Compartment syndrome is a condition caused by increased pressure within a confined space, or compartment, in the body. It mostly is associated with fracture of tibia, forearm fractures, foot injuries and hand injuries.
Compartment syndrome results in ischaemia of the tissues. If untreated, it can result in necrosis of the muscles and other tissues.
However, rapid diagnosis and treatment can lead to complete recovery.
How Does It Occur?
When fracture occurs, the force of injury also results in soft tissue injury. Bleeding from the bone or other tissues accumulate in muscle compartments which are limited by fasciae and muscular septae. This causes elevation of the pressure in the compartment andcapillary blood flow is compromised.
Ischaemia or decreased tissue perfusion results in edema of the soft tissue which further raises the intra-compartment pressure. Venous and and lymphatic drainage of the injured area gets compromised, adding further insult. This furter increases the pressure and vicious cycle is formed.
Untreated compartment syndrome mediated ischemia of the muscles and nerves lead to eventual irreversible damage and death of the tissues within the compartment.
There are classically 5 “Ps” associated with compartment syndrome — pain out of proportion to what is expected, paraesthesia, pallor, paralysis, pulselessness; sometimes a 6th P, for polar poikilothermia (i.e. cold) is added.
- Pain is is usually of severe, deep, constant, and poorly localized and is sometimes described as out of proportion with the injury. The pain is aggravated by stretching the muscle group within the compartment and is not relieved by analgesia.
- Paresthesia (alterated sensation e.g. “pins & needles”) in the cutaneous nerves of the affected compartment is another typical sign.
- Paralysis of the limb is usually a late finding. The compartment may feel very tense and firm as well (pressure).
- Lack of pulse rarely occurs in patients. and is not a reliable sign. Moreover, it is present in very late stages. Pulse is only affected if the relevant artery is contained within the affected compartment.
Gauging the pressure within the muscle compartments would guide about compartment syndrome.
The normal mean interstitial tissue pressure is near zero mmHg in non-contracting muscle. If this pressure becomes elevated to 30 mmHg or more, small vessels in the tissue become compressed, which leads to reduced nutrient blood flow i.e., ischemia and pain.
When diastolic blood pressure exceeds compartment pressure by less than 30mmHg it is considered an emergency.
Acute compartment syndrome is a medical emergency. It requires opening up of compartments to release pressure. This procedure is called fasciotomy.
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