Compartment Syndrome

What It Is

• Elevated fascial compartment pressures leading to decreased blood flow within

the compartment.

Why It’s an Emergency

• Decreased blood flow can lead to irreversible ischemic injury with resultant
nerve and muscle damage.

How “Emergent” Is It?

• Truly emergent. Irreversible changes occur in muscles and nerves within

4–8 h.

When to Be Suspicious

• The key to treatment is early recognition and compartment fasciotomies of the

affected limb.
• Increasing pain requirements after an acute injury, usually in the 24–48-h
window.
• Sensory changes (paresthesias) and vascular changes (decreased pulses) are usually
late findings.

© Springer International Publishing Switzerland 2017 15

M.C. Makhni et al. (eds.), Orthopedic Emergencies,
DOI 10.1007/978-3-319-31524-9_4
16 J. Shillingford

How to Diagnose

• Compartment syndrome is primarily a clinical diagnosis

• Historical hallmarks: pain, pallor, paresthesias, pulselessness, paralysis
• Swelling with firmness
• Pain out of proportion to injury and exam *IMPORTANT*

° Earliest and most sensitive finding

° Difficult to assess in sedated, polytrauma, child patients, or patient with significant
nerve damage
° Pain with passive stretch of the muscles within the compartment
° Increasing narcotic requirement
• Stryker needle pressure measurement when exam findings are equivocal or
inconclusive or patient is obtunded (polytrauma or sedated)

° Absolute pressure above 30 mmHg concerning

° “Delta P” = difference between diastolic pressure and compartment pressure
less than 30 mmHg also concerning

How to Treat

• Definitive treatment is emergent fasciotomy/compartment release

References

Hammerberg EM, Whitesides Jr TE, Seiler 3rd JG. The reliability of measurement of tissue pres-
sure in compartment syndrome. J Orthop Trauma. 2012;26(1):24–31.
McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure
threshold for decompression. J Bone Joint Surg Br. 1996;78(1):99–104.
Olson SA, Glasgow RR. Acute compartment syndrome in lower extremity musculoskeletal
trauma. J Am Acad Orthop Surg. 2005;13(7):436–44.