Acute compartment syndrome

Acute compartment syndrome is a limb and life-threatening surgical emergency. It is a painful condition caused by increased intracompartmental pressure, compromising perfusion and resulting in muscle and nerve damage within that compartment.

Acute compartment syndrome is more common in men under 35 years of age 1. It is ten times more common in males and most commonly seen following tibial shaft fractures 2.

There are five characteristic signs and symptoms for acute compartment syndrome and they generally appear in a stepwise fashion:

  • pain:
    • patients with acute compartment syndrome often report pain in which the severity is out of proportion to the apparent injury
    • this is an early and common finding
    • often described as deep and burning in nature
  • paraesthesia: this suggests ischemic nerve injury
  • pallor: this occurs secondary to vascular insufficiency and is uncommon
  • pulselessness: uncommon
  • paralysis: this is rare and often a late finding

Acute compartment syndrome results primarily from an increase in intracompartmental pressure. This is often associated with trauma such as fractures or muscle injury.  It occurs when the interstitial pressure within the compartment exceeds the perfusion pressure of the capillary beds. This results in ischemia and ultimately cellular anoxia leading to damage to nerve and muscle tissues 3.

Acute compartment syndrome is diagnosed based on clinical findings and measurement of compartmental pressures. The utilisation of imaging is generally limited 4.

Immediate management of suspected acute compartment syndrome involves relieving all external pressures on the compartment (e.g. dressing, splint, or cast) and placing the limb level with the heart.

If conservative management is unsuccessful, emergent fasciotomy is usually required for limb salvage.

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Article information

rID: 60854
Section: Syndromes
Tag: cases
Synonyms or Alternate Spellings:
  • Compartment syndrome

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