UPPER EXTREMITY FASCIOTOMY - SUFFICIENCY OF CLINICAL-ASSESSMENT AND RELATIONSHIP TO PERSISTENT FUNCTIONAL DEFICIT

The authors analyzed 11 upper extremity fasciotomies performed for spe cific clinical indications following trauma and evaluated the reliabil ity of the clinical diagnosis and causes of postsurgical reduced funct ional recovery. Tissue-pressure measurements were not used in this stu dy. Types of injury in 11 study patients included: four (36%) gunshot, three (27%) blunt, three (27%) intravascular drug injections, and one (9%) shotgun. Average time from injury to fasciotomy was 9.25 (range: 2 to 18) hours. After follow-up evaluation at 6 weeks to 3 months, fo ur (36%) patients had full functional recovery of the limb; 7 (64%) ha d diminished function. Two patients required amputation: one after a s hotgun injury complicated by sepsis and another in a drug-abuse patien t with pressure necrosis secondary to an extended period of prehospita l unconsciousness. Diagnosis of upper extremity compartment syndrome w as reliably made by using specific and accepted clinical criteria. Des pite early fasciotomy, significant morbidity resulted.