Compartment Syndrome
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Clinically Relevant Anatomy
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Compartmental Syndrome is defined as a critical pressure increase within a confined compartmental space causing a decline in the perfusion pressure to the tissue within that compartment.[1] The increase in interstitial pressure occurs within the osseo-fasical compartment.[2] This syndrome is a condition that can appear in many parts of the body: foot, leg, thigh, forearm, hand, buttocks etc.[3]
The commonest cause of all compartmental syndromes are tibial shaft fractures with a range from 2-9%.[4] Any event that increases compartment pressure can cause this syndrome, including poor patient positioning of the unconscious patient. The incidence is thought to be 3.1 per 100000 population. Males are ten times more likely than females to develop this syndrome.[5]
Mechanism of Injury / Pathological Process
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The connective tissue of a compartment is not able to stretch, so when there appears a bleeding or a swelling of the muscles within the compartment, the pressure rises likely. [6][7]
Normally a non-contracting muscle contains a pressure near zero, nevertheless if the pressure rises up to 30 mmHg, the vessels will be compressed resulting into pain and a reduction of blood flow. Also the lymphatic drainage will activate to prevent the increasing interstitial fluid pressure[3], when this reached to its maximum; the pressure between the compartments will cause physiological defects such as a nerve dysfunction and deformation. A hemorrhage of an edema causes the interstitial pressures within the soft tissues to increase, creating possible ischemia by loss of capillary refill.[8]
Ischemia starts when the local blood flow can’t fulfill the metabolic demands of the tissues. When a body part is not provided with blood for more than eight hours, the damage is irreversible and may lead to the death of the concerning tissues.[9]
Clinical Presentation[edit | edit source]
Considering the 5 P’s: Pain, Pallor, Paresthesia, Paralysis, Pulselessness.[3]
Diagnostic Procedures[edit | edit source]
The only way to diagnose a compartment syndrome is to measure the pressure within the compartments of the affected limb.
- Intracompartmental pressure monitoring (ICP): [6]
When measuring the ICP using a needle, a plastic tube filled with a saline solution and air, connected to a mercury manometer.
This objective method can provide a continuous recording of pressure measurement for up to 16 to 24 hours.
The normal ICP ranges from zero to 10 mmHg. When the pressure is near a 30 mmHg below the diabolic pressure a fasciotomy is required.[3] Time is also a very significant parameter but very difficult to measure.[7] Decompression within 6 hours will be resulted in a full recovery. If more than 12 hours pass by without any acting an inevitable disability will be identified.
Outcome Measures[edit | edit source]
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Management / Interventions
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Differential Diagnosis
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These common pathologies may give the same pain characteristics or symptoms:[10]
- shin splints
- stress fractures
Key Evidence[edit | edit source]
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Resources
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References[edit | edit source]
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- ↑ Hartsock LA, O’Farrell D, Seaber AV, Urbaniak JR. Effect of increased compartment pressure on the microcirculation of skeletal muscle. Microsurgery 1998;18:67–71.
- ↑ Donaldson J, Haddad B, Khan WS. The Pathophysiology, Diagnosis and Current Management of Acute Compartment Syndrome. Open Orthop J 2014;8:185-193.
- ↑ 3.0 3.1 3.2 3.3 Abraham T Rasul Jr. Compartment syndrome. eMedicine. 11 March 2009 A1 (2)http://emedicine.medscape.com/article/307668-overview Level of evidence: A1
- ↑ DeLee JC, Stiehl JB. Open tibia fracture with compartment syndrome. Clin Orthop Relat Res 1981;(160):175–184.
- ↑ Kalyani BS, Fisher BE, Roberts CS, Giannoudis PV. Compartment syndrome of the forearm: a systematic review. J Hand Surg Am 2011;36:535–43
- ↑ 6.0 6.1 Kirsten G B, Elliot A, J Johnstone. Diagnosing acute compartment syndrome. The journal of bone and joint surgery, Vol. 85, N°5, July 2003 A1 (2)http://web.jbjs.org.uk/cgi/reprint/85-B/5/625.pdf Level of evidence: A1
- ↑ 7.0 7.1 Galanakos S, Sakellariou V I, Kkotoulas H, Sofianos I P. Acute Compartment Syndrome: The significance of immediate diagnosis and the consequences from delayed treatment. E.E.X.O.T, Vol 60: 127-133, 2009 Level of evidence: A1
- ↑ Tucker Alicia K. Chronic exertional compartment syndrome of the leg. Current Reviews in Musculoskeletal Medicine. 2 September 2010 A1 http://ukpmc.ac.uk/articles/PMC2941579/ Level of evidence: A1
- ↑ Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S. Compartment syndrome of the lower leg and foot. The Association of bone and joint surgeons. 27 may 2009 http://emedicine.medscape.com/article/140002-overview Level of evidence: B
- ↑ http://www.physioadvisor.com.au/10513350/compartment-syndrome-chronic-compartment-syndrom.htm
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