Compartment syndrome

Question 1

What is acute compartment syndrome?

Answer 1

An orthopaedic emergency

Pressure within a fascial compartment is abnormally elevated

Blood flow to the contents of that compartment cut off

(Fascia is unable to stretch/expand and surrounds fascial compartments containing muscles, nerves and BVs)

Question 2

Presentation of acute compartment syndrome

Answer 2

Usually after an acute injury e.g. bone fractures, crush injuries

5Ps

• Pain disproportionate to injury and worsened by passive stretch - key feature
• Paraesthesia
• Pale
• Pressure (high)
• Paralysis (late and worrying feature)

Question 3

How can acute compartment syndrome be differentiated from acute limb ischaemia?

Answer 3

Pulses remain intact in compartment syndrome

Question 4

Management of acute compartment syndrome

Answer 4

Mostly a clinical diagnosis

Needle manometry can be used to measure compartment pressure

Initial management:

• Escalate to senior orthopaedic team
• Remove external dressings
• Maintain good BP (avoid hypotension

Definitive management - fasciotomy (+ debridement of any necrotic muscle)

Wound is left open and covered with dressing

Patients need repeated theatre (every few days) to explore for necrosis and debride it

Skin closed gradually as swelling improves (graft may be needed)

Question 5

What is chronic compartment syndrome?

Answer 5

Usually associated with exertion

Compartment pressure rises during exertion restricting blood flow

Symptoms as in acute compartment syndrome but symptoms quickly resolve with rest

Not an emergency

Needle manometry can be used to investigate and may be treated with fasciotomy