Background: Acute COMPARTMENT syndrome (ACS) is a devastating condition, further aggravated by delayed diagnosis. Since ACS is a clinical diagnosis, identification of risk factors for individual patients may help with earlier detection. This study aims to identify the risk factors associated with the development of ACS of the extremities. Methods: We performed a systematic review and meta-analysis of studies with adult patients at risk for and with traumatic ACS of the extremity. Non-traumatic, chronic exertional, vascular and abdominal COMPARTMENT syndrome were excluded. Technical reports, biomechanical studies, abstracts, studies of non-human subjects, non-English studies, and studies with less than five subjects were excluded. Meta-analysis was performed on a subset of studies including a control group. We addressed cases of substantial heterogeneity among the studies with subgroup analysis, and whenever heterogeneity remained significant, we employed random effect meta-analysis for the data pooling. The study protocol has been registered in PROSPERO (ID = CRD42019126603). Results: There were 19 studies with 48, 887 patients investigating risk factors of traumatic ACS. Of these, there were 1, 716 patients with the diagnosis of traumatic ACS. Fourteen studies (46, 300 controls and 1, 358 ACS patients) qualified for meta-analysis. Male to female ratio was 5. 5 with an average age of 36 years. Factors that were significantly associated with the development of ACS were: age 18-64 (OR: 1. 34, 95% CI: 1. 07-1. 68), male (OR: 2. 18, 95% CI: 1. 53-3. 10), gunshot wound with fracture and vascular injury (OR: 12. 5, 95% CI: 5. 69-27. 46), combined forefoot and midfoot injury (OR: 3. 3, 95% CI: 2. 39-4. 57), injury severity score (ISS) 0-9 (OR: 1. 58, 95% CI: 1. 27-1. 97), OTA/AO type C fractures (OR: 2. 75, 95% CI: 1. 04-7. 28), vascular injury (OR: 9. 05, 95% CI: 6. 69-12. 26), and high-energy trauma (OR: 3. 10, 95% CI: 1. 60-5. 82). Factors such as tibia fracture and crush injury were reported but were not included in quantitative analysis, due to lack of control groups and/or only one study qualifying for meta-analysis. Conclusion: This study reports on the current significant risk factors for developing traumatic ACS. The most common risk factors included age, sex, gunshot wound with a vascular injury, OTA/AO fracture type C and high-energy trauma.

Background & Aims: Increase in abdominal pressure can lead to the so-called intra–abdominal COMPARTMENT syndrome (ACS) that is often observed during the first 24 hours after sever abdominal trauma and surgery. Measurement of the intra abdominal pressure through the bladder as a non-invasive measurement can provide a quick and accurate assessment of abdominal pressure changes. This study was performed to compare the diagnostic value of intra-abdominal pressure measurement through the bladder with that of physical exam in the diagnosis of surgery indication.Methods: This descriptive- analytical study was performed on patients with intra-abdominal COMPARTMENT syndrome due to blunt abdominal trauma referred to Nemazee hospital, Shiraz, Iran. Tools for data collection included a check list consisting demographic information, and intra-abdominal pressure measurement instruments. Data analysis was done through SPSS software.Results: Of 100 patients with abdominal trauma whose abdominal pressures were measured, 28 ones had abdominal COMPARTMENT syndrome of whom, 21 ones (75 percent) were referred to the operation room by physician. Among all patients who were sent to the surgery room, 5 patients (23.80%) were survived and all those who were not sent to the surgery room died. Mean diagnosis time of measuring abdominal pressure for detection of operation indication was significantly lower than that of physical exam (P<0.01). Age, sex, type of trauma and type of injury to internal organ had no significant relationship with the rate of abdominal COMPARTMENT syndrome. Also, there was no significant difference between the two methods in finding surgery indication. Conclusion: Implementing education on methods of early diagnosis of intra-abdominal pressure increase for medical team especially nurses is one of the treatment priorities.

Background: Acute COMPARTMENT syndrome is considered a debilitating complication of limb trauma. Early detection of this COMPARTMENT syndrome helps us in the early initiation of treatment which will result in preventing its subsequent complications reported in these cases. Methods: This research was an analytical cross-sectional study. Patients with direct trauma to extremities, who were referred to the emergency department of Valiasr and Amir Al-Momenin hospitals were studied from October 2018 to April 2019 in Arak, Iran. Patients were selected if they met all of the inclusion criteria and none of the exclusion criteria. Vital signs were measured and recorded for each patient. Also, the results of physical examination, intra-COMPARTMENTal pressure measurement by a wick catheter and the level of the creatine phosphokinase were recorded. All data analyses were performed with the use of SPSS v21 software. Results: A total number of 70 subjects were included in this study, comprising 65 males (93. 1%) and 5 females (6. 9%). The results showed that there is a significant relationship between intra-COMPARTMENT pressure and the level of creatine phosphokinase enzyme. The higher the intraCOMPARTMENTal pressure, the higher the creatine phosphokinase level. Statistically significant associations were observed between intraCOMPARTMENTal pressure and pallor, edema, lack of limb pulse, and diastolic blood pressure. No significant relationship was found between intraCOMPARTMENTal pressure and limb pain, numbness, inability to move the injured limbs, and systolic blood pressure. In addition, our findings indicated that creatine phosphokinase is significantly associated with edema and lack of limb pulse. No significant relationship was found between creatine phosphokinase with pain, pallor, numbness, inability to move limbs, and systolic and diastolic blood pressure. Conclusion: The study findings suggest that measurement of intraCOMPARTMENTal pressure could be considered as an effective alternative approach to creatine phosphokinase levels to diagnose COMPARTMENT syndrome. So, this will prevent irreparable damage to the extremities and is of great importance.

