COMPARTMENT SYNDROME

Nathan McNeil, MD11/22/2010

Definition

“a condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space”

Most common after injuries to leg and forearm, but can occur in any enclosed space.

Compartment Syndrome

40% of all acute compartment syndromes occur after fractures of the tibial shaft. Incidence from 1-10%

23% of are caused by soft-tissue injuries with no fracture

18% are caused by fractures of the forearm

Outcomes

The end results of an unchecked acute compartment syndrome is catastrophic, including: neurological deficit muscle necrosis ischemic contracture infection delayed healing of a fracture

Early diagnosis and treatment crucial to prevent irreversible damage

Diagnosis

Making the diagnosis is often difficult and the decision to operate is often delayed.

No reliable, clear-cut diagnostic guidelines exist.

Usually diagnosis is clinical

Diagnosis

Constellation of physical signs and symptoms which include: increasing pain out of proportion to the stimulus altered sensation pain on passive stretch of the affected muscle

compartment muscle weakness palpable tenseness of the compartment

Based on the clinical studies which have been undertaken to date the symptoms and signs which appear to be the most reliable in making an early diagnosis, are increasing pain and pain on passive stretching of the muscles within the affected compartment

Compartment Pressure Measurement

Handheld devices have limitations in accuracy

Absolute intracompartmental pressure above which fasciotomy should be performed range from 30 – 50 mmHg (lower value more commonly used)

“Delta pressure” Diastolic blood pressure minus intracompartmental pressure Less than or equal to 30 mmHg significant

Treatment--Fasciotomy

Treatment--Fasciotomy

Timing: within 6 hours of onset of compartment syndrome is generally recommended guideline.

References

DIAGNOSING ACUTE COMPARTMENT SYNDROME. Journal of Bone & Joint Surgery - British Volume. 85-B(5):625-632, July 2003