Compartment syndrome as a complication of fracture

 Compartment syndrome:

This is a particular complication that may occur following fractures (or following ischemia reperfusion injury in vascular patients. It is characterized by raised pressure within a closed anatomical space.

• The raised pressure within the compartment will eventually compromise tissue perfusion resulting in necrosis. The two main fractures carrying this complication include supracondylar fractures and tibial shaft injuries.

Symptoms and signs

• Pain, especially on movement (even passive)

• Parasthesiae

• Pallor may be present

• Arterial pulsation may still be felt as the necrosis occurs as a result of a microvascular compromise

• Paralysis of the muscle group may occur

Diagnosis

• Is made by measurement of intracompartmental pressure measurements. Pressures over 20mmHg are

abnormal and >40mmHg is diagnostic.

Treatment

• This is essentially prompt and extensive fasciotomies

• In the lower limb the deep muscles may be inadequately decompressed by the inexperienced operator when

smaller incisions are performed

• Myoglobinuria may occur following fasciotomy and result in renal failure and for this reason these patients

require aggressive IV fluids

• Where muscle groups are frankly necrotic at fasciotomy they should be debrided and amputation may have to

be considered

• Death of muscle groups may occur within 4-6 hours