Introduction & Objective: COMPARTMENT syndrome has been defined as "a condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space". Intense pain, swelling, and elevated COMPARTMENT pressures characterize the early presentation in the affected muscle group. If untreated myonecrosis, myoglobinuria, and renal failure may result. To avoid a delay in diagnosis requires vigilance intraCOMPARTMENTal pressure measurement. Diagnosis of limb COMPARTMENT syndrome is based on clinical vigilance and repeated examination. Many techniques exist for tissue pressure measurement but they are indicated only in doubtful cases, the unconscious or obtunded patient and children. However, monitoring of pressure has no harmful effect and may allow early fasciotomy. In acute situations, fasciotomy can be done prophylactically or as early therapeutic decompression, the latter being performed as soon as the first symptoms of COMPARTMENT syndrome are present.This review encompasses limb COMPARTMENT syndrome, including diagnosis and treatment.Material & Methods: In this preview article it was tried to answer these questions by literature review since 2000 till now.Results: Faciotomy doesn’t increase renal complication and we perform fasciotomy in proper time to preserve limb function.Conclusions: It is recommended to perform fasciotomy for COMPARTMENT syndrome according to clinical sign and symptom COMPARTMENT pressure monitoring timely and properly.

Introduction: It is very important to consider that increased intra-abdominal pressure above the terminal capillary blood pressure causes progressive tissue hypoperfusion, ischemia of the intestines and kidneys as well as other peritoneal and retroperitoneal structures.Materials and Methods: Eleven patients out of 3415 admitted patients in Alzahra and Issabne Maryam (SA) Hospitals were diagnosed to have abdominal COMPARTMENT syndrome (ACS) between 1999 and 2006. Cases with intra-abdominal pressure of 26 to 35 CmH20 and clinical signs of ACS, anuria, hypoxia and tachycardia were decompressed. Patients with intraabdominal pressure of 36cm H2O or higher were decompressed urgently.Results: Eleven patients (7 males, 4 females) were studied with the youngest being 18 and the oldest being 86. Mortality rate was 64%. One of the important causes of increased mortality was prolonged ACS duration and abdominal decompression delay. The most probable causes of ACS were severe abdominal trauma, sepsis and aggressive resuscitation.Conclusion: High index of suspicion for ACS has an important role in its diagnosis and further life saving.

Introduction: Rhabdomyolysis (RM) may cause some complications such as COMPARTMENT syndrome and disseminated intravascular coagulation (DIC), which can affect its prognosis. This systematic review and meta-analysis aimed to investigate the prevalence of the mentioned complications following RM. Methods: Medline, Embase, and Scopus databases were searched using keywords related to COMPARTMENT syndrome, DIC, and rhabdomyolysis with appropriate combination. Cohort and cross-sectional studies that conducted research on the prevalence of COMPARTMENT syndrome and DIC in patients with RMwere included in the present study. The desired datawere extracted fromthe included studies and meta-analysis was conducted on them to calculate pooled prevalence of these complications. Results: Twenty articles were included in our systematic review. The rate of COMPARTMENT syndrome reported in these studies ranged from 0 to 30. 7%. Our meta-analysis revealed the pooled prevalence of 4% (95% confidence interval (CI): 2. 20 to 7. 40) for COMPARTMENT syndrome in these studies. The pooled prevalence of this complication was 7. 1% (95% CI: 2. 90 to 16. 00) among patients with severe RM and 4. 4% (95% CI: 1. 80 to 10. 00) in traumatic RM. The rate of DIC reported in the included studies ranged from 0 to 40. 47%. Our meta-analysis showed the pooled prevalence of 8. 3% (95% CI: 03. 90 to 16. 50) for this complication among RMpatients. Conclusion: We reported the rates of COMPARTMENT syndrome and DIC in RMpatients based on rhabdomyolysis etiologies through an epidemiologic systematic review and meta-analysis. The rate of COMPARTMENT syndrome was slightly higher in patients with severe RMand its rate in patients with traumatic RM was close to the overall rate of COMPARTMENT syndrome.

Background: Tibial plateau fractures consist 1% of all fractures and are one of the most challenging intraarticular fractures to fix as an orthopedic surgeon (1, 2). Several classification systems have been developed to categorize the tibia plateau fractures and until recently, Schatzker, Hohl and Moore, and AO classifications have been the most popular systems among the 38 classification systems introduced so far (3-9). . .