Rhabdomyolysis and acute compartment syndrome

Dr. Oldham presented a fascinating case of a young gentleman with severe depression who presented with RLE pain, swelling, and weakness in the setting of prolonged immobilization, who was found to have AKI, myoglobinuria, and elevated CK concerning for rhabdomyolysis. He subsequently developed acute compartment syndrome requiring fasciotomy.

Learning Points:

1) Rhabdomyolysis

Rhabdomyolysis causes can be categorized as traumatic (crush syndrome, prolonged immobilization), non-traumatic exertional (marked exertion in untrained individuals, hyperthermia, metabolic myopathies), and non-traumatic non-exertional (drugs or toxins, infections, or electrolyte disorders).

Complications of rhabdo include AKI, compartment syndrome and DIC.

Heme pigment injures kidneys in three ways: tubular obstruction, direct proximal tubular epithelial cell injury, and vasoconstriction.

2) Acute compartment syndrome

Causes: long bone fracture, trauma without fracture (crush injury, burns), non-traumatic cases (ischemia-reperfusion injury, thrombosis, bleeding disorders, vascular disease, prolonged limb compression).

Clinical features: the 5 P's

  • Pain out of proportion to apparent injury
  • Pallor
  • Pulselessness
  • Paresthesia
  • Paralysis

The utility of these clinical features is debatable, but it is true that the probability of compartment syndrome increases if three or more findings are present.

When in doubt, it is best to perform serial exams and involve our surgical colleagues.