant particular observation following operative intervention.

Purpose Acute compartment syndrome (ACS) is a severe complication associated with tibial fractures, which can result in irreversible muscle and nerve damage if not promptly identified and treated. Method This study systematically searched PubMed, EMBASE, the Cochrane Library, and Web of Science. Data on demographics, fracture attributes, injury mechanisms, and biomarkers were extracted. Meta-analyses were performed using both fixed- and random-effects models, depending on the degree of heterogeneity. Result A total of 17 studies were included. Younger adult age and older age in pediatric populations were both linked to higher ACS risk, depending on the age group. ale sex was strongly associated with ACS. High-energy traumaand polytrauma were also associated with a heightened risk. Delayed external fixation also showed a protective effect, albeit based on limited evidence. Biomarkers, including elevated monocyte count and creatine kinase-MB levels, were also significant predictors. Conclusion Younger adult age, male sex, high-energy trauma, and polytrauma were identified as critical risk factors for ACS in tibial fractures. Findings emphasize the need for standardized definitions and prospective investigations. Further research addressing pediatric age ranges, fracture location, and biomarker validation is essential to refine risk assessment and optimize early interventions.

Purpose To update the World Society of the Abdominal Compartment Syndrome (WSACS) consensus definitions and management statements relating to intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS). Methods We conducted systematic or structured reviews to identify relevant studies relating to IAH or ACS. Updated consensus definitions and management statements were then derived using a modified Delphi method and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines, respectively. Quality of evidence was graded from high (A) to very low (D) and management statements from strong RECOMMENDATIONS (desirable effects clearly outweigh potential undesirable ones) to weaker SUGGESTIONS (potential risks and benefits of the intervention are less clear). Results In addition to reviewing the consensus definitions proposed in 2006, the WSACS defined the open abdomen, lateralization of the abdominal musculature, polycompartment syndrome, and abdominal compliance, and proposed an open abdomen classification system. RECOMMENDATIONS included intra-abdominal pressure (IAP) measurement, avoidance of sustained IAH, protocolized IAP monitoring and management, decompressive laparotomy for overt ACS, and negative pressure wound therapy and efforts to achieve same-hospital-stay fascial closure among patients with an open abdomen. SUGGESTIONS included use of medical therapies and percutaneous catheter drainage for treatment of IAH/ACS, considering the association between body position and IAP, attempts to avoid a positive fluid balance after initial patient resuscitation, use of enhanced ratios of plasma to red blood cells and prophylactic open abdominal strategies, and avoidance of routine early biologic mesh use among patients with open abdominal wounds. NO RECOMMENDATIONS were possible regarding monitoring of abdominal perfusion pressure or the use of diuretics, renal replacement therapies, albumin, or acute component-parts separation. Conclusion Although IAH and ACS are common and frequently associated with poor outcomes, the overall quality of evidence available to guide development of RECOMMENDATIONS was generally low. Appropriately designed intervention trials are urgently needed for patients with IAH and ACS.