Review of compartment syndrome due to group A streptococcal infection.

PURPOSE: To present a case of nontraumatic compartment syndrome secondary to group A streptococcal infection and review the literature regarding this unusual clinical entity. METHODS: Case reports of compartment syndrome due to group A streptococci in the English language literature were identified through a computer-generated search using MEDLINE 1950-2007. Reviews of the cited literature in pertinent articles were also undertaken to find additional cases. Cases with evidence of chronic infection or trauma were excluded; cases were included for analysis if enough demographic information was available to allow identification of individual patients. RESULTS: Thirteen cases, including the current case of group A streptococcus, were identified. The average age was 34 years (range 2-76). The majority of patients (77%) were previously healthy with no significant medical history or evidence of immunosuppression. All patients presented with either fever, or hypotension, or white blood cells >10,000 cells/mm and 77% presented with at least 2 of these signs. All patients received prompt surgical intervention and antibiotic therapy with gram-positive activity. The mortality rate was 15%. CONCLUSIONS: Nontraumatic acute compartment syndrome presenting with fever, or hypotension, or leukocytosis may be associated with infection such as group A streptococcus. Prompt surgical and antibiotic therapy was associated with a relatively low mortality rate. A high clinical index of suspicion should occur for the possibility of infection with an organism such as group A streptococcus in patients presenting with acute extremity pain and tense compartments without trauma and with signs of a systemic inflammatory response.

Medial tibial plateau fractures: a new classification system.

BACKGROUND: : Fractures of the medial plateau are associated with significant soft tissue injuries. A predictive measure of which medial plateau fractures are at higher risk of associated injuries has not been described. The authors propose a simple classification that is both easy to remember, recognize, and predictive of associated injuries. A type A fracture is where the fracture line is medial to the intercondylar spines, a type B is where the fracture line is within the intercondylar spines, and a type C fracture is where the fracture line is lateral to the intercondylar spines. METHODS: : All patients treated at a Level I trauma center for tibial plateau fractures between 1998 and 2005 were identified. The radiographs of these patients were reviewed, and 28 patients were included in the study. The medical charts were then reviewed, and any associated injuries were noted. The patients were placed into one of three groups based on their fracture pattern. RESULTS: : Of the seven type A fractures, there was one patient with compartment syndrome (14%) and another with an ACL tear and medial meniscal tear. Of the 12 type B fractures, there were four patients with compartment syndrome (33%) and one with an ACL avulsion and medial meniscal tear. Of the nine type C fractures, there were six patients with compartment syndrome (67%), one of these also had a peroneal nerve injury, and another patient had an anterior tibial artery injury that required vascular surgery intervention. CONCLUSION: : As the fracture line moves laterally the severity of the associated injuries increases. We think it is significant that the only neurologic and vascular injuries seen were in the type C fractures. Also, we noted an increase propensity for type C fractures to develop compartment syndrome. This information can be helpful during the initial evaluation of the patient so that the physician can be wary of these developing problems.