Acute compartment syndrome

Abstract

Compartment syndrome is an orthopaedic emergency. It is defined as an increase in pressure within an osseofascial compartment, which results in hypoxia and necrosis of the structures within the compartment. It is commonly associated with high energy injuries, particularly tibial fractures. Diagnosis is largely based on clinical assessment, with pain as the most important and reliable feature. Other features such as nerve compromise or pulselessness are late signs. Urgent treatment should be based on guidelines written by the British Orthopaedic Association. Fasciotomy of the affected limb is required within an hour of the diagnosis being made to reduce morbidity associated with the condition. In the leg there are four compartments, which can be decompressed through two skin incisions. The wounds cannot be closed primarily, and multiple theatre attendances may be required. If a fracture is present as well as compartment syndrome, this will need to be stabilized at the same time. A variety of options for managing the wounds are available, with no single ideal method.