Compartment syndrome

This is a surgical emergency.

 

Symptoms

• Pain : this is far more severe than you would expect from the appearance of the injury

 

Causes

• Trauma 
• Bone fracture
• Crush injury
• Periods of hypoperfusion

 

Pathophysiology

The body contains many fascial compartments.
After trauma, bleeding or swelling may fill the limited volume of the compartment.
The fascial have a very limited capacity for stretching so the volume remains constant and the pressure rises.
At high pressure, the circulatory system cannot adequately perfuse the tissues of the compartment.
Hypoxia and necrosis quickly follow.

 

Complications

• Necrosis
• Neurovascular damage
• Amputation
• Permanent disability
• Volkmann's contracture

 

Diagnosis

Intra-compartmental interstitial pressure must be measured as soon as possible.

• Wick catheter
• Simple needle manometry
• Slit catheter
• Side-porter needle 
• Fibre-optic transducer

 

Management

• Urgent surgergy to release the pressure. The compartment is opened by fasciotomy and the pressure is relieved.