Althea Vol 2 No 4 Final.indd
Althea Medical Journal. 2015;2(4)
497
Profile of Hand Compartment Syndrome in Dr. Hasan Sadikin General
Hospital, West Java, 2008−2012
Kajendaran Manogaran,1 Nucki Nursjamsi Hidajat,2 Arifin Soenggono3
1Faculty of Medicine Universitas Padjadjaran, 2Department of Orthopaedics & Traumatology
Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung,
3Department of Anatomy and Cell Biology, Faculty of Medicine Universitas Padjadjaran
Abstract
Background: Compartment syndrome is a serious disorder caused by elevated pressure in a muscle
compartment that can progress to muscle and nerve damage. This disorder can happen to anyone but more
frequently in young adults. The occurrence frequency of hand compartment syndrome is relatively low. The
aim of this study is to identify the profile of compartment syndrome in patients hand
Methods: A descriptive study was perfomed to 15 cases that were collected from medical records from
2008-2012, in Dr. Hasan Sadikin General Hospital. The profile of the case consisted of age, sex, symptoms
and signs, etiology, facsiotomy schedule after admission, length of stay and patient’s outcome. The collected
data were presented using tables.
Results: The study showed that 12 out of 15 cases were males and 7 out of 15 cases were 20−39 years old
patients. The common clinical findings were swelling, pain, limited range of motion and normal sensibility.
The faciotomy procedure was conducted 1 day after the admission with length of stay more than 1 week.
The patients condition were improved after operation.
Conclusions: Hand compartment syndrome is a rare case, mostly affects younger adults and male. Most
of the symptoms and signs are swelling, limitation of movement, pain in the location area with normal
sensibility. The faciotomy procedure is conducted 1 day after admission. The length of stay is more than 1
week with an improved outcome. [AMJ.2015;2(4):497–501]
Keywords: Compartment syndrome, hand, swelling
Correspondence: Kajendaran Manogaran, Faculty of Medicine, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang
Km.21, Jatinangor, Sumedang, Indonesia, Email: kajendaran@yahoo.com
Introduction
Compartment syndrome is a serious medical
disorder caused by elevated pressure in a
muscle compartment that can progress to
muscle and nerve damage. This condition is
influenced by external and internal force or
injury that increases the intracompartmental
pressure.1,2 The most common findings for
compartment syndrome are pain, tenderness
and swelling. Others include paraesthesia,
pallor, paralysis and pulselessness.3,4 Apart
from clinical signs and symptoms, the
important diagnostic method is by measuring
intracompartmental pressure.5 The choice
of treatment normally done for patient with
compartment syndrome is through a surgical
method. The essential step of patient treatment
with compartment syndrome is by performing
fasciotomy procedure to release the pressure
within involved compartment.6,7
From the previous study in 2011 by
Duckworth and Mcqueen5, it was noted
that the occurrence of hand compartment
syndrome is less frequent. The involvement of
upper extremities is less common comparing
to lower extremities. The yearly occurrence
of acute compartment syndrome is 3.1 per
100.000 population with the ratio in male
to female is 10:1.5 Even though it is a rare
syndrome, this condition can lead to a serious
complication and affect the patient’s quality
of life and daily living activities. The aim of
the study is to identify the profile of patients
with hand compartment syndrome which is a
common orthopedic disorder.
Althea Medical Journal. 2015;2(4)
498 AMJ December, 2015
Methods
A descriptive study was performed to 15
medical records of patients with hand
compartment syndrome during 2008-2012 in
Dr. Hasan Sadikin General Hospital. The data
collection was carried out from August 2013
to November 2013. The profile of the patients
consisted of age and sex. Futhermore, 7 out
of 15 cases which were patients between
20−39 years old, were analyzed according
to diagnosis criteria, etiology, facsiotomy
schedule after admission, length of stay and
patient’s outcome.
The collected data was presented in tables
for each variable to represent the hand profile
of compartment syndrome. The study was
approved by the Health Research Ethics
Committee of Dr. Hasan Sadikin General
Hospital.
Results
From 2008 until 2012, there were only 15
cases of hand compartment syndrome. Most of
the cases were affected by male patients who
were 20−39 years old .
