COMPARTMENT SYNDROME

DEFINITION
The limbs contain muscles in compartments enclosed by bones, fascia
and interosseous membrane. A rise in pressure within these
compartments due to any reason may jeopardize the blood supply to
the muscle and nerves within the compartment, resulting in what is
known as “compartment syndrome”.

CAUSES
The rise in compartment pressure can be due to any of the following
reasons:

 Any injury leading to oedema of muscles.

 Fracture haematoma within the compartment.
 Ischaemia to the compartment, leading to muscle oedema.

CONSEQUENCES
The increased pressure within the compartment compromises the
circulation leading to further muscle ischaemia.
A vicious cycle is thus initiated and continues until the total
vascularity of the muscles and nerves within the compartment is
jeopardized.
This results in ischaemic muscle necrosis and nerve damage. The
necrotic muscles undergo healing with fibrosis, leading to
contractures.
Nerve damage may result in motor and sensory loss. In extreme case
gangrene may occur.
DIAGNOSIS
Compartment syndrome can be diagnosed early by high index of
suspicion. Excessive pain, not relieved with usual dose of analgesics,
in a patient with an injury known to cause compartment syndrome
must raise an alarm in the mind of the treating doctor.
An injury with a high risk of developing compartment syndrome areas
follows:

 Supracondylar fracture of the humerus.

 Forearm bone fractures
 Closed tibial fracture
 Crush injuries to leg and forearm.
Stretch test: This is the earliest sign of impending compartment
syndrome. The ischaemic muscles when stretched, give rise to pain. It
is possible to stretch affected muscles by passively moving the joints
in direction opposite to that of the damaged muscle’s action.
Other signs include a tense compartment, hypoaesthesia in the
distribution of involved nerves, muscle weakness etc. Compartment
syndrome can be confirmed by measuring compartment pressure. A
pressure higher than 40 mm of water is indicative of compartment
syndrome. Pulses may remain palpable till very late in impending
compartment syndrome, and should not provide a false sense of
security that all is well.

TREATMENT
A close watch for an impending compartment syndrome and effective
early preventive measures like limb elevation, active finger
movements etc. can prevent this serious complication. Early surgical
decompression is necessary in established cases. This can be
performed by the following methods:
• Fasciotomy: The deep fascia of the compartment is slit
longitudinally (e.g., in forearm).
• Fibulectomy: The middle third of the fibula is excised in order to
decompress all compartments of the leg.