COMPARTMENT SYNDROME

Authored by Dr. Angie Rombola

Background:

• Occurs when high compartment pressure prevent adequate perfusion
• Irreversible muscle and nerve damage after 4-6 hrs
• Most commonly: lower leg (40%)
• Can occur anywhere skeletal muscle is surrounded by fascia (forearm, thigh, hand, foot, buttock)

Mechanism:

• Fractures (69%)
  • Increased incidence with openfractures
  • Tibial fracture (most common)
• Soft tissue injury 
  • Crush Injuries
  • Contusions
  • Burns
  • Prolonged limb compression 
• External compression 
  • Tight casts, dressings
• Vascular
  • Hemorrhage
• Ischemic-reperfusion injury 
  • Arterial injury 

 
Clinical Features: 

• Common
  • Pain out of proportion (earliest)
  • Pain with passive stretch (most sensitive)
  • Rapidly increasing & tense swelling
• Paresthesias (early)
  • Uncommon
  • Decreased sensation
  • Motor weakness (late)
  • Pulselessness (uncommon)

Diagnosis:

• Primarily a clinical diagnosis
• Measure of tissue pressures is confirmatory 
• Measuring compartment pressure indicated in polytrauma, sedated/AMS patients

Compartment Pressure:

• Intra-compartment pressure: > 30mm Hg
• Delta pressure (DBP – compartment p) < 30 mmHg
  • Better measurement
  • Helps avoid unnecessary fasciotomies 

Management:

• Remove external compressive wrappings
• Address underlying cause
• Surgical consult for fasciotomy
• Supplemental Oxygen
• Correct hypotension
• Reverse patients on anticoagulants

4 Compartments of the lower leg

• Anterior
• Lateral
• Superficial posterior
• Deep posterior 
  

• Need to measure all 4 compartments