Acute compartment syndrome of the extremity

Pathophysiology

• ↑ Pressure within enclosed fascial space
• ↓ Blood flow & tissue perfusion

Common causes

• Crush injury, long bone fracture, rhabdomyolysis
• Reperfusion after prolonged ischemia
• Massive fluid resuscitation

Clinical features

• Early:
  • Progressive, severe pain
  • Rapidly ↑ & tense swelling
  • ↑ Pain with passive stretching
  • Paresthesia
• Late:
  • ↓ Sensation
  • Weakness (within hours), paralysis (late)
  • Loss of pulses (uncommon)

Management

• Compartment pressure measurement* can confirm diagnosis
• Emergency fasciotomy

*Delta pressure (diastolic pressure − compartment pressure) ≤30 mm Hg is consistent with compartment syndrome.