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
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.
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 Factors Leading to Compartment Syndrome |Favorite Table|Download (.pdf)
Table 60–1 Factors Leading to Compartment Syndrome
|Conditions That Increase the Content of the Compartment|
Direct soft tissue trauma with or without long bone fracture (10–20% incidence after closed fracture)
Closed tibial shaft fractures (40%) and closed forearm
- Soft tissue crush injuries without
fractures in 23% of cases of compartment syndrome5,6
- Open fractures, which should theoretically decompress
the adjacent compartments, may lead to
- Hemorrhage: Vascular injury, coagulopathy
- Anticoagulation therapy8
- Revascularization of limb after ischemia
- High-energy trauma, as from high-speed motor vehicle accident or crush injury
- Increased capillary permeability after burns
- Infusions or high-pressure injections (eg, regional blocks, paint guns)
- Extravasations of arthroscopic fluid (eg, after
routine knee arthroscopy9)
- Reperfusion after prolonged periods of ischemia
- Anabolic steroid use, resulting in muscle
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessAnesthesiology Full Site: One-Year Subscription
Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more
Pay Per View: Timed Access to all of AccessAnesthesiology
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.