Atraumatic compartment syndrome results from prolonged compression of a limb by an obtunded subject. It is most commonly seen in drug abusers and presentation is frequently late. The key factor in the pathogenesis is the fact that muscle necrosis precedes the development of a compartment syndrome.

We set out to establish if surgical decompression of these compartment syndromes, as recommended in the literature, was justified. We reviewed 16 patients who underwent decompression of 19 limbs within our unit. Patients presented between 5 and 100 hours following their overdose (mean 30.5 hours) and surgery was performed at a mean time of 64.5 hours after admission. Surgical decompression resulted in the requirement for multiple operations, mean 3.7, and an extremely high complication rate. Infection was particularly prevalent, occurring in 10 of the 19 limbs decompressed. Only one of the 16 patients had normal limb function at follow up.

Based on these results and an understanding of the pathogenesis of the condition, we conclude that surgical decompression of atraumatic compartment syndromes is illogical, leads to an increased complication rate and is therefore unjustified.

The purpose of this study was to evaluate the effect on movement under load of different techniques of reattachment of the humeral tuberosities following 4-part proximal humeral fracture.

Biomechanical test sawbones were used. 4-part fracture was simulated and a cemented Neer3 prosthesis inserted. Three different techniques of reattachment of the tuberosities were used – 1)tuberosities attached to the shaft, and to each other through the lateral fins in the prosthesis with one cerclage suture through the anterior hole in the prosthesis, 2)as 1 without cerclage suture, and 3)tuberosities attached to the prosthesis and to the shaft. All methods used a number 5 ethibond suture. Both tuberosities and the shaft had multiple markers attached. Two Digital cameras formed an orthogonal photogrammetric system allowing all segments to be tracked in a 3-D axis system. Humeri were incrementally loaded in abduction using an Instron machine, to a minimum 1200N, and sequential photographs taken. Photographic data was analysed to give 3-D linear and angular motions of all segments with respect to the anatomically relevant humeral axis, allowing intertuberosity and tuberosity-shaft displacement to be measured.

Techniques 1 and 2 were the most stable constructs with technique 3 allowing greater separation of fragments and angular movement. True intertuberosity separation at the midpoint of the tuberosities was significantly greater using technique 3 (p< 0.05). The cerclage suture used in technique 2 added no further stability to the fixation.

In conclusion, our model suggests that the most effective and simplest technique of reattachment involves suturing the tuberosities to each other as well as to the shaft of the humerus. The cerclage suture appears to add little to the fixation in abduction, although the literature would suggest it may have a role in resisting rotatory movements.