- Definition:
- ↑ of pressure w\in a confined anatomical compartment -> compromised perfusion
- Most common:
- Leg (esp anterior compartment), forearm
- Causes:
- Fractures, hematoma, constrictive cast, burns, thermal injuries, frost bites, IV fluid extravasation
- Ddx:
- DVT
- Ischemia
- Muscle rupture
- Cellulitis
- Peripheral nerve injury
- Clinical presentation:
- Pain out of proportion
- 3 sings: pain w\ passive stretch, decreased two-point discrimination, decreased vibration
- Swollen, tense compartment
- Hypo\paresthesia in the compartment’s nerve distribution
- Paralysis, pallor, pulseless (late findings)
- Diagnosis:
- If the pt is awake: diagnosis is made clinically
- If the pt is not awake:
- Pressure measurement (w\ either Stryker needle or pump method)
- Absolute pressure > 30 mmHg
- Diastolic pressure – compartment pressure < 30 mmHg
- If chronic\exertional compartment syndrome:
- Measure pre- and post-exercise compartment pressure; difference of > 20 mmHg
- Treatment:
- If acute:
- Urgent fasciotomy to all 4 leg compartments (w\in 6 hrs)
- Anterolateral incision -> anterior + lateral compartment
- Risk: injury to superficial peroneal N
- Medial incision -> deep + superficial posterior compartments
- Urgent fasciotomy to all 4 leg compartments (w\in 6 hrs)
- If chronic:
- Stop exercise, if persistent + objective measurement -> elective fasciotomy
- If acute:
- Care for fasciotomy incisions:
- Closure is by either VAC or shoelace technique
- Take to OR every 48 hrs to debride and change
- Complications:
- Volkmaan’s contractures
- Rhabdomyolysis
- Renal failure