What is compartment syndrome and how is it prevented, diagnosed, and treated? What are the consequences of not treating a compartment syndrome and over-treating a (falsely) suspected compartment syndrome?
Compartment syndrome is the clinical condition of increased pressure within an enclosed fascial space, leading to muscle and nerve death from ischemia.
The leg is a typical location because of its well defined (and not very roomy!) compartments, as shown
Compartment syndrome could occur from tibia fractures (bleeding), compressive devices (casts, ace wraps), IV infiltration or burns. (Reprofusion after vascular repair is a non-musculoskeletal cause too.)
The hallmark of compartment syndrome is severe pain that is out of proportion to what is expected from the given injury/situation. One clue what is "out of proportion to what is expected" is pain that increases over time (by contrast, a patient with a splinted fracture should start hurting less once immobilized).
The patient controlled analgesia machines (by which the pain medicine is self-dosed) can give a clue as to the patient's pain.
In more advanced cases, symptoms may also include decreased sensation, pale skin, and weakness of the affected area.
Physical exam will reveal tensely swollen and shiny skin, and pain when the compartment is squeezed.
Confirming the diagnosis of compartment syndrome involves directly measuring the pressure in the compartment, which is done by inserting a needle attached to a pressure meter into the compartment—or treating empirically if needed.
Treatment is a surgical procedure, fasciotomy, where long surgical cuts are made in the fascia to relieve the pressure. The incisions are generally left open to be closed during a second surgery about 48-72 hours later.
If compartment syndrome is not prevented, permanent nerve injury and loss of muscle function can result and in severe cases amputation may be required. Performing a fasciotomy can potentially increase the risk of infection but overall the risk of not operating is considerably higher…