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Compartment Syndrome
Last updated 14th May 2021
Presentation
- Most commonly seen following trauma, may occur after ischaemic reperfusion injuries and burns
- Tibial shaft and forearm fractures are commonly affected compartments
- Pain out of proportion to stimulus or pain on passive stretch of the affected muscle compartment is initial clinical sign
- Paraesthesia, paralysis, pallor and pulselessness (5 P’s) – these are late signs
Management
- Early decompression of affected compartments – if in a plaster cast, remove this immediately
- Urgent orthopaedics review – fasciotomy with decompression of muscle compartments
- Resuscitation – Ensure patient is normotensive, maintain limb at heart level and supplemental oxygen
Intracompartmental pressure measurement
- There are devices that allow ICP to be measured, however this isn’t routinely used
- If compartment syndrome is obvious on clinical examination, this may not be necessary
- Useful adjunct in unconscious patient and patients with equivocal clinical findings
- Inadequate perfusion when pressure within closed compartment rises to within 10-30mmHg of patients diastolic blood pressure