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Compartment Syndrome

Definition and Epidemiology

  • Compartment syndrome occurs when increased pressure within one of the body’s anatomical compartments impairs blood flow, endangering muscle and nerve function.
  • Can be acute or chronic, with acute being a medical emergency.
  • Commonly affects the lower leg and forearm, but can occur in any enclosed muscle compartment.
  • Typically results from traumatic injury, but can also be due to burns, fractures, or tight bandaging.

Pathophysiology

  • Increased pressure within a confined space (compartment) compromises circulation and nerve function.
  • Leads to ischemia and can result in cell death if not relieved promptly.
  • The fascia surrounding the compartment does not stretch, exacerbating the condition.

Clinical Features

  • The “5 P’s”: Pain, Pallor, Pulselessness, Paresthesia, and Paralysis.
  • Pain disproportionate to injury and worsened by passive stretching of the muscles in the compartment.
  • Swelling and tightness of the affected area.
  • Decreased sensation or motor function in severe cases.

Diagnosis

  • Clinical diagnosis is paramount; high suspicion in the context of the appropriate clinical setting.
  • Compartment pressure measurement: a pressure within 30 mmHg of diastolic blood pressure is indicative.
  • Imaging (e.g., MRI) might be used to assess tissue damage but is not primary for diagnosis.

Management

  • Acute Compartment Syndrome:
    • Immediate surgical consultation for fasciotomy to relieve pressure.
    • Avoidance of constrictive dressings and elevation above heart level, which can worsen ischemia.
  • Chronic Compartment Syndrome:
    • Conservative treatment with activity modification and physiotherapy.
    • Surgical intervention in refractory cases.

Prognosis

  • Early recognition and treatment of acute compartment syndrome are crucial to prevent permanent damage.
  • Chronic compartment syndrome has a better prognosis and often resolves with conservative management.

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