Transcript Compartment Syndrome

Nathan McNeil, MD
11/22/2010
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“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.
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40% of all acute compartment syndromes occur
after fractures of the tibial shaft.
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Incidence from 1-10%
23% of are caused by soft-tissue injuries with
no fracture
18% are caused by fractures of the forearm
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The end results of an unchecked acute
compartment syndrome is catastrophic,
including:
neurological deficit
 muscle necrosis
 ischemic contracture
 infection
 delayed healing of a fracture
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Early diagnosis and treatment crucial to
prevent irreversible damage
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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
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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
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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
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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
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Less than or equal to 30 mmHg significant
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Timing: within 6 hours of onset of
compartment syndrome is generally
recommended guideline.
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DIAGNOSING ACUTE COMPARTMENT
SYNDROME. Journal of Bone & Joint Surgery British Volume. 85-B(5):625-632, July 2003