11.6
Compartment Syndrome
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 11, Musculoskeletal Disorders.
Clinical Description
Condition where the Osseo fascial compartment pressure rises to a level that decreases perfusion to the limb and may lead to irreversible muscle and neurovascular damage.
Diagnosis is made with the presence of severe and progressive limb pain that worsens with passive motion. Compartment syndrome may occur anywhere that skeletal muscle is surrounded by fascia.
Causes
- High energy trauma, burns
- Tight casts, dressings, or external wrappings
- Extravasation of IV infusion
- Post-ischemic swelling
- Bleeding disorders and arterial injury
Signs and Symptoms
- Pain out of proportion to the clinical situation is usually the first symptom
Investigations
On Physical examination
- pain on passive stretch of the compartment
- paresthesia and hypoesthesia
- paralysis*
- palpable swelling*
- peripheral pulses absent*
Late signs
- Clinical diagnosis but imaging required to rule out fracture
Treatment
Non operative
- Obervation and limb elevation
- bivalving the cast and loosening circumferential dressings
Operative
- Emergent fasciotomy of all limb compartments
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