Introduction[edit | edit source] Show
Acute Compartment Syndrome is a condition in which there is increased pressure within a closed osteofascial compartment, resulting in impaired local circulation. Without prompt treatment, acute compartment syndrome can lead to ischemia and eventually, necrosis.[1] The anterior compartment of the leg is the most common location for compartment syndrome. Other locations in which acute compartment syndrome is seen include the forearm, thigh, buttock, shoulder, hand, and foot.[1] See Compartment Syndrome of the Lower Leg; Compartment Syndrome of the Forearm; Compartment Syndrome of the Foot. Etiology[edit | edit source]Acute compartment syndrome can occur without any precipitating trauma but typically occurs after a long bone fracture, with tibial fractures being the most common cause of the condition, followed by distal radius fractures.
Epidemiology[edit | edit source]The incidence of acute compartment syndrome is estimated to be 7.3 per 100,000 in males and 0.7 per 100,000 in females, with the majority of cases occurring after trauma. Tibial shaft fracture is the most common cause of acute compartment syndrome (associated with a 1 to 10 percent incidence of acute compartment syndrome)[1]. Mechanism of Injury / Pathological Process[edit | edit source]The connective tissue forming a compartment is not pliable, so when bleeding or swelling occurs within the compartment, the intra-compartmental pressure rises.[2][3] Normally a non-contracting muscle contains a pressure near zero.
Clinical Presentation[edit | edit source]Symptoms of Chronic Compartment Syndrome[edit | edit source]Obtaining an accurate patient history is vital, due to the objective examination often not showing much of note. In a typical case, the patient will present with pain in a compartment of the leg, at the same time, distance and intensity of exercise.[7] The pain shall continue to increase until it becomes unbearable and the patient stops exercising, causing the pain to subside with rest.
Remember the 5 P’s: Pain, Pallor, Paresthesia, Paralysis, Pulselessness[4] Prognosis[edit | edit source]The prognosis after treatment of compartment syndrome depends mainly on how quickly the condition is diagnosed and treated. When fasciotomy is done within 6 hours, there is almost 100% recovery of limb function. After 6 hours, there may be residual nerve damage. Data show that when the fasciotomy is done within 12 hours, only two-thirds of patients have normal limb function. In very delayed cases, the limb may require an amputation. Diagnostic Procedures[edit | edit source]
Outcome Measures[edit | edit source]
For more see Outcome Measures Database Management / Interventions[edit | edit source]In the event of a diagnosis of Compartment syndrome (when there is a intra-compartment pressure of >30 mmHg[10][11]) immediate surgical fasciotomy is needed to reduce the intracompartmental pressure. Image 2: Compartment syndrome with fasciotomy procedure
After a fasciotomy is performed and swelling dissipates, a skin graft is commonly used for incision closure. Patients must be closely monitored for complications which include infection, acute renal failure, and rhabdomyolysis. If necrosis occurs before fasciotomy is performed, there is a high likelihood of infection which may require amputation. If infection occurs, debridement is necessary to prevent systemic spread or other complications[1]. Physiotherapy[edit | edit source]Physiotherapy role in the treatment of the condition is vital, with or without surgical intervention. The physiotherapist may employ modalities that will improve range of motion, strength of the affected muscles, function and relief pain. See highlighted links in Introduction for site specific Physiotherapy Differential Diagnosis[edit | edit source]These common pathologies may give the same pain characteristics or symptoms in the lower limbs:[12]
References[edit | edit source]
Which signs and symptoms would the nurse find in a patient with compartment syndrome?The symptoms of compartment syndrome can include:. Bulging or visible swelling of the muscle.. Feeling like the muscle is fuller, swollen or somehow larger than normal.. Numbness.. Muscle pain that is stronger than you'd expect from the injury.. Severe pain when you stretch the muscle.. Tightness in the muscle.. What factors may contribute to compartment syndrome?Compartment syndrome can develop from the fracture itself, due to pressure from bleeding and edema. Or compartment syndrome may occur later, as a result of treatment for the fracture (such as surgery or casting). Acute compartment syndrome can also occur after injuries without bone fractures, including: Crush injuries.
What is the earliest indicator of compartment syndrome?Early symptoms include progressive pain out of proportion to the injury; signs include tense swollen compartments and pain with passive stretching of muscles within the affected compartment.
Can compartment syndrome occur in open fracture?A common pitfall is to assume that a patient with an open fracture has already decompressed. However, patients with open fractures are at risk of developing compartment syndrome.
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