Acute compartment syndrome

Acute compartment syndrome

Acute compartment syndrome occurs when there is increased interstitial pressure within a closed osteofascial compartment, which results in microvascular compromise. It is a surgical emergency as delayed treatment may lead to irreversible muscle ischaemia and signifi cant long-term morbidity . Compartment syndrome most commonly occurs after lower limb fractures, both open and closed (see Chapter 32 ). It also occurs in the upper limb, buttock and abdomen. Other causes include soft-tissue trauma, arterial injuries, burns and prolonged compression. It is characterised by pain out of pro - portion to the injury , particularly with passive movement of the a ff ected compartment muscles. Paraesthesia is another early sign. Absent pulses are uncommon and suggest the possibility of vascular injur y . Compartment syndrome is generally a clinical diagnosis. It can be di ffi cult to diagnose in the presence of impaired con - sciousness, in c hildren and in patients with regional nerve blocks. Monitoring intracompartment pressures (ICPs) can sometimes help to guide management. A pressure of ≤ 30 /uni00A0 mmHg between the diastolic pressure and ICP has been recommended as the threshold for fasciotomy . Fasciotomy involves incising the skin and deep fascia with long axial incisions ( Figure 3.13 ). If the compartment pressure - was high, the muscle will then be seen bulging out through the fasciotomy opening. The lower limb is reliably decompressed via two incisions. A medial longitudinal incision 1–2 /uni00A0 cm poste - ). rior to the medial border of the tibia decompresses the super - fi cial and deep posterior compartments. A lateral longitudinal incision 2 /uni00A0 cm lateral to the anterior tibial border decompresses the peroneal and anterior compartments. Late diagnosis of compartment syndrome is a management dilemma as a late fasciotomy may r esult in rhabdomyolysis, infection, need for amputation and even death.

et 21 (1):

Acute compartment syndrome

Acute compartment syndrome occurs when there is increased interstitial pressure within a closed osteofascial compartment, which results in microvascular compromise. It is a surgical emergency as delayed treatment may lead to irreversible muscle ischaemia and signifi cant long-term morbidity . Compartment syndrome most commonly occurs after lower limb fractures, both open and closed (see Chapter 32 ). It also occurs in the upper limb, buttock and abdomen. Other causes include soft-tissue trauma, arterial injuries, burns and prolonged compression. It is characterised by pain out of pro - portion to the injury , particularly with passive movement of the a ff ected compartment muscles. Paraesthesia is another early sign. Absent pulses are uncommon and suggest the possibility of vascular injur y . Compartment syndrome is generally a clinical diagnosis. It can be di ffi cult to diagnose in the presence of impaired con - sciousness, in c hildren and in patients with regional nerve blocks. Monitoring intracompartment pressures (ICPs) can sometimes help to guide management. A pressure of ≤ 30 /uni00A0 mmHg between the diastolic pressure and ICP has been recommended as the threshold for fasciotomy . Fasciotomy involves incising the skin and deep fascia with long axial incisions ( Figure 3.13 ). If the compartment pressure - was high, the muscle will then be seen bulging out through the fasciotomy opening. The lower limb is reliably decompressed via two incisions. A medial longitudinal incision 1–2 /uni00A0 cm poste - ). rior to the medial border of the tibia decompresses the super - fi cial and deep posterior compartments. A lateral longitudinal incision 2 /uni00A0 cm lateral to the anterior tibial border decompresses the peroneal and anterior compartments. Late diagnosis of compartment syndrome is a management dilemma as a late fasciotomy may r esult in rhabdomyolysis, infection, need for amputation and even death.

et 21 (1):

Acute compartment syndrome

Acute compartment syndrome occurs when there is increased interstitial pressure within a closed osteofascial compartment, which results in microvascular compromise. It is a surgical emergency as delayed treatment may lead to irreversible muscle ischaemia and signifi cant long-term morbidity . Compartment syndrome most commonly occurs after lower limb fractures, both open and closed (see Chapter 32 ). It also occurs in the upper limb, buttock and abdomen. Other causes include soft-tissue trauma, arterial injuries, burns and prolonged compression. It is characterised by pain out of pro - portion to the injury , particularly with passive movement of the a ff ected compartment muscles. Paraesthesia is another early sign. Absent pulses are uncommon and suggest the possibility of vascular injur y . Compartment syndrome is generally a clinical diagnosis. It can be di ffi cult to diagnose in the presence of impaired con - sciousness, in c hildren and in patients with regional nerve blocks. Monitoring intracompartment pressures (ICPs) can sometimes help to guide management. A pressure of ≤ 30 /uni00A0 mmHg between the diastolic pressure and ICP has been recommended as the threshold for fasciotomy . Fasciotomy involves incising the skin and deep fascia with long axial incisions ( Figure 3.13 ). If the compartment pressure - was high, the muscle will then be seen bulging out through the fasciotomy opening. The lower limb is reliably decompressed via two incisions. A medial longitudinal incision 1–2 /uni00A0 cm poste - ). rior to the medial border of the tibia decompresses the super - fi cial and deep posterior compartments. A lateral longitudinal incision 2 /uni00A0 cm lateral to the anterior tibial border decompresses the peroneal and anterior compartments. Late diagnosis of compartment syndrome is a management dilemma as a late fasciotomy may r esult in rhabdomyolysis, infection, need for amputation and even death.

et 21 (1):