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Compartment Syndrome: Pathophysiology, Diagnosis, and Treatment

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Textbook of Polytrauma Management

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Abstract

Acute compartment syndrome (ACS) is a potentially devastating development typically following trauma but may occur following atraumatic events and even as a result of patient positioning during surgery. The common pathway leading to the development of an ACS is increased intercompartmental pressures resulting in compromised blood flow, muscle and nerve ischemia, and potential muscle and nerve necrosis. Vigilance, early recognition, and definitive diagnosis of an ACS are essential for successful treatment of this pathologic process. Vigilance comes from understanding that there are many possible-initiating factors for ACS and early diagnosis and treatment depend upon a thorough understanding of the sometimes-subtle symptomatology of a developing, or established ACS. Once the diagnosis of an ACS is established or strongly suspected, treatment must be initiated without delay. The definitive treatment for an ACS is fasciotomies of the involved muscle compartments to restore normal intra-compartment tissue pressures and re-establish normal blood flow. It is important to remember “time is tissue” and “a chance to cut, is a chance to cure” in the treatment of an ACS. Although fasciotomies are not without risks and complications, they are the only effective recognized treatment for an ACS. Certainly, every orthopedic surgeon and any physician likely to come into contact with a patient suffering an ACS should be familiar with the different clinical scenarios and presentations that have been associated ACS and be familiar with means to make a diagnosis of an ACS or consult others more familiar with the condition. Early identification of a developing ACS allows timely and effective treatment which can minimize tissue damage and maximize outcomes. This chapter reviews (i) the mechanism by which an ACS develops, (ii) the various clinical scenarios that have been associated with the development of an ACS, and (iii) most importantly the clinical findings that are typically associated with an ACS, and (iv) the various muscle compartments throughout the body and how best to surgically decompress each in an effort to minimize the potential damage from an ACS.

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Authors and Affiliations

  1. Department of Orthopedics and Sports Medicine, University of South Florida, Morsani College of Medicine/Florida Orthopaedic Institute, Tampa, FL, USA

    Joseph Borrelli Jr. & David Donohue

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  1. Joseph Borrelli Jr.
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  2. David Donohue
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Editors and Affiliations

  1. Department of Trauma Surgery, University Hospital Zürich, Zürich, Switzerland

    Hans-Christoph Pape

  2. Department of Orthopaedic Surgery & Sports Medicine, The University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Joseph Borrelli Jr.

  3. Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA

    Ernest E. Moore

  4. Klinik für Traumatologie, University Hospital of Zürich, Zürich, Switzerland

    Roman Pfeifer

  5. Rocky Vista University, College of Osteopathic Medicine, Parker, CO, USA

    Philip F. Stahel

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Borrelli, J., Donohue, D. (2022). Compartment Syndrome: Pathophysiology, Diagnosis, and Treatment. In: Pape, HC., Borrelli Jr., J., Moore, E.E., Pfeifer, R., Stahel, P.F. (eds) Textbook of Polytrauma Management . Springer, Cham. https://doi.org/10.1007/978-3-030-95906-7_25

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  • DOI: https://doi.org/10.1007/978-3-030-95906-7_25

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