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Chapter 49: Acute Compartment Syndrome of the Limb: Implications for Regional Anesthesia

Sam Van Boxstael

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    AMA Citation
    Boxstael S. Boxstael S Boxstael, Sam Van.Acute Compartment Syndrome of the Limb: Implications for Regional Anesthesia. In: Hadzic A, Balocco A. Hadzic A, Balocco A Eds. Admir Hadzic, and Angela Lucia Balocco.eds. Hadzic's Textbook of Regional Anesthesia and Acute Pain Management: Self-Assessment and Review New York, NY: McGraw-Hill; . http://accessanesthesiology.mhmedical.com/content.aspx?bookid=2655&sectionid=218433174. Accessed September 22, 2019.
    MLA Citation
    Boxstael S. Boxstael S Boxstael, Sam Van.. "Acute Compartment Syndrome of the Limb: Implications for Regional Anesthesia." Hadzic's Textbook of Regional Anesthesia and Acute Pain Management: Self-Assessment and Review Hadzic A, Balocco A. Hadzic A, Balocco A Eds. Admir Hadzic, and Angela Lucia Balocco. New York, NY: McGraw-Hill, , http://accessanesthesiology.mhmedical.com/content.aspx?bookid=2655&sectionid=218433174.

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Chapter 49. Acute Compartment Syndrome of the Limb: Implications for Regional Anesthesia

In which anatomic location does acute compartment syndrome (ACS) occur most often?

A. Hand

B. Lower leg and forearm

C. Thigh

D. Upper arm

B is correct. ACS is most common in the lower leg and forearm. 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.

What is the only objective and accurate test to diagnose acute compartment syndrome?

A. Arterial duplex of the affected limb

B. Elevated serum creatinine kinase

C. Computed tomography angiography of the affected limb

D. Direct compartment pressure measurement in the suspected compartment

D is correct. Changes in compartment pressures can precede the clinical signs of compartment syndrome. Compartment pressure measurement is the only objective and accurate test to diagnose and record compartment syndrome.

From which compartmental pressure in a normotensive patient is emergent intervention indicated?

A. 10 mm Hg

B. 20 mm Hg

C. 30 mm Hg

D. 40 mm Hg

C is correct. Compartmental pressures greater than 30 mm Hg require emergent intervention because ischemia is imminent.

Which of the following is a possible factor leading to compartment syndrome?

A. Tight circumferential dressings

B. Open fractures

C. Reperfusion after prolonged periods of ischemia

D. All of the above

A, B, and C are all possible factors, so option D is correct. See Table 49–1 for factors leading to compartment syndrome.

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Table 49–1. Factors leading to compartment syndrome.

Conditions that Increase the Compartment Volume

  • Direct soft tissue trauma with or without long bone fracture (10%–20% incidence after closed fracture)

  • Closed tibial shaft fractures (40%) and closed forearm fractures (12%)

  • Soft tissue crush injuries without fractures in 23% of cases of compartment syndrome1,2

  • Open fractures, which should theoretically decompress the adjacent compartments, ...

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