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Compartment syndrome
Last reviewed: 07.07.2025
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Compartment syndrome is an increase in tissue pressure within closed fascial spaces, leading to tissue ischemia. The earliest symptom is pain, disproportionate to the severity of the injury. Diagnosis is based on measuring intrafascial pressure. Treatment is fasciotomy.
Compartment syndrome is a vicious circle. It begins with edema, usually following trauma (e.g., due to soft tissue swelling or hematoma). If this edema builds up within a fascial space, usually in the anterior or posterior compartment of the legs, there is little room for the edema to expand, and interstitial pressure begins to rise. As interstitial pressure rises above 20 mmHg, cellular perfusion slows and may eventually cease. (NB: since 20 mmHg is significantly lower than arterial pressure, cellular perfusion may cease long before the pulse disappears.) The resulting tissue ischemia further increases the edema, thus perpetuating the vicious circle. As ischemia progresses, muscle necrosis occurs, limb loss may occur, and, if untreated, the patient may die. Compartment syndrome can also be caused by tissue ischemia secondary to arterial damage.
Common causes include fractures, severe bruises, and in rare cases snake bites, plaster casts and other rigid fixing devices that limit the volume of swelling and increase intrafascial pressure.
Compartment syndrome most often occurs in the anterior fascial compartment of the leg. The earliest manifestation is increased pain. It is usually disproportionate to the degree of visible damage and is aggravated by passive tension of the muscles within the compartment (e.g., for the anterior compartment of the leg, pain is aggravated by passive flexion of the toes due to contraction of the extensor muscles of the toes). Later, other signs of tissue ischemia are added: pain, paresthesia, paralysis, pale skin, and loss of pulse; the fascial compartment may be tense on palpation.
Diagnosis is based on measuring intrafascial pressure (normal - <20 mm Hg) using a special catheter. At pressure from 20 to 40 mm Hg, in some cases conservative treatment with analgesics, elevated position of the limb and splinting is possible. The plaster is removed or cut. At pressure >40 mm Hg, immediate fasciotomy is usually necessary to reduce it.
Diagnosis and treatment must be made before pallor and loss of pulse occur, indicating the onset of necrosis. Necrosis may be an indication for amputation. Necrosis may cause rhabdomyolysis and infection.