Isolated Finger Compartment Syndrome Following Crush Injury

Excerpt

A healthy 60-year-old woman presented to her primary care provider with pain, swelling, and purple discoloration in her left third digit (Fig. 1), which developed after a ground-level-fall while running a race one day prior. Exam of the distal phalanx revealed coolness, delayed capillary refill, diminished sensation, pain with flexion, and an absent distal doppler signal. X-ray showed a tuft fracture (Fig. 2). Given pain, pallor, pulselessness, and paresthesia (four of the hallmark “five P's,” excluding paresis), there was concern for compartment syndrome associated with the fracture.¹ Incision and drainage of the digit was performed with hematoma evacuation. The patient was treated with empiric amoxicillin-clavulanic acid for one week given the open fracture after incision. A splint was applied to her distal phalanx for fracture stabilization. At follow-up two weeks later, the patient reported return to baseline function and sensation of the left finger (Fig. 3). While compartment syndrome isolated to one finger is rare,² primary care providers should be vigilant about the classic “five P” signs and symptoms of this condition, particularly in the setting of fracture. If compartment syndrome is suspected, patients should be rapidly referred for surgical evaluation and possible decompression.¹

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