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• Re:Response to Gluteal compartment syndrome with severe rhabdomyolysis
  Nitisha Narayan
  Published on: 30 July 2014
• Response to Gluteal compartment syndrome with severe rhabdomyolysis
  Mark D Latimer
  Published on: 1 October 2013

• Published on: 30 July 2014

  Re:Response to Gluteal compartment syndrome with severe rhabdomyolysis

  • Nitisha Narayan, Surgical Trainee

  Dear Mr. Latimer Thanks you for your response to my case report. Fasciotomy and debridement in the presence of crush syndrome is a controversial topic. As far as evidence is concerned there are proponents and opponents of fasciotomy in the presence of rhabdomyolysis. Although there is a theoretical risk of worsening the renal function and electrolyte imbalance, leaving the compartment closed in the presence of clinical...

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  Dear Mr. Latimer Thanks you for your response to my case report. Fasciotomy and debridement in the presence of crush syndrome is a controversial topic. As far as evidence is concerned there are proponents and opponents of fasciotomy in the presence of rhabdomyolysis. Although there is a theoretical risk of worsening the renal function and electrolyte imbalance, leaving the compartment closed in the presence of clinical evidence of compartment syndrome is not advisable. I have reference some recent evidence that suggest that the most appropriate treatment for crush syndrome is on going resuscitation to restore renal function and electrolyte balance but if there is an associated compartment syndrome, the compartments have to be surgically released. In our case if the compartment hadn't been released it could have led to permanent damage to the sciatic nerve. Secondly, leaving dead muscle in a patient who is already immunocompromised can lead to life threatening sepsis. Therefore, the management of crush syndrome with compartment syndrome should consist of continuous medical management along with surgical release of compartment, the decision is however clinical and should be tailored to the individual patient.

  References:

  1. Shaikh N. Complication of crush injury, but a rare compartment syndrome. J Emerg Trauma Shock 2010 Apr;3(2):177-81.

  2. Mrsi V1, Nesek Adam V, Grizelj Stojc E, Rasi Z, Smiljani A, Turci I. Acute rhabdomyolysis: a case report and literature review Acta Med Croatica 2008 Jul;62(3):317-22.

  3. Genthon A, Wilcox SR. Crush syndrome: a case report and review of the literature J Emerg Med 2014 Feb;46(2):313-9.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 1 October 2013

  Response to Gluteal compartment syndrome with severe rhabdomyolysis

  • Mark D Latimer, Consultant Trauma & Orthopaedic Surgeon
  • Other Contributors:
    • Nnamdi J Obi

  Dear Editor,

  We read with great interest the case report entitled "Gluteal compartment syndrome with severe rhabdomyolysis" by Naryan et al. (1) This is an outstanding case report and is a useful reminder to all trauma surgeons of the urgent necessity for aggressive re-hydration and alkaline diuresis in patients presenting with severe muscle crush injuries.

  We have little doubt that the team at The Roy...

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  Dear Editor,

  We read with great interest the case report entitled "Gluteal compartment syndrome with severe rhabdomyolysis" by Naryan et al. (1) This is an outstanding case report and is a useful reminder to all trauma surgeons of the urgent necessity for aggressive re-hydration and alkaline diuresis in patients presenting with severe muscle crush injuries.

  We have little doubt that the team at The Royal London Hospital saved this mans life through their immediate resuscitation. However, the role of fasciotomy in the treatment of crush injuries is less certain.

  A recent article by Reis and Better claims rather emphatically that:

  'In view of the evidence that has accumulated it can now be categorically stated that fasciotomy is contraindicated in patients with closed acute muscle crush compartment syndrome'. (2)

  The authors have clearly achieved an excellent outcome for this patient and we would be very interested to know how they might wish to refine the advice offered by Reis and Better.

  Your sincerely,

  Mark D Latimer MA MEng FRCS

  Nnamdi J Obi BSc MBBS MRCS

  References

  1. Narayan N, Griffiths M, Patel HDL. Gluteal compartment syndrome with severe rhabdomyolysis. BMJ Case Rep 2013; doi:10.1136/bcr-2013-010370

  2. Reis ND, Better OS. Mechanical muscle-crush injury and acute muscle-crush compartment syndrome. J Bone Joint Surg (Br) 2005;87-B:450-3

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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