Seven cases from 20−39 years old patients
had been selected to identify other variables
than age and sex.
Most of the patients had the same symptoms
and signs. Those were swelling, limited in
range of motion, yet there was one patient
who did not feel pain.
From seven cases, most of the patients had
an injury before and only one case was occur
because of a tight bandage. Fasciotomy was
performed one day after the admission, but
there were still cases performed more than
2 day after the admission. Furthermore, the
Table 1 Distribution of Patients According
to Age and Sex
Age
(years)
Sex Total
(n)Male (n) Female (n)
<20 2 3 5
20–39 7 0 7
40–59 2 0 2
>60 1 0 1
Total 12 3 15
length of stay between patients varied from
6 to 74 days. Most of the patients outcomes
were improved.
Discussion
The incidence of hand compartment syndrome
is very low.5 In this study, only 15 cases
found during 2008-2012. Most of the cases
were affected to 20−39 years old patients.
The possible reason is adults normally more
engaged in daily activities, sports activities,
and more exposed to outer environment
compare to other age group population. This
finding is supported by epidemiology research
done by Duckworth and Mcqueen.5 It is
important to note that hand is important part
of our body with many influential functions.
Gambrel explains that in a certain situation
such as in sports or working environment, it
requires overuse of hand in completing a task
or activity. This can lead to higher chances of
damage or injury to the hand.8
This study also shows that males are
more affected by this syndrome than female.
Previous study by Duckworth and Mcqueen5
Table 2 Diagnostic Criteria of Compartment Syndrome of The Hand
Patient Swelling Pain ROM* Wound Sensibility Other
disorders
ICP**
1 Yes Yes Limited Yes Normal Burn injury Not done
2 Yes Yes Limited Yes Normal Leg injury Not done
3 Yes No Limited Yes No Burn injury Not done
4 Yes Yes Limited No Normal None Not done
5 Yes Yes Limited No Normal None Not done
6 Yes Yes Limited Yes Normal Leg injury Not done
7 Yes Yes Limited Yes No None Not done
Note: *ROM, range of motion, **ICP, intracompartmental pressure
Althea Medical Journal. 2015;2(4)
499
statistically presented that mostly males were
usually the main sufferer in compartment
syndrome cases with ratio of 10:1 to female.
In this study, most of the patients have the
history of injury before the occurrence of hand
compartment syndrome. A previous study by
Mabvuure et al.6 supported this findings. The
study also mentioned that trauma commonly
resulted in compartment syndrome.
Traumatic accident and working hazard injury
can prolong and progress to range of mild to
severe hand injury as explained by Chow et
al.9 All the causal factors stated can explain
the pathophysiology of the compartment
syndrome as all the causes can either increase
the compartment volume or decrease the
compartment size.10 This condition increases
intracompartmental pressure.
Diagnostic criteria of compartment
syndrome of the hand are studied. It includes
the clinical findings that are different from
person to person and depend on the severity
of disorder. Results show common findings
in all seven patients are swelling and limited
range of motion. Presence of swelling or pain
sensation will limit the movement of hand and
fingers. Any deep or severe injury can cause
damage to nerve and muscle, thus it progress
into more chronic compartment syndrome.
This condition as explained in previous articles
will affect the normal functioning of the hand.
Other findings in the patients include pain,
loss of sensibility, and wound. As already
written in the literature before, the classic
clinical findings are 5P (pain, paraesthesia,
pallor, paralysis, pulselessness). In certain
condition not all the findings will present, so it
is important to study the characteristic of the
syndrome before diagnosing the patient.3,5,10
Measuring intracompartmental pressure
is also an important diagnostic criteria for
compartment syndrome as explained in
study by Duckworth and Mcqueen.5 Based
on study, all seven cases did not use the
measurement of intracompartment pressure,
probably due to the emergency and serious
disorder need a fast and prompt management.
Chandraprakasam and Kumar4 also state that
clinical findings are the most important part
in diagnosing compartment syndrome and
intracompartment pressure measurement can
be done as the confirmation of disorder.4,10
Fasciotomy is an invasive procedure to treat
the compartment syndrome. The objective of
this procedure is to open the involved tissue
compartments to relieve the pressure before
irreversible tissue damage occur.6 Olson and
Glasgow suggested that if there was clinical
indications of acute compartment syndrome
more than 8 hours and with absence in
muscular and neurologic function, then
amputation procedure must be conducted.7,11
In this study, not all of the patients underwent
fasciotomy promptly. As explained by Ebraheim
et al.12, the compartment syndrome should
be diagnosed and treated as fast as possible.
