Nathan McNeil, MD 11/22/2010

 “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.

 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

 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

 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

 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

 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

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

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