Compartment syndrome

Question 1

What is compartment syndrome?

Answer 1

Raised pressure within a fascial compartment.

Raised pressure within the compartment will eventually compromise tissue perfusion resulting in necrosis.

Acute compartment syndrome is an orthopaedic emergency.

Question 2

What are fascial compartments?

Answer 2

Involve muscles, nerves and blood vessels surrounded by fascia.

Question 3

What is fascia?

Answer 3

A sheet of strong, fibrous connective tissue that encases the contents of the compartment.

It is NOT able to stretch or expand.

Question 4

What can cause compartment syndrome?

Answer 4

1) Following fractures

2) Following ischaemia reperfusion injury in vascular patients

Acute compartment syndrome is usually associated with an acute injury, where bleeding or tissue swelling (oedema) associated with the injury increases the pressure within the compartment.

Question 5

What are the 2 main fractures that carry the complication of compartment syndrome?

Answer 5

1) Supracondylar fractures

2) Tibial shaft injuries

Question 6

Features of acute compartment syndrome? (5 P’s)

Answer 6

Pain - “disproportionate” to the underlying injury

Paraesthesia

Pale

Pressure (high)

Paralysis (a late and worrying feature)

Question 7

What increases pain in compartment syndrome?

Answer 7

Movement (even passive)

Question 8

What should raise suspicion for compartment syndrome?

Answer 8

Excessive use of breakthrough analgesia

Question 9

How do the P’s of compartment syndrome differ from acute limb ischaemia?

Answer 9

Compartment syndrome –> pulses can STILL be felt

Question 10

How is a diagnosis of compartment syndrome made?

Answer 10

Primarily a clinical diagnosis.

BUT can use needle manometry to measure the compartment pressure.

Question 11

What intracompartmental pressure is diagnostic of compartment syndrome?

Answer 11

Pressures in excess of 20mmHg are abnormal and >40mmHg is diagnostic

Question 12

Definitive mx of compartment syndrome?

Answer 12

Emergency fasciotomy

Also ensure to:
1) Remove any external dressings or bandages
2) Elevate the leg to heart level
3) Maintaining good BP (avoiding hypotension)

Question 13

What is a fasciotomy?

Answer 13

A surgical operation to cut through the fascia, down the entire length of the compartment, and release the pressure.

Question 14

What complication can occur following a fasciotomy?

Answer 14

Myoglobinuria –> can cause renal failure.

Give aggressive IV fluids.

Question 15

In compartment syndrome, how quickly can death of muscle groups occur?

Answer 15

4-6 hours