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Anatomic bases of the forearm compartment syndrome

Bases anatomiques des syndromes compartimentaux de l'avant-bras

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Summary

One of the most common sites for the compartment syndrome (CS) is the forearm. Its compartments have been studied by injection of colored gelatin into the particular anatomical spaces. The three “pressure — measuring — points” recommended in the clinical literature to measure intracompartmental tissue pressure in equivocal diagnostic cases were used for the dye injections on the forearms of five preserved cadavers of adults. However, instead of the compartments especially affected in CS two adjacent spaces were revealed. In order to elucidate the clinical relevant spaces two additional approaches for the injection had been used. Cross-sections at 15 mm intervals of the injected forearms had been performed. Some of them are presented and schematically summarized in this article. Recent studies have suggested that there are different guidelines for description of the anatomically isolated spaces. However, especially one of these spaces seems to be responsible for the CS on the forearm. The remarkable features of this so called “deep flexor compartment” are its very restrictive envelopes, its rare fascial contacts, its impermeable seal in proximal-radial direction as well as the extremely endangered structures within the compartment. The flexor carpi ulnaris muscle is recommended to be the “primary structure” for measuring the tissue pressure as well as for surgical decompression. The article reviews the anatomical base of the CS.

Résumé

L'un des sites les plus courants des syndrômes canalaires est l'avant-bras. Ses compartiments ont été étudiés par injection de gélatine colorée dans les différents espaces anatomiques. La prise de pression en trois points, recommandée dans la littérature clinique pour mesurer la pression tissulaire intra-compartimentale en cas de diagnostic douteux, a été utilisée pour les injections d'avant-bras de 5 cadavres adultes embaumés. Cependant au niveau des compartiments affectés spécialement par les syndrômes canalaires, deux espaces adjacents supplémentaires ont été observés. Pour préciser ces espaces d'intérêt clinique, deux sites d'injection supplémentaires ont été utilisés. Des coupes transversales séparées par des intervalles de 15 mm ont été réalisées sur les avant-bras ainsi injectés. Certaines d'entre elles sont présentées et schématisées dans cet article. Des études récentes ont suggéré qu'il y avait différentes façons de décrire l'anatomie de ces compartiments. Cependant, l'un surtout de ces compartiments semble être incriminé dans les syndrômes canalaires de l'avant-bras. Les observations principales relatives à ce compartiment profond des mm. fléchisseurs concernent ses enveloppes peu extensibles, ses contacts limités avec le fascia antébrachial, l'absence quasi complète d'ouverture en direction proximo-radiale et les structures particulièrement vulnérables cheminant dans ce compartiment. Le m. fléchisseur ulnaire du carpe apparaît comme la structure première au niveau de laquelle est mesurée la pression tissulaire et réalisée la décompression chirurgicale. Cet article fait aussi le point des bases anatomiques des syndrômes canalaires.

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Fröber, R., Linss, W. Anatomic bases of the forearm compartment syndrome. Surg Radiol Anat 16, 341–347 (1994). https://doi.org/10.1007/BF01627651

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