The Journal of Bone and Joint Surgery (American). 2009;91:642-645.
doi:10.2106/JBJS.H.00377
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Compartment Syndrome Associated with Distal Radial Fracture and Ipsilateral Elbow Injury

Raymond W. Hwang, MD, MEng1, Pieter Bas de Witte, BSc2 and David Ring, MD, PhD2

1 Department of Orthopaedic Surgery, Massachusetts General Hospital, White 535, 55 Fruit Street, Boston, MA 02114
2 Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring{at}partners.org

Investigation performed at the Department of Orthopaedic Surgery, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Commercial entities (Small Bone Innovations, Smith and Nephew, Acumed, and Tornier) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

Background: Forearm compartment syndrome is an uncommon sequela of distal radial fractures. This investigation tested the hypothesis that the risk of forearm compartment syndrome associated with an unstable, operatively treated fracture of the distal end of the radius is higher with a concomitant injury of the ipsilateral elbow.

Methods: All patients who sustained an unstable fracture of the distal end of the radius and/or injury to the elbow (a fracture of the proximal end of the radius and/or ulna, simple elbow dislocation, elbow fracture-dislocation, or distal humeral fracture) and were operatively treated at two level-I trauma centers over a five-year period were identified from a comprehensive database. The prevalence of compartment syndrome in a cohort with an isolated distal radial fracture and a cohort with a simultaneous distal radial fracture and elbow injury were compared.

Results: Nine (15%) of fifty-nine patients who sustained a simultaneous ipsilateral distal radial fracture and elbow injury had forearm compartment syndrome develop compared with three (0.3%) of 869 patients with an isolated unstable distal radial fracture (p < 0.001, relative risk = 50). The average time from presentation to the development of compartment syndrome and subsequent fasciotomy was twenty-seven hours. Three of the nine patients with injuries to both the elbow and the wrist had a compartment syndrome develop after initial operative treatment of the injuries, requiring a return to the operating room for fasciotomy.

Conclusions: Forearm compartment syndrome is a frequent complication of simultaneous unstable injuries to the elbow and the distal end of the radius. Heightened vigilance for compartment syndrome is paramount in patients with this combination of injuries.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.


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