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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.
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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.
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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.
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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.
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