Acute Compartment Syndrome Treatment & Management

  • Author: Abraham T Rasul Jr, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Nov 11, 2011
 

Approach Considerations

The treatment of choice for acute compartment syndrome is early decompression. If the tissue pressure remains elevated in a patient with any other signs or symptoms of a compartment syndrome, adequate decompressive fasciotomy must be performed as an emergency procedure. Following fasciotomy, fracture reduction or stabilization and vascular repair can be performed, if needed.

If a developing compartment syndrome is suspected, place the affected limb or limbs at the level of the heart. Elevation is contraindicated because it decreases arterial flow and narrows the arterial-venous pressure gradient.[51, 52]

In patients with tibial fracture and suspected compartment syndrome, immobilize the lower leg with the ankle in slight plantar flexion, which decreases the deep posterior compartment pressure and does not increase the anterior compartment pressure. (Postoperatively, the ankle is held at 90° to prevent equinus deformity.)

All bandages and casts must be removed. Releasing 1 side of a plaster cast can reduce compartment pressure by 30%, bivalving can produce an additional 35% reduction,[44] and complete removal of the cast reduces the pressure by another 15%, for a total decrease of 85% from baseline.[53] Cutting undercast padding (Webril, Kendall Healthcare Products Co) may decrease compartmental pressure by 10-30%.[54, 44, 9]

Administer antivenin in cases of snake envenomation; this may reverse a developing compartment syndrome. Correct hypoperfusion with crystalloid solution and blood products.

Relative hypertension and correction of acute anemia may help prevent the development of an impending acute compartment syndrome. Ongoing research continues to examine the role of nitric oxide.

In the setting of an acute compartment syndrome, capillary permeability is altered after 3 hours, resulting in postischemia tissue swelling of 30-60%. The role of mannitol in decreasing tissue edema is still under investigation; it may reduce compartment pressures and lessen reperfusion injury.[55, 56, 57] Vasodilator drugs or sympathetic blocking drugs appear to be ineffective, probably because maximal local vasodilatation is already present in this condition.

For more information, see Emergent Management of Acute Compartment Syndrome.

Next

Renal Protection

Ischemia that lasts 4 hours leads to significant myoglobinuria, which reaches a maximum about 3 hours after the circulation is restored but persists for as long as 12 hours. In the face of rhabdomyolysis, IV fluid administration and, potentially, bicarbonate may be used to keep urine output at 1-2 mL/kg/hr.

The combination of hypovolemia, acidemia, and myoglobinemia may cause acute renal failure. Alkalization of the urine and diuresis appear to be renal-protective, presumably because hemoglobin and myoglobin are more soluble in an alkaline solution. Patients who survive almost always recover renal function, even those patients who require prolonged hemodialysis. Current recommendations are as follows:

  • Correct hypovolemia with crystalloid solution
  • Infuse 500 mL/hr of crystalloid solution and 22.4 mEq bicarbonate (12 L/day, forcing diuresis of approximately 8 L/day)
  • If diuresis is less than 300 mL/hr, administer mannitol dose of 1 g/kg
  • If blood pH is greater than 7.45, administer 250 mg acetazolamide
  • Monitor vital signs and urine pH level and volume hourly
  • Assess osmolarity and electrolytes and arterial blood gas every 6 hours
Previous
Next

Indications for Fasciotomy

The definitive surgical therapy for compartment syndrome is emergent fasciotomy to release the involved compartment, with subsequent fracture reduction or stabilization and vascular repair, if needed. When compartment pressures are elevated, especially in acute settings, prompt surgical evaluation should be performed, since elevated pressures can, over a prolonged period, cause irreversible damage.[58, 59] However, no consensus exists regarding the exact pressure at which fasciotomy should be performed.[13, 15, 17, 18, 60]

Whitesides et al advised that fasciotomy should be performed when the compartment pressure rises to within 10-30 mm Hg of the patient's diastolic blood pressure (the so-called delta-P).[61, 62] McQueen and Court-Brown, studying compartment syndrome in dogs, affirmed the difference of 30 mm Hg between the compartment pressure and the diastolic blood pressure as a more reliable measure than absolute pressure measurements.[38]

Currently, many surgeons use a measured compartment pressure of 30 mm Hg as a cutoff for fasciotomy. Multiple pressure readings are often obtained, and the clinician must decide how to incorporate these readings with the clinical picture in the decision-making process.

