Combined Upper Extremity and Gluteal Compartment Syndrome Following Illicit Drug Abuse: A Retrospective Case Series
January 7, 2021
Healthcare providers must be more aware of drug’s potential to cause compartment syndrome. Studies have shown that illicit drug use has been associated with acute compartment syndrome as obtundation and immobility can lead to an increase in pressure within a compartment.
Compartment syndrome is time sensitive and important to emphasize within any setting of illicit drug use. It is common among any drug addict that they are often not fully functional and not able to fully participate a clinical exam (the 5 P’s). The measurement of the intra-compartmental pressure using a pressure monitor is the best method for a proper diagnosis among illicit drug patients. In this specific patient population, all healthcare providers should have a high clinical suspicion for compartment syndrome.
Brief Case Description
This study specifically reports four different cases of both upper and lower extremity compartment syndrome present following trauma and commonly associated with fractures. In a systematic review, upper extremity compartment syndrome was found to be related to fractures in 35% of the cases, and narcotic overdoses occurred in 10%. Depressants, including alcohol and heroin, have been described in the literature in multiple case reports as direct causes of obtundation and immobility leading to compartment syndrome. The authors concluded that due the increased potency of the new formulations compared with THC, these have been associated with higher incidences of obtundation and impossibilities.
Intervention and Outcome Summary
As drugs become more accessible in society, healthcare providers must be more aware of the substance’s potential to cause compartment syndrome. It is important that all health care workers are aware of compartment syndrome and the importance of time to diagnosis and proper diagnosis. When diagnosing a patient under the influence, it is the best to combine clinical signs (the 5 P’s) with the measurement of the patient’s intra-compartmental pressure and to obtain proper medical history. Healthcare providers must obtain a high suspicion for compartment syndrome as the subsequent muscle breakdown can lead to rhabdomyolysis, renal failure, and death. This process is time sensitive, so early diagnosis and treatment is paramount.
Matthew W Konigsberg, John D Mueller, Jordan A Lebovic, R Kumar Kadiyala