This is important to prevent progression of
syndrome and prevent complications.3 Patient
can also develop a contracture of chronic stage
in the compartment syndrome that is clinically
characterized by fibrosis and a shortening of
muscle because of inadequate vascularization.
Systemic complications include renal
insufficiency is caused by rhabdomyolysis
and myoglobulinaemia as the results of high
intracompartmental pressure.13 It is important
for patient to immediately consult to a doctor
after an injury or trauma and to accept the
Kajendaran Manogaran, Nucki Nursjamsi Hidajat, Arifin Soenggono: Profile of Hand Compartment
Syndrome in Dr. Hasan Sadikin General Hospital, West Java, 2008−2012
Table 3 Profile of Patients with Compartment Syndrome of The Hand
Patient Age
(years)
Sex Etiology Fasciotomy
(days after
admission)
Length of
hospital
stay
(days)
Outcome
1 30 Male Burn injury 7 42 Improved
2 33 Male Accident 1 36 Improved
3 24 Male Burn injury 15 74 Complicated
4 20 Male Tight bandage 1 11 Improved
5 20 Male Fall 3 39 Improved
6 37 Male Accident 1 29 Improved
7 28 Male Crush injury 1 6 Complicated
Althea Medical Journal. 2015;2(4)
500 AMJ December, 2015
management plan provided for them. The
other two cases require a longer time because
it has other accompanying serious disorder
(Table 2).
From seven cases, the length of stay in
hospital varies, most patients have been
treated for a longer time in hospital. The
length of hospitalization is essential to check
for presence of any complications after the
operative procedure example such as local
complications that are post-operative wound
infection and deeper infection involving soft
tissue or bones that could lead to amputation,
nerve damage or other disorder.7,11 Once the
patient has recovered from the surgery without
complications, then they can be sent home.
The length of hospitalization also depends on
the severity of the injury. Multiple site injuries
require more long term management. This
applies to a patient that has been treated for a
longer period.
This study also represents the management
outcome of hand compartment syndrome
shown that most patients, five in number of
cases discharged with an improved condition
after management. Most of these patients
were managed well and fast to prevent any
complication and the injury not to severe
enough to cause irreversible disorder. From the
study, two patient’s outcomes are complicated
into nerve damage and contracture. It is
because of the late admission after injury
causing irreversible damage. According to
study by Szatmary et al.13 with a quick and
proper treatment and management, the risks
in developing complication can be avoided.
This is important as it can preserve the normal
hand functions and patient’s quality of life
The limitation of the study is the low
number of data obtained regarding this
disease due to a rare disease factor. Secondly,
incompleteness of the information in medical
records are also proved to be a barrier in the
study. It is recommended that the necessary
information should be completed in all
medical records to ease further study of the
disease. Although compartment syndrome
of the hand is considered as a rare disorder,
it is important for the healthcare workers to
develop skills and techniques for the diagnosis
and management of the patients with this
condition. Public needs to be educated about
the risk of having compartment syndrome.
They should try avoiding the risk and causal
factors of compartment syndrome to prevent
the occurrence of this condition that could
lead to many complications if it is untreated.
They also should be educated about the
overuse syndrome of hand especially for
workers or athletes that often use repetitive
and forceful movement of the hand. If they find
any abnormality in hand, it will be better to
immediately consult to a doctor to treat their
conditions.
It can be concluded that hand compartment
syndrome is a rare case, mostly affected
younger adults and male. Most of the
symptoms and signs are swelling, limitation
of movement, pain in the location area with
normal sensibility. The procedure to treat
this condition is fasciotomy. Futhermore, the
length of stay is more than 1 week with an
improved outcome.
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Kajendaran Manogaran, Nucki Nursjamsi Hidajat, Arifin Soenggono: Profile of Hand Compartment Syndrome
in Dr. Hasan Sadikin General Hospital, West Java, 2008−2012