Found Down: Non-Traumatic Acute Extremity Compartment Syndrome Secondary to Substance Use
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Smith, Richard David James
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CitationSmith, Richard David James. 2020. Found Down: Non-Traumatic Acute Extremity Compartment Syndrome Secondary to Substance Use. Doctoral dissertation, Harvard Medical School.
AbstractBackground: Non-traumatic acute extremity compartment syndrome (NTAECS) is an orthopedic emergency that can lead to extensive morbidity and even death. As the opioid epidemic has spread across America, NTAECS secondary to substance use has become an increasingly common problem. While operative treatment is common for traumatic acute extremity compartment syndrome, it is unclear whether patients with NTAECS secondary to substance use should be managed operatively or non-operatively.
Aims and hypotheses: The primary aim of this study was to compare clinical outcomes in patients treated operatively vs non-operatively for NTAECS secondary to substance use. The secondary aims of this study were to determine patient demographics, clinical symptoms, diagnostic tests, and hospital course. The null hypothesis of this study was that there would be no difference in clinical outcomes of patients treated operatively compared to patients treated non-operatively.
Materials and methods: This was an institutional review board-approved retrospective review of the electronic medical records of patients who developed NTAECS secondary to substance use. The Research Patient Database Registry (RPDR) system was queried using the ICD-10 codes for ‘non-traumatic compartment syndrome’ from January 2006-December 2019 for patients treated within the Partners Health Care System Hospitals. Data was extracted from the electronic medical record of eligible patients. Patients were divided based on treatment into the ‘operative group’ or ‘non-operative group'.
Results: Over the 14-year period, 91 patients were identified and included in this study. Eighty-five patients were treated operatively, and 6 patients were treated non-operatively. The average age of patients in the operative group was 37 compared to 33 in the non-operative group. The majority of patients in both groups were male. Opioids were the most common substance used in both groups, with many patients using more than one substance. Patients in the operative group underwent an average of 4 surgeries during their hospitalization and 37 (44%) required a skin graft. Wound infections developed in 21 (25%) patients in the operative group and 9 (11%) patients underwent limb amputation. In the non-operative group, no patients developed a wound infection and no patient required a limb amputation. Persistent weakness, persistent sensory deficit, and contractures were common complications in both groups. There was a trend that patients treated operatively had higher rates of persistent pain at follow-up, but this did not reach statistical significance.
Conclusion: NTAECS secondary to substance use is an increasingly common problem that often leaves young adults with life-long disability. The results from this study suggest that clinical outcomes are similar in patients treated operatively and non-operatively. However, patients treated operatively required more procedures and had higher rates of wound infection and amputation compared to patients in the non-operative group. This patient population also faces difficulty accessing healthcare and attending follow-up appointments. These factors should be considered when deciding how best to treat patients who develop NTAECS secondary to substance use.
Citable link to this pagehttps://nrs.harvard.edu/URN-3:HUL.INSTREPOS:37365234