Mubarak and Hargens recommended that fasciotomy be performed for the following patients[24] :

  • Those who are normotensive with positive clinical findings, who have compartment pressures of greater than 30 mm Hg, and whose duration of increased pressure is unknown or thought to be longer than 8 hours
  • Those who are uncooperative or unconscious, with a compartment pressure of greater than 30 mm Hg
  • Those with low blood pressure and a compartment pressure of greater than 20 mm Hg

The tolerance of tissue to prolonged ischemia varies depending on the type of tissue that is involved. Matsen showed that muscles have functional impairment after 2-4 hours of ischemia and irreversible functional loss after 4-12 hours.[10]

Nerve tissue shows abnormal function after 30 minutes of ischemia, with irreversible functional loss after 12-24 hours. Additional experimental data, however, have shown significant changes in somatosensory potentials as early as 45 minutes after compartment pressure increases up to 30 mm Hg.

If the compartment pressure is greater than 40 mm Hg, a fasciotomy is usually performed emergently, and fasciotomy is indicated if the pressure remains 30-40 mm Hg for longer than 4 hours. As a rule, when in doubt, the compartment should be released.

In a study of patients with clinical signs of compartment syndrome after revascularization surgery for lower limb ischemia, Arato et al reported that measurement of intracompartmental pressure and tissue oxygenation (measured with near-infrared spectroscopy) could be used to determine whether fasciotomy was needed.[63] Patients with pressure below 40 mm Hg and normal tissue oxygen saturation were treated conservatively.

With compartment syndrome in the hand, surgeons should have a lower threshold for decompression; a compartmental pressure of greater than 15-20 mm Hg is a relative indication for release.

If compartment syndrome is diagnosed late, fasciotomy is of no benefit. In fact, fasciotomy probably is contraindicated after the third or fourth day following the onset of compartment syndrome.

When fasciotomy is performed late, severe infection usually develops in the necrotic muscle. However, if the necrotic muscle is left alone and the compartment is not open, it can heal with scar tissue. This may result in a more functional extremity with fewer complications. However, if the duration of compartment syndrome is unclear, the surgeon should elect to decompress the indicated compartments.

In the setting of a vascular injury, a fasciotomy should be performed on high-risk patients before arterial exploration. High-risk patients include those with prolonged ischemia time, significant preoperative hypotension, associated crush injury, combined arterial and venous injury, or the need for a major venous ligation in the popliteal or femoral area.

Previous
Next

Compartment Syndrome After Arthroscopy

Studies by Nillius and Rooser, Peek and Haynes, and Fruensgaard and Holm documented the incidence of compartment syndrome following knee arthroscopy and evaluated fasciotomies as treatment.[64, 65, 66] However, Kaper et al have suggested that emergency fasciotomies are not absolutely indicated.[67] Rather, observation of the patient in the recovery room, with serial examinations and repeat compartment pressure measurements, may be considered.

Pressure measurements of the contralateral extremity may be useful as a control to verify the accuracy of the readings. If persistently elevated pressures are recorded or the development of clinical findings consistent with compartment syndrome are noted, the patient can still be returned to the operating room within the 6 hours prior to development of irreversible myonecrosis.

Previous
Next

Hyperbaric Oxygen Therapy

The Hyperbaric Oxygen (HBO) Committee of the Undersea and Hyperbaric Medical Society (UHMS) reported 13 major syndromes amenable to HBO, of which fourth on the list is crush injury, compartment syndrome, and other acute traumatic ischemias.[68] HBO promotes hyperoxic vasoconstriction, which reduces swelling and edema and improves local blood flow and oxygenation. It also increases tissue oxygen tensions and improves the survival of marginally viable tissue.[69]

At the time of surgical debridement, prior treatment with HBO aids in the demarcation of nonviable tissue. The best results are obtained when therapy is started early. Twice-daily treatments at 2.0 atmosphere absolute (ATA) to 2.5 ATA for 90-120 minutes are recommended for 5-7 days, with frequent examinations of the affected area. Despite the recommendation for HBO, most authors strongly advise caution in employing this modality. The treatment of choice for compartment syndrome is early decompression.

Physical Therapy and Occupational Therapy

The patient who undergoes fasciotomy requires a physical therapy program to regain function. Postoperative care and rehabilitation are just as important as the procedure itself.

