Subacute compartment syndrome in case of gunshot injuries of the extremities

Authors

  • Sergiy Strafun SI «Institute of Traumatology and Orthopedics of the Academy of Medical Sciences of Ukraine», Kyiv, Ukraine
  • Andriy Laksha Ukrainian Military Medical Academy of the Ministry of Defense of Ukraine, Kyiv, Ukraine
  • Volodymyr Shipunov National Military Medical Clinical Center «Main Military Clinical Hospital» of the Ministry of Defense of Ukraine, Ukraine
  • Natalia Borzykh SI «Institute of Traumatology and Orthopedics of the Academy of Medical Sciences of Ukraine», Kyiv, Ukraine
  • Oleksandr Strafun SI «Institute of Traumatology and Orthopedics of the Academy of Medical Sciences of Ukraine», Kyiv, Ukraine

DOI:

https://doi.org/10.15674/0030-59872020115-19

Keywords:

subacute compartment syndrome, local hypertensive ischemic syndrome, gunshot injuries of the extremities

Abstract

A local hypertensive ischemic syndrome or compartment syndrome (CS) is a serious complication of gunshot injuries of the extremities (GIE), it is usually considered as an acute process. However, we have repeatedly observed patients with subacute course of this pathology.

Objective: to study cases of subacute CS (SaCS) with GIE, that are characterized by a latent course and veiled clinical picture of the complications.

Methods: there were 15 cases of subacute CS after gunshot injuries for the period 2014–2018. 9 (60 %) were combined injuries of trunk and limbs, 6 (40%) — isolated limb wounds. Lesions of the lower extremities predominated — 10 (66.6 %). In 8 (53.3 %) patients, SaCS developed after shrapnel wounds of the limbs, and in 5 (33.3 %) cases — mine-explosive. Results: in 9 (60 %) cases, SaCS was observed in the bone-fascial sheath of the damaged area of the limb, in 6 (40 %) — in the adjacent segment. In 10 (66.6 %) patients, the course of SaCS was preceded by major vessels injury, in 8 (53.3 %) cases — it was combined with peripheral nerves injuries. In 12 wounded at the stages of evacuation, a tourniquet was used for more than an hour. In 5 cases, the course of SaCS was observed in patients with a combined wound of two or more anatomical sites with the development of a shock or prolonged hypotension. The time from the moment of injury to secondary surgical treatment, when the morphological signs of existed local hypertensive ischemic syndrome in bone-fascial sheath were identified, was from 5 days to 3 weeks.

Conclusions: CS in case of GIE can have both acute and subacute flow patterns. SaCS usually develops in the intact segment of the injured limb without pronounced clinical manifestations. Risk factors for the course of SaCS: injuries of the main vessels, tourniquet for more than an hour, multilevel injuries with the development of a shock or prolonged hypotension, incomplete (untimely) fasciotomy at the evacuation stages.

Author Biographies

Sergiy Strafun, SI «Institute of Traumatology and Orthopedics of the Academy of Medical Sciences of Ukraine», Kyiv

MD, Prof. in Traumatology and Orthopaedics

Andriy Laksha, Ukrainian Military Medical Academy of the Ministry of Defense of Ukraine, Kyiv

Ukrainian Military Medical Academy of the Ministry of Defense of Ukraine, Kyiv

Volodymyr Shipunov, National Military Medical Clinical Center «Main Military Clinical Hospital» of the Ministry of Defense of Ukraine

National Military Medical Clinical Center «Main Military Clinical Hospital» of the Ministry of Defense of Ukraine

Natalia Borzykh, SI «Institute of Traumatology and Orthopedics of the Academy of Medical Sciences of Ukraine», Kyiv

PhD

 

Oleksandr Strafun, SI «Institute of Traumatology and Orthopedics of the Academy of Medical Sciences of Ukraine», Kyiv

PhD in Traumatology and Orthopaedics

References

  1. Emergency military surgery (trans. from English). (2015). Lviv: Nautilus. [in Ukrainian]
  2. Strafun, S. S., Brusko, A. T., & Lyabah, A. P. (2007). Prevention, diagnosis and treatment of ischemic contractures of the hand and foot. Kyiv: Stilos. [in Ukrainian]
  3. Gaiko, G. V., Strafun, S. S., & Burjanov, O. A. (2014). Compartment syndrome in gunshot wounds of the extremities; ed. A. P. Lyabach. Kyiv. [in Ukrainian]
  4. Cubano, M. A., Lenhart, M. K., & Bailey, J. A. (2013). Emergency war surgery. Fourth United State Revision. Office of the Surgeon General, Fort Sam Houston. Texas, Borden Institute

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How to Cite

Strafun, S., Laksha, A., Shipunov, V., Borzykh, N., & Strafun, O. (2024). Subacute compartment syndrome in case of gunshot injuries of the extremities. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (1), 15–19. https://doi.org/10.15674/0030-59872020115-19

Issue

No. 1 (2020)

Section

ORIGINAL ARTICLES

License

Copyright (c) 2020 Sergiy Strafun, Andriy Laksha, Volodymyr Shipunov, Natalia Borzykh, Oleksandr Strafun

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