Diagnosis

Compartment syndrome

Etiology

Cause [3kq][fbe]

• Orthopedic:

  • Fracture (69-75%)

  • Blunt or Penetrating Trauma

  • Total knee arthroplasty

• Vascular:

  • Reperfusion therapy

  • Arterial puncture or injury

  • Hemorrhage

  • Deep Vein Thrombosis

• Soft Tissue:

  • Crush injury

  • Contusion

  • Burn

  • Envenomation (Snake Bite)

• Iatrogenic

  • Drugs (Anticoagulants)

  • Bleeding Disorders (Sickle cell)

  • Casts or Splints

  • Constrictive Dressings

  • Extravasation of drugs and fluids

  • Prolonged lithotomy positioning

  • Viral myositis

  • Diabetic muscle infarction

Pathophysiology [4za]

1. The muscle fascia is thin, inelastic and surrounds muscle compartments --> limits the capacity for rapid expansion

2. Injury --> edema and/or blood accumulation --> increased pressure within a compartment --> compresssion of draining veins --> reduced venous outflow

3. Perfusion pressure = systolic pressure - compartment pressure

4. Delta pressure = diastolic pressure - measured intracompartmental pressure

5. Disequilibrium between venous outflow and arterial inflow

6. Impaired local circulation -->  ischemia --> necrosis

7. Anterior compartment of the leg is the most common location --> drop fot

8. Other locations: forearm, thigh, buttock, shoulder, hand, and foot

Risk factors [4za]

• Male

• Trauma

• Peripheral vascular disease

• Bleeding disorder: hemophilia, leukemia

Complications

• Contractures

• Rhabdomyolysis

• Nerve damage and associated numbness and/or weakness

• Infection

• Renal failure

Epidemiology

Incidence per 100.000 [3kq][93p]

Approach

• Clinical diagnosis: [4za]

  • Pain (severe)

  • Pulselessness

  • Paresthesia

  • Paralysis are found in the late stage

• Measurement of Intra-Compartmental Pressure (pathological > 30 mmHg)

• Creatinine kinase

• Urine myoglobin

• Ultrasound: look for occlusion or thrombus

Treatment

1. Immediate surgical fasciotomy (sooner than later) [4za]

2. Treat underlying cause

3. Renal protection

   • Rhabdomyolysis --> IV fluid + bicarbonate --> keep urine output at 1-2 mL/kg/hr

Differential diagnoses

Acute extremity ischemia, Cellulitis, Deep venous thrombosis, Erysipelas, Fracture, Necrotizing fasciitis, Rhabdomyolysis