Compartment Syndrome

***Must inform registrar and/or consultant on-call***

introduction (1,2)

  • Limb-threatening and potentially life-threatening condition
      • Perfusion pressure falls below tissue pressure/compartment pressure leading to tissue necrosis, renal failure and death if untreated.
  • Commonly affects lower limb, abdomen, buttocks and upper limb.
  • Mechanism of injury
      • Crush injuries with multiple fractures which can lead to vascular injury and swelling of soft tissue.
      • Prolonged extrinsic compression.
      • Combination of injuries.


Image reference: Orthobullet's "Hand & Forearm Compartment Syndrome" (2019)

assessment (3,4)

  • Symptoms ‘five Ps of ischaemia’:
      • Pain – persistent, progressive, severe (out of proportion to clinical findings)
      • Passive – stretching of muscles is exquisitely tender
      • Paraesthesia
      • Paralysis
      • Pallor
      • Pulselessness – not always present and should not be a discriminating factor.


      • These are not always reliable; therefore, clinical impression is important.

management (1)

  • Discuss with senior immediately
  • Keep NBM
  • Manage injury appropriately while awaiting review


  • Splint in a position of function with strict elevation in Bradford sling.
  • Urgent decompression/fasciotomy required in theatre.
  • TAnticipate rhabdomyolysis/myoglobinuria and treat it appropriately (IV hydration and/or mannitol)

references

1. Chiu TW. Stone’s Plastic Surgery Facts: A Revision Guide, Fourth Edition. CRC Press; 2018. 2. Green DP, Wolfe SW. Green’s operative hand surgery. Elsevier/Churchill Livingstone; 2011. 3. Torlincasi AM, Lopez RA, Waseem M. Acute Compartment Syndrome. StatPearls. StatPearls Publishing; 2020. 4. Reichman EF. Compartment Syndrome of the Hand: A Little Thought about Diagnosis. Case Rep Emerg Med. 2016;2016:2907067.
Useful resource:Henderson R. Compartment Syndrom. patient.co.uk 2015 Jan 23 (v23)
Image References:Header Image Reference: Licensed by Adobe Stock (2019)Compartment Syndrome Image Reference: Orthobullet's "Hand & Forearm Compartment Syndrome" (2019)
This subpage has been reviewed by:
1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (09/02/2020)