Forearm Compartment Syndrome: an update

The Forearm compartment syndrome (FCS) is attributed to an increase in pressure within fascial compartments that may lead to decreased tissue perfusion. Its etiology may range from common to the unusual, including supracondylar humerus fractures in pediatric patients and distal radius fractures in both adult and pediatric patients. In case the diagnosis is delayed, it may cause devastating complications, such as neurological abnormalities of the upper extremity, muscular necrosis, gangrene and Volkman's ischemic contracture. Material and Methods: A thorough review of English and French literature published in PubMed from 2011-2021 was conducted, using the general term forearm compartment syndrome. From 421 articles that were received from this data base, 15 were studied in depth, including systematic reviews, reviews and clinical series of tertiary medical centers. Some additional articles discovered in the references of these 15 were also studied, due to focusing on specific aspects of the disease not mentioned in the reviews. Results: Classically symptoms and signs of FCS are manifested with the five "P's" in the English literature: pain out of proportion, pallor, paresthesias, paralysis and pulselessness. Excessive pain and pain with passive stretching of the fingers are considered the first, while the others when present show that the diagnosis was delayed. Compartmental pressure may be measured through laboratory methods (higher than 30mmHg is diagnostic of FCS), although diagnosis is usually clinical. Surgical fasciotomy is the only therapeutic approach and apart from cases where compartmental pressure is constantly measured, surgical decompression should be performed to all four forearm compartments. Volkman's ischemic contracture is a complication of FCS and may cause serious dysfunction of the upper extremity. Conclusions: Although multiple surgical techniques may be applied in FCS therapy, early diagnosis and prompt surgical decompression of fascial compartments constitute reliable prerequisites for a favorable prognosis. Time is valuable in FCS cases and any delay concerning the therapeutic intervention may cause devastating consequences. It has to be noted, that ischemia duration and the area it affects are major prognostic factors and should be taken into consideration primarily aiming to rapid treatment.