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Review
. 2015 Mar 27;5(1):18-22.
eCollection 2015 Jan-Mar.

Acute compartment syndrome

Alessio Giai Via  1 , Francesco Oliva  1 , Marco Spoliti  2 , Nicola Maffulli  3
Affiliations
Review

Acute compartment syndrome

Alessio Giai Via et al. Muscles Ligaments Tendons J. .

Abstract

Background: acute compartment syndrome (ACS) is one of the few true emergencies in orthopedics and traumatology. It is a painful condition caused by the increase interstitial pressure (intracompart-mental pressure - ICP) within a closed osteofascial compartment which impair local circulation. It occurs most often in the legs, but it can affects also the arms, hands, feet, and buttocks. It usually develops after a severe injury such as fractures or crush injury, but it can also occurs after a relatively minor injury and it may be iatrogenic. Uncommon causes of ACS have been also described, that suggest surgeons to pay great attention to this serious complication. Diagnosing ACS is difficult in clinical practice, even among expert surgeons. Currently, the diagnosis is made on the basis of physical examination and repeated ICP measures. ICP higher than 30 mmHg of diastolic blood pressure is significant of compartment syndrome. Once diagnosis is made, fasciotomy to release the affected compartment should be performed as early as possible because delayed decompression would lead to irreversible ischemic damage to muscles and peripheral nerves.

Conclusion: acute compartment syndrome is a surgical emergency. There is still little consensus among authors about diagnosis and treatment of these serious condition, in particular about the ICP at which fasciotomy is absolutely indicated and the timing of wound closure. New investigations are needed in order to improve diagnosis and treatment of ACS.

Keywords: acute compartment syndrome; complications; fasciotomy; fracture; intracompartmental pressure; myofascial compartment.

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Figures

Figure 1.
Figure 1.
Medial and lateral incisions for leg fasciotomy.
Figure 2.
Figure 2.
Surgical approach to decompress forearm compartments. The incision should also allow decompression of the carpal tunnel.
Figure 3.
Figure 3.
Surgical approach for decompressing interossei compartments and fasciotomy of the hand.
See this image and copyright information in PMC

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