Compartment Syndrome Approach

• 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
  • If chronic:
    • Stop exercise, if persistent + objective measurement -> elective fasciotomy

• 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

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