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.