Compartment syndrome

Question 1

What are the 4 leg compartments?

Answer 1

Anterior
Lateral/perineal
Superficial posterior
Deep posterior

Question 2

What is the most commonly affected leg compartment?

Answer 2

Anterior

Question 3

What is it?

Answer 3

Increased pressure in the osteofascial compartments
Leads to decreased capillary flow
Resulting in muscle ischaemia
Muscle and nerve necrosis if left untreated

Question 4

What is infarcted muscle replaced by?

Answer 4

Inelastic fibrous tissue

Question 5

Causes (6)

Answer 5

Fractures (elbow, forearm, proximal third of tibia or multiple fractures in hand/foot)
Internal fixation (due to suturing)
Infection
Crush injury
Circumferential burn
Tight plaster cast

Question 6

Clinical features

Answer 6

Six P’s of ischaemia
-Pain
-Paresthesia
-Paralysis
-Pallor
-Pulselessness
-Passively hyperextended - increased pain in calf/forearm

Question 7

Which features normally come on first?

Answer 7

Pain - bursting sensation
Altered sensation
Paresis (muscle weakness)

Question 8

How is it diagnosed?

Answer 8

Most cases are clinically diagnosed (swelling + pain in high risk population)
Use a split catheter to measure intra-compartmental pressure
If the difference between this and general diastolic (differential pressure) is less than 30 then it is diagnosed as compartment syndrome