Patients “found down” after an opioid overdose can develop crush injuries that result in compartment syndrome, and these patients were found to have a high rate of surgical complications and poor recovery of function, according to a study published in the Journal of Bone and Joint Surgery.

The worsening opioid epidemic has increased the number of patients with crush injuries after being “found down” after an overdose. These crush injuries can result in unique compartment syndrome presentations, with rhabdomyolysis, muscle necrosis, and elevated compartment pressures. For this retrospective review of the records of patients who were admitted to a trauma center with these types of injuries, the investigators examined clinical data and outcomes for patients who underwent fasciotomy or remained under observation. A total of 30 patients treated over the course of 12 years were classified into 3 groups according to presentation (unexaminable, complete deficits, or partial deficits) and their functional status, laboratory values, hospital course, and operative findings were examined.

Of these 30 patients, 25 received fasciotomy, with an average of 4.2 operations per patient. In this group the amputation and infection rates were as% and 20%, respectively. Typically, these patients had elevated levels of creatinine, creatinine phosphokinase, and lactate, but these were not associated with a return of function or muscle viability. Muscle appeared to be nonviable at the time of the initial debridement in 56% of patients, although 28% of those with questionable muscle viability saw returning muscle function. On initial examination, 4 patients had no neurological or motor function, and none of the 4 had a meaningful return to functioning at the latest follow-up. Of the 10 patients with partial neurological deficits at presentation, 70% experienced some improvements in ultimate function after fasciotomy.

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 “Patients who are ‘found down’ following an opiate overdose with crush injuries resulting in compartment syndrome have a high surgical complication rate and poor recovery of function. The limited data from the present study suggest that those with absent function at the time of presentation are unlikely to gain function after fasciotomy, and the risk-benefit ratio of fasciotomy in this patient population may be different from that for patients with traumatic compartment syndrome,” concluded the stud authors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Parzych L, Jo J, Diwan A, Swart E. “Found down” compartment syndrome: Experience from the front lines of the opioid epidemicJ Bone Joint Surg Am. 2019;101(17):1569-1574.