During the immediate postoperative period, weight bearing is limited, and assistive devices (eg, crutches) are needed. Within a few days and with adequate pain control, the use of crutches can be discontinued. The rehabilitation program then involves range of motion (ROM) and flexibility exercises involving the muscles of the affected compartment. Adjacent joints need to be exercised to maintain their normal ROM.

Once the patient is able to ambulate with a normalized gait pattern, a program of graduated resistive exercises (depending on the person's regular activities or work) is initiated. In the case of athletes, sports-specific exercises are started with the intention of returning to a regular athletic schedule. Cross training is also beneficial for these athletes. Activities such as swimming, pedal exercises, water jogging, and running help athletes regain muscle strength and flexibility without loading the affected compartment.

With surgical intervention for decompression, occupational therapy consultation should be considered early in the postoperative period for assessment of appropriate treatment and of the patient's deficits with regard to activities of daily living (ADL). Therapy for ADL as well as instruction in the use of any necessary assistive device(s) may be indicated.

Previous
Next

Complications

With late diagnosis, irreversible tissue ischemia can develop in the acute setting. Thus, permanent muscle and nerve damage, along with chronic pain, may occur. Peroneal nerve palsy, in particular, may develop. With muscle damage, muscle contractures may be observed. For more information on management of contractures, see the Medscape Reference article Volkmann Contracture.

Hypesthesia and painful dysesthesia can also result from compartment syndrome. These may resolve slowly with time. Phenytoin (Dilantin), gabapentin (Neurontin), or carbamazepine (Tegretol) may be of some value in making the patient more comfortable.

Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Abraham T Rasul Jr, MD  Medical Director for Rehabilitation, Specialty Hospital of Washington; Founder, Arizona Golf Medicine Institute

Abraham T Rasul Jr, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health, Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

Samuel Agnew, MD, FACS Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville College of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center

Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Jason H Calhoun, MD, FACS Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association

Disclosure: Nothing to disclose.

William K Chiang, MD Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Patrick M Foye, MD Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Stuart B Goodman, MD, PhD, FRCS(C), FACS, FBSE Robert L and Mary Ellenburg Professor of Surgery, Professor, Department of Orthopedic Surgery, Fellowship Director, Orthopedic Adult Reconstruction, Affiliated Faculty, Department of Bioengineering, Affiliated Faculty, Stanford Center on Longevity, Stanford University School of Medicine, Stanford University Medical Center

Stuart B Goodman, MD, PhD, FRCS(C), FACS, FBSE is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, California Medical Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Orthopaedic Trauma Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Mary Ann E Keenan, MD Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania

Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association

Disclosure: Nothing to disclose.

Rick Kulkarni, MD

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Richard Paula, MD Assistant Professor of Emergency Medicine, Director of Research, University of South Florida College of Medicine

Richard Paula, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Steven I Rabin, MD Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic

Steven I Rabin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Fracture Association, AO Foundation, and Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Douglas G Smith, MD Associate Professor, Department of Orthopedic Surgery, Harborview Medical Center, University of Washington School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Jeffrey L Visotsky, MD Assistant Professor, Department of Clinical Orthopedic Surgery, Northwestern University, The Feinberg School of Medicine

Jeffrey L Visotsky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American College of Physician Executives, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, Arthroscopy Association of North America, Chicago Medical Society, and Illinois State Medical Society

Disclosure: Depuy Consulting fee Speaking and teaching; Pegasus Honoraria Board membership

Stephen Wallace, MD Staff Physician, Department of Emergency Medicine, Memorial Hospital of Sweetwater County

Stephen Wallace, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Rajesh R Yadav, MD Associate Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas Medical School at Houston

Rajesh R Yadav, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

Samuel Agnew, MD, FACS Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville College of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center

Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Jason H Calhoun, MD, FACS Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association

Disclosure: Nothing to disclose.

William K Chiang, MD Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Patrick M Foye, MD Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Stuart B Goodman, MD, PhD, FRCS(C), FACS, FBSE Robert L and Mary Ellenburg Professor of Surgery, Professor, Department of Orthopedic Surgery, Fellowship Director, Orthopedic Adult Reconstruction, Affiliated Faculty, Department of Bioengineering, Affiliated Faculty, Stanford Center on Longevity, Stanford University School of Medicine, Stanford University Medical Center

Stuart B Goodman, MD, PhD, FRCS(C), FACS, FBSE is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, California Medical Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Orthopaedic Trauma Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Mary Ann E Keenan, MD Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania

Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association

Disclosure: Nothing to disclose.

