Compartment Syndrome

This is a condition where there's a raised pressure within a fascial compartment, which ends up cutting off blood flow to further areas.

A muscle compartment contains muscles, nerves, and vessels, which are together surrounded by a non-expandable fascia. When there's an increase in pressure, the lower pressure systems i.e. venous, are affected first. Venous outflow becomes blocked whilst arterial inflow remains unaffected.

It can be an acute or chronic rise in pressure. Acute is usually associated with injury where bleeding or oedema occurs to increase the compartmental pressure. The chronic type usually has symptoms that only come on exertion as the pressure in the compartment rises, and resolve during rest.

Presentation

It usually presents after an acute injury, particularly with bone fractures and crush injuries. The 5 P's of it's presentation are:

• Unproportional Pain – So severe that analgesics aren’t effective (this comes on with passive stretch)

• Pale

• Pressure

• Paraesthesia

• Paralysis – Late and worrying feature

The symptoms are very similar to acute limb ischaemia, but the main differentiating factor is that Compartment Syndrome won’t be pulseless (only low pressure systems e.g. veins are affected first).

• It'll only become pulseless at the very very late stages when arterial inflow eventually becomes affected

Management

• Fasciotomy

• Elevate legs

• Maintain good BP

Complications

• Reperfusion injury (monitor with ECG, VBG/ABG, U&Es)

• Rhabdomyolysis (monitor with CK and U&Es)

• Acute limb ischaemia (monitor with pulse)