Acute Compartment Syndrome

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Abstract

Acute compartment syndrome is a pathological process where increased intra-compartmental pressures result in decreased tissue perfusion, leading to cellular anoxia and death if cellular perfusion is not restored. Compartment syndrome can occur in any location of the upper or lower extremities but is most commonly diagnosed in the leg and forearm. Diagnostic methods remain imperfect, with serial physical examinations as the mainstay of diagnosis. Direct pressure measurements with commercial devices or an arterial line setup can be made. A difference ≤30 mmHg between the diastolic blood pressure and intra-compartmental pressure (∆P) is a recommended threshold for fasciotomy. However, direct pressure measurements have been shown to be inaccurate with significant inter-observer variability and high false positive rates. Pressure measurements are best used in obtunded patients or those where physical examination is clouded due to other factors. Once diagnosed, treatment is simple with decompressive fasciotomies, which merely require a scalpel and anatomic knowledge.

Keywords

Compartment syndrome Fasciotomies Acute compartment syndrome; 
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Supplementary material

Video 41.1

Four compartment fasciotomies of the leg are demonstrated in a 37-year-old male status post motor vehicle collision with compartment syndrome and an ipsilateral tibial plateau fracture (MP4 343581 kb)

References

  1. 1.
    Frink M, Klaus AK, Kuther G, Probst C, Gosling T, Kobbe P, et al. Long term results of compartment syndrome of the lower limb in polytraumatised patients. Injury. 2007;38(5):607–13.CrossRefPubMedGoogle Scholar
  2. 2.
    Crespo AM, Manoli 3rd A, Konda SR, Egol KA. Development of compartment syndrome negatively impacts length of stay and cost after tibia fracture. J Orthop Trauma. 2015;29(7):312–5.CrossRefPubMedGoogle Scholar
  3. 3.
    Volkmann R. Die ischämischen Muskellähmungen und Kontracturen. Centralblatt für Chirurgie. 1881;8:801–3.Google Scholar
  4. 4.
    Jepsen P. Ischemic contracture. Ann Surg. 1926;86(6):785–95.CrossRefGoogle Scholar
  5. 5.
    Bisarya K, George S, El Sallakh S. CASE REPORT acute compartment syndrome of the forearm following blood gas analysis postthrombolysis for pulmonary embolism. Eplasty. 2013;13, e15.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Witkowski M, Mochmann HC, Rauch U, Knie W, Landmesser U, Skurk C. Acute thrombotic occlusion of the left brachial artery after intra-arterial administration of amiodarone. Crit Care Med. 2015.Google Scholar
  7. 7.
    Chavez JM, Gonzalez PG. Suspected lumbar compartment syndrome: a rare cause of low back pain after strenuous exercise. Spine J. 2013;13(10):1409–10.CrossRefPubMedGoogle Scholar
  8. 8.
    Duckworth AD, Mitchell SE, Molyneux SG, White TO, Court-Brown CM, McQueen MM. Acute compartment syndrome of the forearm. J Bone Joint Surg Am. 2012;94(10), e63.CrossRefPubMedGoogle Scholar
  9. 9.
    O’Toole RV, Whitney A, Merchant N, Hui E, Higgins J, Kim TT, et al. Variation in diagnosis of compartment syndrome by surgeons treating tibial shaft fractures. J Trauma. 2009;67(4):735–41.CrossRefPubMedGoogle Scholar
  10. 10.
    McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg (Br). 2000;82(2):200–3.CrossRefGoogle Scholar
  11. 11.
    Hope MJ, McQueen MM. Acute compartment syndrome in the absence of fracture. J Orthop Trauma. 2004;18(4):220–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Branco BC, Inaba K, Barmparas G, Schnuriger B, Lustenberger T, Talving P, et al. Incidence and predictors for the need for fasciotomy after extremity trauma: a 10-year review in a mature level I trauma centre. Injury. 2011;42(10):1157–63.CrossRefPubMedGoogle Scholar
  13. 13.
    Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg. 2002;10(6):620–30.CrossRefPubMedGoogle Scholar
  14. 14.
    Ulmer T. The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder? J Orthop Trauma. 2002;16(8):572–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Whitesides TE, Haney TC, Morimoto K, Harada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res. 1975;113:43–51.CrossRefGoogle Scholar
  16. 16.
    Hargens AR, Romine JS, Sipe JC, Evans KL, Mubarak SJ, Akeson WH. Peripheral nerve-conduction block by high muscle-compartment pressure. J Bone Joint Surg Am. 1979;61(2):192–200.CrossRefPubMedGoogle Scholar
  17. 17.
    Heckman MM, Whitesides Jr TE, Grewe SR, Judd RL, Miller M, Lawrence 3rd JH. Histologic determination of the ischemic threshold of muscle in the canine compartment syndrome model. J Orthop Trauma. 1993;7(3):199–210.CrossRefPubMedGoogle Scholar
  18. 18.
    Whitney A, O’Toole RV, Hui E, Sciadini MF, Pollak AN, Manson TT, et al. Do one-time intracompartmental pressure measurements have a high false-positive rate in diagnosing compartment syndrome? J Trauma Acute Care Surg. 2014;76(2):479–83.CrossRefPubMedGoogle Scholar
  19. 19.
    Large TM, Agel J, Holtzman DJ, Benirschke SK, Krieg JC. Interobserver variability in the measurement of lower leg compartment pressures. J Orthop Trauma. 2015;29(7):316–21.CrossRefPubMedGoogle Scholar
  20. 20.
    McQueen MM, Christie J, Court-Brown CM. Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg (Br). 1996;78(1):95–8.Google Scholar
  21. 21.
    Guse TR, Ostrum RF. The surgical anatomy of the radial nerve around the humerus. Clin Orthop Relat Res. 1995;320:149–53.Google Scholar
  22. 22.
    Maheshwari R, Taitsman LA, Barei DP. Single-incision fasciotomy for compartmental syndrome of the leg in patients with diaphyseal tibial fractures. J Orthop Trauma. 2008;22(10):723–30.CrossRefPubMedGoogle Scholar
  23. 23.
    Rorabeck CH. The treatment of compartment syndromes of the leg. J Bone Joint Surg (Br). 1984;66(1):93–7.Google Scholar
  24. 24.
    Sheridan GW, Matsen 3rd FA. Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg Am. 1976;58(1):112–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Finkelstein JA, Hunter GA, Hu RW. Lower limb compartment syndrome: course after delayed fasciotomy. J Trauma. 1996;40(3):342–4.CrossRefPubMedGoogle Scholar
  26. 26.
    Matsen 3rd FA, Stephens L, Jette JL, Warme WJ, Posner KL. Lessons regarding the safety of orthopaedic patient care: an analysis of four hundred and sixty-four closed malpractice claims. J Bone Joint Surg Am. 2013;95(4):e201–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Bhattacharyya T, Vrahas MS. The medical-legal aspects of compartment syndrome. J Bone Joint Surg Am. 2004;86-A(4):864–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Cascio BM, Wilckens JH, Ain MC, Toulson C, Frassica FJ. Documentation of acute compartment syndrome at an academic health-care center. J Bone Joint Surg Am. 2005;87(2):346–50.PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryMcGovern Medical School at University of Texas Health Science Center at HoustonHoustonUSA

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