Compartment
Syndrome
James Mordock
Compartment
Syndrome
What is it?
Definition
Compartment syndrome is a condition where there is an increased pressure in a
muscle compartment that usually leads to an impairment of tissue perfusion.
This commonly affects the lower extremities, but it can occur in other extremities or
abdomen as well.
It is usually categorized as either an acute compartment syndrome (occurs after
trauma) and is considered a surgical emergency presenting with rapid progressive
pain, paresthesia, and pallor or a chronic compartment syndrome (from excessive
training in athletes).
Causes of Compartment Syndrome
External Compression:● Trauma Causes
○ Burn eschars
○ Constrictive bandage/cast applied before limb
has stopped swelling.
● Non-Trauma Causes
○ Prolonged poor positioning of limbs
Internal Compression:● Trauma causes
○ Hematoma and Edema from long bone
fractures
○ Hemorrhage I muscle compartment
○ Burn Edema
○ Reperfusion syndrome with ischemia
● Non-Trauma Causes
○ Spontaneous bleeding in coagulopathic patients
Pathology
I.
External or internal forces as initiating event
II. Increased compartment pressure
III. Obstruction of venous outflow and collapse of arterioles
IV. Decreased tissue perfusion → lower oxygen supply to muscles
V. Irreversible tissue damage (necrosis) to muscles and nerves
after 4–6 hours of ischemia
Clinical Features
Acute compartment syndrome (ACS)
rapid progression of symptoms
Early presentation
 Pain
 Often out of proportion to the extent of injury
 Worse with passive movement or extension of
muscles
 Tight wood like muscles tender for the touch
 Paresthesia
 Tissue swelling
Late presentation
 Muscle weakness to paralysis
 Cold peripheries
 Pallor
 Weak/absent distal pulse
Chronic compartment syndrome
 More common in young athletes and
runners
 Usually effects lower limbs
 Muscle pain, weakness +swelling
worsened with exercise and relieved
with rest
 Paresthesia and numbness
Diagnosis
Compartment pressure measurement
 Delta Pressure ≤ 30 mm Hg assists in diagnosis
Laboratory Test:
 Assess for rhabdomyolysis – creatine
phosphokinase, renal function tests
Imaging:
 X-Ray
 Doppler Ultrasound
 Angiography
Pulse Oximetry – Identify limb hypoperfusion
Treatment options
Compartment Syndrome
1)
Surgical
Treatments
Fasciotomy: relieve pressure and restore
1)
Supportive
Treatments
Eliminate underlying cause
perfusion
2)
Fibulectomy: if fasciotomy fails
3)
Escharotomy: circumferential compression
4)
Amputation: WARNING Last Resort
2)
Cool and position limb to relieve
pressure
3)
Monitor & frequent examination with
Correction of fluid imbalance
4)
Supplemental oxygen
5)
Analgesia
Complications
 Muscle and Soft Tissue Necrosis
 Nerve lesions with paralysis or deficits in
sensory and motor nerves
 Malunion Fractures
 Volkmann ischemic Contracture
 Supracondylar Humeral Fracture
Thanks!
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