- More common in males and those <35yrs
- Most commonly the osseo-fascial compartments of the leg or the forearm, but other sites include:
- Upper arm and hand
- Buttock, thigh or foot
- Abdomen
Compartment Syndrome
Compartment Syndrome
Resources
- A condition in which increased pressure within a closed compartment compromises the circulation to and function of tissues within that space
- Occurs when compartment pressure > venous pressure
- Capillary collapse
- Venous backflow occurs which further increases pressure
- Causes irreversible tissue injury after 6hrs
- Abdominal compartment syndrome is covered elsewhere
- Trauma is the most common cause
Vascular
- Ischaemia due to arterial or venous injuries
- Reperfusion injuries
- Haemorrhage inc. arterial/venous injuries in the anticoagulated patient
Soft tissue
- Burns
- Crush injuries
- Prolonged compression
Iatrogenic
- Prolonged lithotomy positioning ("well leg compartment syndrome")
- Casts and circular dressings
Other
- Muscle overuse
- Snakebites
- Severe pain
- Despite analgesia
- Disproportionate injury
- Worse when muscle stretched
- Pale limb
- No pulse distally to limb
- Paraesthesia
- Reduced limb temperature
- Compartment pressure >45mmHg or 30mmHg above diastolic BP
- Raised CK
- Raised serum or urine myoglobin
- Radiography of affected limb
- Urgent steps to decrease tissue pressure, restore blood flow, and minimize tissue damage and related functional loss
- Remove external pressure e.g. casts, bandages
- Keep limb at level of the heart (elevation will reduce perfusion pressure)
- Urgent surgical decompression e.g. open fasciotomy
- Debridement of necrotic tissue
- Medical management of sequelae e.g. rhabdomyolysis, hyperkalaemia