Acute compartment syndrome in patients undergoing fasciotomy of the forearm and the leg

Purposes: The primary objective of this study is to compare the likelihood of acute compartment syndrome in the leg versus the forearm in patients who undergo fasciotomy for a clinical diagnosis of suspected acute compartment syndrome. The secondary objective is to identify factors associated with higher likelihood of acute compartment syndrome or with the use of split-thickness skin graft in these patients. Methods: We identified 449 patients diagnosed with suspected acute compartment syndrome of 468 legs and 119 patients diagnosed with suspected acute compartment syndrome of 119 forearms, treated with fasciotomy, from January 2000 to June 2015. Patients clinically diagnosed with suspected acute compartment syndrome were scored for likelihood of acute compartment syndrome based on muscle appearance, time to closure, neurologic deficit at final follow-up, and contracture at final follow-up. Results: There was no difference in likelihood of acute compartment syndrome between the leg and the forearm, with about 70% having relatively high likelihood. Forearm fasciotomy was associated with documentation of poorer muscle appearance (p = 0.01) and contracture (p < 0.001) compared with leg fasciotomy. Multivariable logistic regression analyses showed that compartment pressure measurement (p = 0.01) was associated with higher likelihood of acute compartment syndrome in legs and that male sex (p = 0.001) and non-vascular mechanism of injury (p = 0.02) were associated with split-thickness skin graft in legs. Conclusions: The likelihood and severity of acute compartment syndrome are comparable in the leg and the forearm.