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:
- 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
- paresthesia: 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
Few of the leading reasons for compartment syndrome include:
- animal bites
- muscle hypertrophy
- bleeding in a joint or enclosed compartment
- intramuscular injections 5
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 the measurement of compartmental pressures. The utilization of imaging is generally limited to 4.
Treatment and prognosis
Immediate management of suspected acute compartment syndrome involves relieving pressures on the compartment (e.g. dressing, splint, or cast) and placing the limb at the level of the heart.
If conservative management is unsuccessful, emergent fasciotomy is usually required for limb salvage.
- 1. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk?. (2000) The Journal of bone and joint surgery. British volume. 82 (2): 200-3. Pubmed
- 2. Taylor RM, Sullivan MP, Mehta S. Acute compartment syndrome: obtaining diagnosis, providing treatment, and minimizing medicolegal risk. (2012) Current reviews in musculoskeletal medicine. 5 (3): 206-13. doi:10.1007/s12178-012-9126-y - Pubmed
- 3. Elliott KG, Johnstone AJ. Diagnosing acute compartment syndrome. (2003) The Journal of bone and joint surgery. British volume. 85 (5): 625-32. Pubmed
- 4. Rominger MB, Lukosch CJ, Bachmann GF. MR imaging of compartment syndrome of the lower leg: a case control study. (2004) European radiology. 14 (8): 1432-9. doi:10.1007/s00330-004-2305-5 - Pubmed
- 5. Taaha M. Mirza, Ayush B. Shrestha. Volkmann Contracture. (2020) Pubmed