Compartment syndrome is a painful, limb threatening condition. It occurs as a result of increased pressure within the limb compartment or excessive swelling of the injured muscle after a fracture or injury. Most commonly it occurs in the anterior (front) compartment of the leg but it can also effect other compartments of arms, legs or abdomen.
According to a study published in BMJ Journals by Dr. Jennifer Cone and Dr. Kenji Inaba, “It has been estimated that the average annual incidence is 0.7 per 100 000 women and 7.3 per 100 000 men.13 roughly 2.8% of patients who sustained extremity trauma need surgical procedure named Fasciotomy.”
It can be categorized in two types:
ACUTE COMPARTMENT SYNDROME:
It is an orthopedic emergency and occurs as a result of fracture or injury.
CHRONIC COMPARTMENT SYNDROME:
It is not an emergency condition and occurs as a result of exertion. Hence it is also called “Exertion Compartment Syndrome”. In this blog, we will be covering Acute Compartment Syndrome as it is a painful and serious orthopedic emergency.
Development of the Syndrome
Anatomically arms and legs are divided into different compartments formed of groups of muscles, blood vessels and nerves, covered by a tough membrane known as Fascia. Fascia keeps the structures within place and has almost no tendency of expansion. After a crush injury or fracture, there is pressure build up within these compartments as result of inflammation or bleeding. Because the fascia does not expand, this pressure buildup leads to compression of nerves and blood vessels and hinder blood supply to the respective tissues and muscles. This further leads to cellular tissue damage and necrosis.
Causes of Acute Compartment Syndrome
The following are the causes that complicate the injury and leads to acute compartment syndrome:
1. FRACTURE: Fracture of a bone is one of the most common causes of compartment syndrome. Fracture mostly lead to muscle injury and internal bleeding and hence building up of the pressure within the compartment.
2. STERIOD USE: Use of steroids for anabolic purposes may cause compartment syndrome.
3. CRUSH INJURIES: Road traffic accidents or other injuries leading to multiple internal wounds may cause internal bleeding and swelling of the tissues causing compartment syndrome to develop.
4. CAST AND TIGHT BANDAGES: This can cause severe swelling, hindrance to the blood flow and eventually lead to the compartment syndrome.
5. Other causes include muscle breakdown (Rhabdomyolysis), Alcohol intoxication, burns, snake bites etc.
Signs & Symptoms
1. “Pain out of proportion”. Slightest of movement can lead to severe pain.
2. Burning sensation in the affected area.
3. Fullness and tightness of the muscles.
4. Numbness and parathesia.
5. Paralysis occurs if left untreated and is a late finding.
6. Pulselessness e.g. in case of lower extremity absence of dorsal pedis pulsation.
7. Tense, pale and shiny skin.
Treatment of Acute Compartment Syndrome
As said “Prevention is better than cure”, therefore measures are always taken-up to avoid development of compartment syndrome. These include limb elevation and icing in order to prevent excessive swelling.
After development of Acute Compartment syndrome, “Surgical Fasciotomy” is the only option left. Fasicotmy is a procedure performed to release the pressure in order to restart the blood flow so as to prevent cellular injury and necrosis. Prognosis depends upon prompt and on time management in order to prevent permanent damage. Delay in management may lead to breakdown of muscles and acute kidney failure. Moreover it may lead to infection, amputation, muscle scaring, permanent nerve damage etc.