Compartment syndrome and orthopedic surgery: Diagnosis and management

Abstract

Compartment syndrome is defined as an elevation of intracompartmental pressure to a level that impairs arterial flow.Compartment syndrome of the upper and lower extremities can have multiple etiologies, including traumatic, exertional, and iatrogenic in the peri-operative setting. Early identification and diagnosis enabling prompt intervention is essential to providing patients the best possible outcomes. In cases of acute compartment syndrome, emergent fasciotomy is generally indicated. Delayed fasciotomies more than 24 h after onset of symptoms is not recommended as it increases morbidity and mortality, however it is often difficult to establish a time zero for onset or irreversibility. Even with timely treatment, multiple surgeries are often necessary to ensure adequate wound debridement, appropriate soft tissue coverage and satisfactory wound closure. Long-term sequelae range from cosmetic concerns secondary to wound complications, the use of skin grafts, limb deformity, amputation, or systemic complications associated with rhabdomyolysis.