Rick Kulkarni, MD

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Richard Paula, MD Assistant Professor of Emergency Medicine, Director of Research, University of South Florida College of Medicine

Richard Paula, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Steven I Rabin, MD Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic

Steven I Rabin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Fracture Association, AO Foundation, and Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Douglas G Smith, MD Associate Professor, Department of Orthopedic Surgery, Harborview Medical Center, University of Washington School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Jeffrey L Visotsky, MD Assistant Professor, Department of Clinical Orthopedic Surgery, Northwestern University, The Feinberg School of Medicine

Jeffrey L Visotsky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American College of Physician Executives, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, Arthroscopy Association of North America, Chicago Medical Society, and Illinois State Medical Society

Disclosure: Depuy Consulting fee Speaking and teaching; Pegasus Honoraria Board membership

Stephen Wallace, MD Staff Physician, Department of Emergency Medicine, Memorial Hospital of Sweetwater County

Stephen Wallace, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Rajesh R Yadav, MD Associate Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas Medical School at Houston

Rajesh R Yadav, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

References

  1. Claes T, Van der Beek D, Claes S, Verfaillie S, Bataillie F. Chronic exertional compartment syndrome of the forearm in motocross racers. Presented at: The European Sports Medicine Congress; Hasselt, Belgium; May 14-16, 2003. [Full Text].

  2. Goubier JN, Saillant G. Chronic compartment syndrome of the forearm in competitive motor cyclists: a report of two cases. Br J Sports Med. 2003;37(5):452-3; discussion 453-4. [Medline]. [Full Text].

  3. Piasecki DP, Meyer D, Bach BR Jr. Exertional compartment syndrome of the forearm in an elite flatwater sprint kayaker. Am J Sports Med. Nov 2008;36(11):2222-5. [Medline].

  4. Qvarfordt P, Christenson JT, Eklof B, et al. Intramuscular pressure, muscle blood flow, and skeletal muscle metabolism in chronic anterior tibial compartment syndrome. Clin Orthop. Oct 1983;(179):284-90. [Medline].

  5. Bleicher RJ, Sherman HF, Latenser BA. Bilateral gluteal compartment syndrome. J Trauma. Jan 1997;42(1):118-22. [Medline].

  6. Tekwani K, Sikka R. High-risk chief complaints III: abdomen and extremities. Emerg Med Clin North Am. Nov 2009;27(4):747-65, x. [Medline].

  7. von Volkmann R. Veilletzungen und Krankenheiten der Berwegungsorgane. In: von Pithe F, Billroth T. Stuttgart, Verlag von Ferdinand Enke, eds. Handbuch der Allgemeinen und Speziellen Chirurgs. Zweiter Band, Zweiter Abteilung, Abschmitt V, Ersted haft: 1882:234-920.

  8. Jepson PN. Ischaemic contracture: experimental study. Ann Surg. 1926;84:785-95.

  9. Owen CA, Mubarak SJ, Hargens AR, Rutherford L, Garetto LP, Akeson WH. Intramuscular pressures with limb compression clarification of the pathogenesis of the drug-induced muscle-compartment syndrome. N Engl J Med. May 24 1979;300(21):1169-72. [Medline].

  10. Matsen FA 3rd. Compartmental syndrome. An unified concept. Clin Orthop Relat Res. Nov-Dec 1975;8-14. [Medline].

  11. Amendala A, Rorabeck CH. Chronic exertional compartment syndrome. In: Welsh RP, Shepard RJ, eds. Current Therapy in Sports Medicine. 1985. Toronto, Canada: BC Decker; 250-2.

  12. Blackman P, Bradshaw C, Crossley K. Chronic exertional compartment syndrome in the lower leg. A comparison of treatment options and outcome. International Conference of Science and Medicine in Sports, Brisbane, Australia. 1994;56-7.

  13. Blackman PG. A review of chronic exertional compartment syndrome in the lower leg. Med Sci Sports Exerc. Mar 2000;32(3 Suppl):S4-10. [Medline].

