Compartment Syndrome

Compartment Syndrome

David Ray Velez, MD

Table of Contents

Definition and Pathophysiology
Causes
Diagnosis
Treatment

Definition and Pathophysiology

Definition: Increased Tissue Pressures Cause Neurovascular Damage

Pathophysiology

  • Increased Pressure Obstructs Venous Outflow (Early) and Arterial Inflow (Late)
  • Causes a Reduced Capillary Perfusion Pressure
  • Muscle Necrosis Occurs from the Inside-Out

Location

  • Can Occur in Any Compartment
    • Including Buttock (Obese After Prolonged Anesthesia), Shoulder, and Hands
  • Most Common in Calf or Forearm
    • Surrounding Fascia is Less Elastic than Other Muscle Compartments

Compartment Syndrome 1

Causes

Most Common Causes: Trauma or Reperfusion Injury

Increased Compartment Mass

  • Ischemic Reperfusion Injury
    • Due to Inflammation and Oxidative Damage in a Previously Ischemic Site
    • Oxygen Radicals Cause Increased Extravasation and Tissue Swelling
    • Primary Mediator: PMN’s (Neutrophils)
  • Bleeding (Fracture, Hemophilia, Anticoagulation, etc.)
  • Crush Injury
  • Venous Thromboembolism (VTE)
  • High-Voltage Electrical Injury
  • Shock
  • IV Infiltration
  • IV Drug Infiltration

Decreased Compartment Size

  • Tight Dressings
  • Casting
  • Eschars from Burns
  • Military Antishock Garments

Diagnosis

Symptoms (6 P’s)

  • Pain – First Sign
  • Paresthesia (Pins and Needles Sensation)
  • Paresis (Weakness) or Paralysis (Unable to Move)
  • Pallor (Pale Color)
  • Poikilothermic (Cold)
  • Pulseless – Late Sign

Diagnosis

  • Generally a Clinical Diagnosis Based on History and Physical Exam
  • Can Measure Compartment Pressures if Uncertain or Unable to Obtain a Reliable Physical Exam
    • Compartment Pressure > 30 mmHg
    • Gradient Between Diastolic and Compartment Pressure < 30 mmHg

Measuring Compartment Pressure 2

Treatment

Primary Treatment: Emergent Fasciotomy

Prophylactic Fasciotomy Indications

  • Ischemia > 6 Hours
  • High Risk Injury:
    • Combined Arterial/Venous Injury
    • Complex Extremity Fractures
    • Arterial or Venous Vascular Ligation
  • Significant Crush Injury

References

  1. Okada Y, Narumiya H, Ishi W, Ryoji I. Lower limb ischemia caused by resuscitative balloon occlusion of aorta. Surg Case Rep. 2016 Dec;2(1):130. (License: CC BY-4.0)
  2. Bresnahan JJ, Hennrikus WL. Chronic Exertional Compartment Syndrome in a High School Soccer Player. Case Rep Orthop. 2015;2015:965257. (License: CC BY-3.0)