Acute Compartment Syndrome of the Limbs: Current Concepts and Management

Abstract

Acute compartment syndrome (ACS) of the limb refers to a constellation of symptoms, which occur following a rise in the pressure inside a limb muscle compartment. A failure or delay in recognising ACS almost invariably results in adverse outcomes for patients. Unrecognised ACS can leave patients with nonviable limbs requiring amputation and can also be life–threatening. Several clinical features indicate ACS. Where diagnosis is unclear there are several techniques for measuring intracompartmental pressure described in this review. As early diagnosis and fasciotomy are known to be the best determinants of good outcomes, it is important that surgeons are aware of the features that make this diagnosis likely. This clinical review discusses current knowledge on the relevant clinical anatomy, aetiology, pathophysiology, risk factors, clinical features, diagnostic procedures and management of an acute presentation of compartment syndrome.

Pressure, perfusion, and compartments

“…Tissue that has been previously subjected to intervals of ischemia, patients under general anesthesia, sedated, or obtunded, and those receiving postoperative epidurals after tibial fracture fixation are especially susceptible to an insidious onset of critical ECS. 2,3 The importance of timeliness of fasciotomy in vascular injuries was investigated by Farber et al, 47 analyzing National Trauma Data Bank data of 612 patients who underwent fasciotomies, 543 early and 69 late (before 8 hours and after 8 hours of vascular repair). Patients in the early fasciotomy group had lower amputation rate and shorter total hospital stay compared with those in the late fasciotomy group.…”

Acute Compartment Syndrome of the Lower Leg after Coronary Artery Bypass Grafting: A Silent but Dangerous Complication

“…If the pressure within the compartment exceeds the ischemic threshold of the tissue, irreversible damage may occur. 1 Well known causes of the syndrome are trauma or surgery of the lower leg. ACoS after coronary artery bypass grafting (CABG) is rare and only 15 cases have been reported in the English language literature (►Tables 1 and 2).…”

“…Disproportionate pain at rest or with passive stretch is an early symptom, while pallor and pulselessness are signs of severe arterial compromise. 1 As irreversible tissue damage can occur as early as 3 hours after the onset of ischemia, in high suspicion of ACoS, prompt surgical treatment is mandatory. In questionable cases, diagnostic tools such as intracompartimental pressure measurement, biomarkers, and imaging techniques can aid.…”

Application of contrast-enhanced ultrasonography in the diagnosis of skeletal muscle crush injury in rabbits

“…AOCS has a 47% mortality, and unrecognized AOCS can leave a patient with non-viable limbs requiring amputation. 4 Severe muscle crush injury can also result in multiple organ dysfunction syndrome, acute respiratory distress syndrome, disseminated intravascular coagulation and severe arrhythmia. 5 Early diagnosis of muscle crush injury and correct assessment of its severity are critical for good prognosis of patients.…”

“…6,7 Impaired microcirculation is the initial pathological change of crushed muscles. 4 A variety of imaging methods have been used to examine reperfusion of the extremities and therefore detect the presence of muscle crush injury, such as CT, MRI and ultrasonography. [8][9][10][11] However, the equipment of CT and MRI is large and inconvenient for bedside or pre-hospital settings or in situ care at the trauma scene.…”