  14. Eisele SA, Sammarco GJ. Chronic exertional compartment syndrome. Instr Course Lect. 1993;42:213-7. [Medline].

  15. Howard JL, Mohtadi NG, Wiley JP. Evaluation of outcomes in patients following surgical treatment of chronic exertional compartment syndrome in the leg. Clin J Sport Med. Jul 2000;10(3):176-84. [Medline].

  16. Liem NR, Bourque PR, Michaud C. Acute exertional compartment syndrome in the setting of anabolic steroids: an unusual cause of bilateral footdrop. Muscle Nerve. Jul 2005;32(1):113-7. [Medline].

  17. Mouhsine E, Garofalo R, Moretti B, et al. Two minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg. Knee Surg Sports Traumatol Arthrosc. Feb 2006;14(2):193-7. [Medline].

  18. Schepsis AA, Martini D, Corbett M. Surgical management of exertional compartment syndrome of the lower leg. Long-term followup. Am J Sports Med. Nov-Dec 1993;21(6):811-7; discussion 817. [Medline].

  19. Clayton JM, Hayes AC, Barnes RW. Tissue pressure and perfusion in the compartment syndrome. J Surg Res. Apr 1977;22(4):333-9. [Medline].

  20. Shrier I, Magder S. Pressure-flow relationships in in vitro model of compartment syndrome. J Appl Physiol. Jul 1995;79(1):214-21. [Medline].

  21. Beraldo S, Dodds SR. Lower limb acute compartment syndrome after colorectal surgery in prolonged lithotomy position. Dis Colon Rectum. Nov 2006;49(11):1772-80. [Medline].

  22. Walker JL, Smith GH, Gaston MS, Robinson CM. Spontaneous compartment syndrome in association with simvastatin-induced myositis. Emerg Med J. May 2008;25(5):305-6. [Medline].

  23. Detmer DE, Sharpe K, Sufit RL, et al. Chronic compartment syndrome: diagnosis, management, and outcomes. Am J Sports Med. May-Jun 1985;13(3):162-70. [Medline].

  24. Mubarak SJ, Hargens AR. Acute compartment syndromes. Surg Clin North Am. Jun 1983;63(3):539-65. [Medline].

  25. King TW, Lerman OZ, Carter JJ, Warren SM. Exertional compartment syndrome of the thigh: a rare diagnosis and literature review. J Emerg Med. Aug 2010;39(2):e93-9. [Medline].

  26. Naidu KS, Chin T, Harris C, Talbot S. Bilateral peroneal compartment syndrome after horse riding. Am J Emerg Med. Sep 2009;27(7):901.e3-5. [Medline].

  27. Malic CC, Hernon C, Austin O, Phipps A. Scalded and swollen-beware the underlying compartment syndrome. Burns. Jun 2006;32(4):504-6. [Medline].

  28. Crick KA, Crick JC, Pulley MT. Hemorrhagic upper extremity complications from tissue plasminogen activator. J Surg Orthop Adv. Spring 2007;16(1):27-30. [Medline].

  29. Wang KL, Li SY, Chuang CL, Chen TW, Chen JY. Subfascial hematoma progressed to arm compartment syndrome due to a nontransposed brachiobasilic fistula. Am J Kidney Dis. Dec 2006;48(6):990-2. [Medline].

  30. Rafiq I, Anderson DJ. Acute rhabdomyolysis following acute compartment syndrome of upper arm. J Coll Physicians Surg Pak. Nov 2006;16(11):734-5. [Medline].

  31. Swaringen JC, Seiler JG 3rd, Bruce RW Jr. Influenza A induced rhabdomyolysis resulting in extensive compartment syndrome. Clin Orthop Relat Res. Jun 2000;243-9. [Medline].

  32. Wirth JJ, Sheka KP, Gheewala A, Rowe NM. Acquired immune deficiency syndrome and systemic lupus erythematosis: potential causes of surgical emergencies of the hand. Ann Plast Surg. Jul 2008;61(1):35-9. [Medline].

  33. Rahm M, Probe R. Extensive deep venous thrombosis resulting in compartment syndrome of the thigh and leg. A case report. J Bone Joint Surg Am. Dec 1994;76(12):1854-7. [Medline].

  34. Aprahamian C, Gessert G, Bandyk DF, Sell L, Stiehl J, Olson DW. MAST-associated compartment syndrome (MACS): a review. J Trauma. May 1989;29(5):549-55. [Medline].

