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Acute Compartment Syndrome after an Olecranon Fracture in a Patient with Mild Hemophilia B

Failure to recognize compartment syndrome in even mild forms can lead to irreversible tissue necrosis within 6h resulting in the loss of function, neurologic deficits, and limb amputations. The management of acute compartment syndrome in patients with hemophilia requires timely recognition, replacement of clotting factors, and emergent fasciotomies.

Abstract
Acute compartment syndrome is a serious condition that must be treated emergently. Acute compartment syndrome occurs when local soft tissue destruction leads to edema and bleeding, resulting in increased osseo fascial compartment pressures which can result in ischemia and necrosis of muscles and nerves unless the compartment measures are released emergently. Increased surveillance for compartment syndrome is especially important when a patient with a bleeding disorder sustains a traumatic injury.

Brief Case Description
This case reports a 40-year-old man with mild hemophilia B and HIV who presented to the emergency department with a sustained olecranon fracture. The patient developed compartment syndrome within his forearm following the fracture. The patient received factor replacement and underwent emergent forearm fasciotomies to avoid muscle necrosis.

Intervention and Outcome Summary
Early recognition, factor replacement and treatment with fasciotomies, if warranted, are paramount to obtaining a successful outcome. Trauma resulting in hematoma and edema can lead to irreversible tissue necrosis within six hours. Compartment syndrome is a limb threatening emergency, which can develop following severe orthopedic injuries (ex., tibial plateau fracture, tibial shaft fracture) in patients with no significant medical problems or following very minor trauma in patients with bleeding disorders such as hemophilia. Orthopedic surgeons and any emergency room physician should be aware of the increased risks of compartment syndrome with patients with hemophilia, even after minor trauma. It is important that they take extra precautions to diagnose patients early to present major complications including tissue necrosis, neurologic injuries, and limb amputations.

Original Publication:
Journal of Orthopaedic Case Reports
Authors:
John M Reynolds, Christy Christophersen, and Mary K Mulcahey

 

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