Compartment syndrome

Question 1

What is compartment syndrome?

Answer 1

A critical pressure increase within a confined fascial compartment.

Question 2

What are common causes of compartment syndrome?

Answer 2

High energy trauma or fractures that cause vascular injury
Iatrogenic vascular injury
Tight casts or splints
Thrombosis (DVT)

Question 3

How does compartment syndrome commonly present?

Answer 3

Within hours of trauma/injury

• severe pain = not improved by analgesia, elevation etc.
• worse when passively stretching the muscles
• parasthesia - due to fluid compression of nerves
• tense feel

Late presentation
- acute arterial insufficiency - 6Ps - pain, pallor, parasthesia, perishingly cold, paralysis, pulselessness

Question 4

How is compartment syndrome diagnosed?

Answer 4

Based on clinical picture

• intracompartment pressure monitoring is sometimes used
• creatine kinase may also be elevated

Question 5

How is compartment syndrome managed?

Answer 5

Urgent fasciotomy
( before this give oxygen, remove any dressings/ casts, analgesia etc)

After fasciotomy - skin incision left open - assessed in 24-48 hrs for any necrosis that needs to be debrided

Monitor renal function (rhabdomyolysis / reperfusion injury)

Question 6

What occurs if compartment syndrome isn’t treated quickly?

Answer 6

Necrosis of nerve and muscle tissue within that compartment