[39] Compartment Syndrome

Question 1

What is compartment syndrome?

Answer 1

Critical pressure increase within a confined compartmental space

Question 2

What fascial compartment can be affected in compartment syndrome?

Answer 2

Any

Question 3

What are the most commonly affected sites in compartment syndrome?

Answer 3

• Leg
• Thigh
• Forearm
• Foot
• Hand
• Buttock

Question 4

When does compartment syndrome typically occur?

Answer 4

• High energy trauma
• Crush injuries
• Fractures that cause vascular injury

Question 5

What are the other causes of compartment syndrome?

Answer 5

• Iatrogenic vascular injury
• Tight casts or splints
• Deep vein thrombosis
• Post-reperfusion swelling

Question 6

Why does compartment syndrome happen?

Answer 6

Fascial compartments are closed and cannot be distended; consequently, any fluid that is deposited therein will cause an increase in the intra-compartmental pressure.

Question 7

What happens as the pressure increases in a fascial compartment?

Answer 7

The veins will be compressed, increasing the hydrostatic pressure and causing fluid to move down its gradient and out of the veins into the compartment, worsening the problem

Question 8

What happens after compression of veins in compartment syndrome?

Answer 8

Traversing nerves are compressed

Question 9

What is the result of the compression of traversing nerves in compartment syndrome?

Answer 9

This causes a sensory +/- motor deficit in the distal distribution. Paraesthesia is therefore a common symptom.

Question 10

What is the final stage in compartment syndrome?

Answer 10

As the intra-compartmental pressure reaches the diastolic blood pressure, the arterial inflow will be compromised, leading to ischaemia

Question 11

How long does compartment injury take to present?

Answer 11

Symptoms tend to present within hours, although can take up to 48 hours post-insult

Question 12

What is the most reliable symptom of compartment syndrome?

Answer 12

Sever pain, disproportionate to the injury, which is not readily improved with initial measures

Question 13

What makes the pain worse in compartment syndrome?

Answer 13

Passively stretching the muscle bellies of the muscles traversing the affected fascial compartment.

Question 14

What are the other clinical features of compartment syndrome?

Answer 14

• Paresthesia distally
• Affected compartment may feel tense
• Features of acute arterial insufficiency

Question 15

Will the compartment appear swollen in compartment syndrome?

Answer 15

No (because fascial compartment is only minimally distensible)

Question 16

When does features of acute arterial insufficiency develop in compartment syndrome?

Answer 16

If the disease progresses and compartment syndrome is missed

Question 17

What are the features of acute arterial insufficiency?

Answer 17

• Pain
• Pallor
• Perishingly cold
• Paralysis
• Pulselessness

Question 18

On what basis is a diagnosis of compartment syndrome made?

Answer 18

Essentially clinically

Question 19

What is the most reliable diagnostic test in compartment syndrome?

Answer 19

Intra-compartmental pressure monitor

Question 20

When might an intra-compartmental pressure monitor be utilised in compartment syndrome?

Answer 20

When there is clinical uncertainty, such as typical presentations or if patient is unconscious

Question 21

What else may aid diagnosis of compartment syndrome?

Answer 21

CK (if elevated or trending upwards)

Question 22

What is the most important part of management of compartment syndrome?

Answer 22

Early recognition and immediate surgical treatment via urgent fasciotomies

Question 23

What does initial management of compartment syndrome, prior to definitive intervention, include?

Answer 23

• Keep limb at neutral level with patient
• High flow oxygen
• Augment blood pressure with bolus of IV crystalloid fluids
• Remove all dressings/splints/casts, down to skin
• Treat symptomatically with opioid analgesia

Question 24

What should be done once fasciotomies have been performed in compartment syndrome?

Answer 24

Skin incisions are left open and re-look planned for 24-48 hours

Question 25

Why is a re-look done in compartment syndrome?

Answer 25

To assess for any dead tissue, which will need to be derided

Question 26

What should be done once happy that remaining tissues are healthy in compartment syndrome?

Answer 26

Wounds can be closed

Question 27

What should be monitored after treatment for compartment syndrome?

Answer 27

Renal function

Question 28

Why should renal function be monitored after treatment for compartment syndrome?

Answer 28

Due to potential effects of rhabdomyolysis or repercussion injury