Compartment syndrome
In general, a compartment syndrome is a "condition in which increased pressure within a limited space compromises the blood circulation and function of tissue within that space. Some of the causes of increased pressure are trauma, tight dressings, hemorrhage , and exercise. Sequelae include nerve compression syndromes; paralysis; ischemic contracture"[1] and ischemic gangrene. Unless the pressure can be reduced quickly by medical methods, it is a surgical emergency. The diagnosis is confirmed by measuring the compartment pressure with a Stryker needle or a hypodermic needle connected to an arterial pressure meter.[2]
Compartment syndrome should be suspected whenever there is significant pain in an extremity. Pain is especially of concern when described as burning or constrictive, remembering that it can coexist with fractures and other trauma. High-velocity injuries, the use of anticoagulants, and extreme exertion all raise suspicion. It can be a complication of arthroscopy[3] or intraosseous infusion.[4] Compartment syndrome can also be part of the complex clinical picture of snakebite or other envenomation involving hemolytic or myolytic toxins.
It is most often associated with the long extremities, where, if not treated, it can lead to tissue necrosis, permanent functional impairment, and, if severe, renal failure and death. [5] It can be catastrophic, in terms of function, in small spaces such as the hand, or Fournier's gangrene of the perineal area.
Anterior compartment syndrome "exhibits as rapid swelling, increased tension, pain, and ischemic necrosis of the muscles of the anterior tibial compartment of the leg, often following excessive physical exertion." [6]
Diagnosis
The accuracy of orthopedic surgeons to palpate intracompartmental pressure of 60 and 80 mm Hg in a study of cadavers was:[7]
- Sensitivity 24%
- Specificity 55%
Treatment
Nonsurgical methods include cooling; immobilization; removing external pressure from casts, bandages or clothing. Elevation had been recommended but is now contraindicated.[8] The minimal surgical intervention is fasciotomy. Ideally, it will be performed by a surgeon, and often an orthopedic surgeon because the most common etiologies are orthopedic. Nevertheless, the condition can progress rapidly and at least fasciotomy may fall to an emergency physician or allied health practitioner.
References
- ↑ Anonymous (2024), Compartment syndrome (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ L.E. Rodriguez & J.E. Gough (2004), Chapter 28, Orthopedic Emergencies, in C.K. Stone & R.L. Humphries, Current Emergency Diagnosis and Treatment (Fifth Edition ed.), Lange Medical Books, McGraw-Hill, p.512
- ↑ Ekman EF ; Poehling GG (1996), "An experimental assessment of the risk of compartment syndrome during knee arthroscopy.", Arthroscopy 12 (2): 193-9
- ↑ Wright R ; Reynolds SL ; Nachtsheim B (1994), "Compartment syndrome secondary to prolonged intraosseous infusion", Pediatr Emerg Care 10 (3): 157-9
- ↑ Richard Paula (December 10, 2008), "Compartment Syndrome, Extremity", eMedicine
- ↑ Anonymous (2024), anterior compartment syndrome (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Shuler, Franklin D.; Matthew J. Dietz (2010-02-01). "Physicians' Ability to Manually Detect Isolated Elevations in Leg Intracompartmental Pressure". J Bone Joint Surg Am 92 (2): 361-367. DOI:10.2106/JBJS.I.00411. Retrieved on 2010-02-02. Research Blogging.
- ↑ Styf J ; Wiger P (1998), "Abnormally increased intramuscular pressure in human legs: comparison of two experimental models.", J Trauma 45 (1): 133-9