![]() ![]() Holistic medicineĪcute compartment syndrome is most commonly due to trauma – specifically long bone fracture of the leg or forearm. If this happens the patient may require dialysis. This may lead to myoglobinuria and possible renal failure. Rhabdomyolysis may occur with muscle ischemia. In the case of delayed or missed diagnosis, compartment syndrome can result in muscle contractures, sensory deficits, paralysis, infection, fracture non-union and limb amputation. The most important determinant of a poor outcome from acute compartment syndrome is a delayed or missed diagnosis Image showing 1 and 2 incision leg fasciotomies like Ĭurrent evidence suggests that muscles can tolerate up to 3 hours of warm ischemia before the onset of necrosis. While the most common sites are forearm and leg, ACS can also occur in the foot, thigh and gluteal regions.ĪCS can also be due to non-traumatic causes such as hemorrhage, fractures, increased capillary permeabiily after burns and post-ischemic swelling. Supracondylar humerus fractures are the most common cause of ACS in children. Specifically, ACS is most commonly seen in patients less than 35 years of age and following either a diaphyseal tibial fracture or a distal radius fracture This article will focus primarily on acute compartment syndrome.Īcute compartment syndrome (ACS) is a surgical emergency, most commonly secondary to significant trauma such as a long bone fracture. When perfusion can no longer meet the demands of the tissue, necrosis ensues. If the pressure increase continues untreated, irreversible damage to the muscles and nerves within the compartment ensuesĬhronic compartment syndrome is most commonly seen in athletes and presents as insidious pain. ![]() As a result of reduced arteriovenous pressure gradient, there is decreased tissue perfusion. Thus, any condition that increases the content or reduces the volume of a compartment could be related to the development of compartment syndrome.Ĭompartment syndrome occurs because intra-compartmental pressure rises, leading to increased venous pressure and reduced venule diameter. At the most basic level, compartment syndrome is elevated pressure within a confined tissue space. Would like a cross-section of the leg indicating fascial compartments like this Ĭompartment syndrome may occur acutely or as a chronic syndrome. ACS is most commonly secondary to distal radius fractures in adults or supracondylar humerus fractures in children.Ĭross-section through middle of leg. The volar compartments contain the digital flexors and are at highest risk for compartment syndrome following trauma. The forearm also has four compartments at risk of compartment syndrome - deep and superficial volar, dorsal and lateral compartments. Signs of ACS affecting this compartment: pain and diminished sensation to lower leg in a superficial peroneal nerve distribution, the deep peroneal nerve may also be affected. It also contains the peroneal artery and the superficial peroneal nerve. The lateral compartment of the leg contains the peroneal muscles, longus and brevis. Signs of ACS affecting this compartment: pain and palpably tense compartment. The superficial posterior compartment of the leg contains the gastrocnemius, soleus and plantaris muscles. Signs of ACS affecting this compartment: plantar hypesthesia, weak to flexion, pain with passive stretch of toes and increasing pain. It also contains the posterior tibial artery and the tibial nerve. The deep posterior compartment of the leg contains tibialis posterior, flexor hallucis longus, flexor digitorum longus and poplitius. The most important symptom may be increasing pain, unrelieved by the usual analgesics and pain with passive flexion of the toes. Later foot drop, claw foot and deep peroneal nerve dysfunction may occur. ![]() Signs of acute compartment syndrome (ACS) affecting this compartment: loss of sensation between the first and second toes, weak foot dorsiflexion. It also contains the anterior tibial artery and the deep peroneal nerve. The anterior compartment of the leg contains tibialis anterior, extensor hallucis longus, extensor digitorum longus. The anterior and deep posterior compartments of the leg are the most common sites for compartment syndrome. Compartment syndrome is possible in any or all of the compartments. The leg and forearm both have four compartments encircled by inflexible facia. It most commonly occurs in the leg or forearm secondary to trauma and leads to decreased tissue perfusion below basal tissue requirements. Compartment syndrome is a limb-threatening condition caused by swelling within the myofacial compartments of the limb. ![]()
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