Chapter 60

Compartment syndrome is an orthopedic emergency. It is an acute condition of the limbs in which the pressure of isolated or groups of compartments increases dramatically and limits local soft tissue perfusion to the point of ischemic necrosis. Regional anesthesia may mask the signs and symptoms of compartment syndrome, so practitioners should be alert to patient risk factors, clinical presentation, and management of this potentially limb-threatening condition. The musculoskeletal structures of the limbs are enclosed within compartments created by investing, inelastic sheets of fascia that have a limited ability to expand. These compartments contain skeletal muscles that form the bulk of their contents, along with the neurovascular structures that pass through the compartment. If missed, compartment syndrome1 can be a life- and limb-threatening condition.

Compartment syndrome is most common in the lower leg and forearm, although it can also occur in the hand, foot, thigh, and upper arm. In theory, the upper leg muscles are at a lower risk for injury than are the smaller muscles of the lower leg, because the muscles of the thigh can dissipate the large forces of direct trauma, causing less muscle injury and resultant edema.2 Acute compartment syndrome occurs more commonly in one of the four smaller compartments of the lower leg.

Historically, the consequences of persistently elevated intracompartmental pressures was first described by Richard von Volkmann,3 who documented nerve injury and late muscle contracture from compartment syndrome after supracondylar fracture of the distal humerus. Jepson4 described ischemic contractures in dog hind legs, resulting from limb hypertension after experimentally induced venous obstruction. Only after almost 30 years (1970s) has the importance of measuring compartmental pressures become apparent.

### Etiology

Any condition that can reduce the volume of the compartment or increase the size of the contents of the compartment can lead to an acute compartment syndrome. Examples of factors leading to these changes are presented in Table 60–1.

Table 60–1 Factors Leading to Compartment Syndrome

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