  35. Ashton H. Effect of inflatable plastic splints on blood flow. Br Med J. Dec 10 1966;2(5527):1427-30. [Medline]. [Full Text].

  36. Verdolin MH, Toth AS, Schroeder R. Bilateral lower extremity compartment syndromes following prolonged surgery in the low lithotomy position with serial compression stockings. Anesthesiology. Apr 2000;92(4):1189-91. [Medline].

  37. Dailiana HZ, Kotsaki D, Varitimidis S, et al. Injection injuries: seemingly minor injuries with major consequences. Hippokratia. Jan 2008;12(1):33-6. [Medline]. [Full Text].

  38. McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br. Jan 1996;78(1):99-104. [Medline]. [Full Text].

  39. DeLee JC, Stiehl JB. Open tibia fracture with compartment syndrome. Clin Orthop Relat Res. Oct 1981;175-84. [Medline].

  40. Feliciano DV, Cruse PA, Spjut-Patrinely V, Burch JM, Mattox KL. Fasciotomy after trauma to the extremities. Am J Surg. Dec 1988;156(6):533-6. [Medline].

  41. Rorabeck CH, Macnab I. The pathophysiology of the anterior tibial compartmental syndrome. Clin Orthop Relat Res. Nov-Dec 1975;52-7. [Medline].

  42. Matsen FA 3rd, Winquist RA, Krugmire RB Jr. Diagnosis and management of compartmental syndromes. J Bone Joint Surg Am. Mar 1980;62(2):286-91. [Medline].

  43. Sheridan GW, Matsen FA 3rd. Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg Am. Jan 1976;58(1):112-5. [Medline].

  44. Rockwood CA Jr, Green DP, Bucholz RW, Heckman JD, eds. Rockwood and Green's Fractures in Adults. 4th ed. Philadelphia, Pa: Lippincott-Raven; 1996.

  45. Matsen FA 3rd, Winquist RA, Krugmire RB Jr. Diagnosis and management of compartmental syndromes. J Bone Joint Surg Am. Mar 1980;62(2):286-91. [Medline].

  46. Cincinnati Children's Hospital Medical Center. Evidence-based care guideline for femoral shaft fractures. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; Dec 2006:[Full Text].

  47. Reach JS Jr, Amrami KK, Felmlee JP, et al. The compartments of the foot: a 3-tesla magnetic resonance imaging study with clinical correlates for needle pressure testing. Foot Ankle Int. May 2007;28(5):584-94. [Medline].

  48. Yu JS, Habib P. MR imaging of urgent inflammatory and infectious conditions affecting the soft tissues of the musculoskeletal system. Emerg Radiol. Jan 9 2009;[Medline].

  49. Jones WG 2nd, Perry MO, Bush HL Jr. Changes in tibial venous blood flow in the evolving compartment syndrome. Arch Surg. Jul 1989;124(7):801-4. [Medline].

  50. Mubarak SJ, Hargens AR, Owen CA, Garetto LP, Akeson WH. The wick catheter technique for measurement of intramuscular pressure. A new research and clinical tool. J Bone Joint Surg Am. Oct 1976;58(7):1016-20. [Medline].

  51. Styf J, Wiger P. Abnormally increased intramuscular pressure in human legs: comparison of two experimental models. J Trauma. Jul 1998;45(1):133-9. [Medline].

  52. Matsen FA 3rd, Wyss CR, Krugmire RB Jr, Simmons CW, King RV. The effects of limb elevation and dependency on local arteriovenous gradients in normal human limbs with particular reference to limbs with increased tissue pressure. Clin Orthop Relat Res. Jul-Aug 1980;187-95. [Medline].

  53. Garfin SR, Mubarak SJ, Evans KL, Hargens AR, Akeson WH. Quantification of intracompartmental pressure and volume under plaster casts. J Bone Joint Surg Am. Mar 1981;63(3):449-53. [Medline].

  54. Wallensten R, Karlsson J. Histochemical and metabolic changes in lower leg muscles in exercise- induced pain. Int J Sports Med. Aug 1984;5(4):202-8. [Medline].

  55. Better OS, Zinman C, Reis DN, et al. Hypertonic mannitol ameliorates intracompartmental tamponade in model compartment syndrome in the dog. Nephron. 1991;58(3):344-6. [Medline].

