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The compartment syndrome
Last reviewed: 19.11.2021
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A 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 the measurement of intrafascial pressure. Treatment - fasciotomy.
The compartment syndrome is a closed vicious circle. It begins with an edema that usually develops after an injury (for example, due to soft tissue swelling or hematoma). If this edema builds up inside the fascial space, usually in the anterior or posterior compartment of the legs, there is little room for swelling to expand, and therefore interstitial (intrafacial) pressure begins to increase. As the intrafascial pressure begins to exceed 20 mm Hg, the perfusion of the cells slows down, and, in the final analysis, can generally cease. (NB: since the pressure of 20 mm Hg is significantly lower than the arterial pressure, cell perfusion may stop long before the pulse disappears). Developing as a result of tissue ischemia further intensifies edema and thus closes a vicious circle. With the development of ischemia, muscle necrosis occurs, there is a threat of limb loss and, in the absence of treatment, the death of the patient. The cause of compartmental syndrome can also be tissue ischemia, secondary damage to the arteries.
To the frequent reasons carry fractures, heavy bruises, in rare cases - snake bites, plaster bandages and other rigid fixing devices that limit the volume of edema and increase intrafacial pressure.
The compartment syndrome often occurs in the anterior fascial lobe of the tibia. The earliest manifestation is pain. It is usually disproportionate to the degree of visible damage and is amplified by passive muscle tension inside the compartment (for example, for the front leg box, the pain increases with passive flexion of the toes due to contraction of the extensor muscles of the toes). Later, other signs of tissue ischemia join: pain, paresthesia, paralysis, skin pallor and lack of pulse; at palpation the fascial bed can be strained.
The diagnosis is based on the measurement of intrafascial pressure (norm - <20 mm Hg) with the help of a special catheter. At a pressure of 20 to 40 mm Hg. In some cases, conservative treatment with analgesics, elevated limb position and splinting is possible. The gypsum is removed or cut. At a pressure of> 40 mm Hg. To reduce it, an immediate fasciotomy is usually necessary.
It is necessary to diagnose and begin treatment before the pallor of the skin appears and the pulse disappears, which will mark the onset of necrosis. Necrosis can be an indication for amputation. Necrosis can be the cause of rhabdomyolysis and infection.