Compartment syndrome

Compartment syndrome is a particular complication that may occur following fractures (or following ischaemia reperfusion injury in vascular patients). It is characterised by raised pressure within a closed anatomical space. The raised pressure within the compartment will eventually compromise tissue perfusion resulting in necrosis. The two main fractures carrying this complication include supracondylar fractures and tibial shaft injuries.

Features

• Pain, especially on movement (even passive)
  • excessive use of breakthrough analgesia should raise suspicion for compartment syndrome
• Parasthesiae
• Pallor may be present
• Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise
• Paralysis of the muscle group may occur

The presence of a pulse does not rule out compartment syndrome.

Diagnosis

• Is made by measurement of intracompartmental pressure measurements. Pressures in excess of 20mmHg are abnormal and >40mmHg is diagnostic
• Compartment syndrome will typically not show any pathology on an x-ray

Treatment

• This is essentially prompt and extensive fasciotomies
• In the lower limb the deep muscles may be inadequately decompressed by the inexperienced operator when smaller incisions are performed
• Myoglobinuria may occur following fasciotomy and result in renal failure and for this reason these patients require aggressive IV fluids
• Where muscle groups are frankly necrotic at fasciotomy they should be debrided and amputation may have to be considered
• Death of muscle groups may occur within 4-6 hours