  56. Shah DM, Bock DE, Darling RC 3rd, et al. Beneficial effects of hypertonic mannitol in acute ischemia--reperfusion injuries in humans. Cardiovasc Surg. Feb 1996;4(1):97-100. [Medline].

  57. Daniels M, Reichman J, Brezis M. Mannitol treatment for acute compartment syndrome. Nephron. Aug 1998;79(4):492-3. [Medline].

  58. Pollak AN. Use of negative pressure wound therapy with reticulated open cell foam for lower extremity trauma. J Orthop Trauma. Nov-Dec 2008;22(10 Suppl):S142-5. [Medline].

  59. Brey JM, Castro MD. Salvage of compartment syndrome of the leg and foot. Foot Ankle Clin. Dec 2008;13(4):767-72. [Medline].

  60. McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br. Jan 1996;78(1):99-104. [Medline].

  61. Whitesides TE, Haney TC, Morimoto K, Harada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res. Nov-Dec 1975;43-51. [Medline].

  62. Whitesides TE Jr, Haney TC, Harada H, Holmes HE, Morimoto K. A simple method for tissue pressure determination. Arch Surg. Nov 1975;110(11):1311-3. [Medline].

  63. Arato E, Kurthy M, Sinay L, et al. Pathology and diagnostic options of lower limb compartment syndrome. Clin Hemorheol Microcirc. 2009;41(1):1-8. [Medline].

  64. Nillius A, Rööser B. [Acute compartment syndrome in knee arthroscopy]. Lakartidningen. Feb 16 1983;80(7):590. [Medline].

  65. Peek RD, Haynes DW. Compartment syndrome as a complication of arthroscopy. A case report and a study of interstitial pressures. Am J Sports Med. Nov-Dec 1984;12(6):464-8. [Medline].

  66. Fruensgaard S, Holm A. Compartment syndrome complicating arthroscopic surgery: brief report. J Bone Joint Surg Br. Jan 1988;70(1):146-7. [Medline].

  67. Kaper BP, Carr CF, Shirreffs TG. Compartment syndrome after arthroscopic surgery of knee. A report of two cases managed nonoperatively. Am J Sports Med. Jan-Feb 1997;25(1):123-5. [Medline].

  68. Undersea and Hyperbaric Medical Society. June 2003. Indications for hyperbaric oxygen therapy. Available at http://www.uhms.org/Indications/indications.htm. Accessed July 24, 2007.

  69. Wattel F, Mathieu D, Nevière R, Bocquillon N. Acute peripheral ischaemia and compartment syndromes: a role for hyperbaric oxygenation. Anaesthesia. May 1998;53 Suppl 2:63-5. [Medline].

  70. Mar GJ, Barrington MJ, McGuirk BR. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. Br J Anaesth. Jan 2009;102(1):3-11. [Medline].

  71. Bywaters EG, Beall D. Crush injuries with impairment of renal function. 1941. J Am Soc Nephrol. Feb 1998;9(2):322-32. [Medline].

  72. Hutchinson MR, Ireland ML. Common compartment syndromes in athletes. Treatment and rehabilitation. Sports Med. Mar 1994;17(3):200-8. [Medline].

 
Previous
Next
 
(Click Image to enlarge.) Volar release in the forearm. The upper illustration shows the incision that is used. The lower left picture depicts the relevant incisional anatomy. The lower right picture depicts the cross-sectional anatomy.
Surgical anatomy of the volar forearm. Photo courtesy of Dr. Smith, Harborview/UW Medical Center, Department of Orthopaedics, Seattle, Wash.
(Click Image to enlarge.) Two-incision anterolateral fasciotomy. Photographs courtesy of DG Smith, MD, Harborview Hospital, Seattle, WA.
(Click Image to enlarge.) Two-incision posteromedial fasciotomy. Photographs courtesy of DG Smith, MD, Department of Orthopedics, Harborview Hospital, Seattle, WA.
(Click Image to enlarge.) Single-incision fasciotomy. Photographs courtesy of DG Smith, MD, Harborview Hospital, Seattle, WA.
Picture of compartment pressure measuring device for use when commercial devices are unavailable.
Stryker STIC Monitor. Image courtesy of Stryker Corporation, used with permission.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.