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Acute Compartment Syndrome

Acute Compartment Syndrome: Pathogenesis and clinical findings Fracture (especially Authors: Nojan Mannani, Chris Sveen Reviewers: Michelle J. Chen, Spencer Montgomery, Yan Yu, Dr. Andrew Reed*, Dr. Gerhard Kiefer* * MD at time of publication of long bones) Penetrating injuries Crush injuries High volume IV transfusion or punctured vein Reperfusion syndrome Venomous animal bites Severe burns Burn eschar (rigid dead tissue) Prolonged limb compression Injury resulting in swelling Bleeding into muscle compartment ↑ Pressure compresses veins (thin walls make them easily compressible), preventing venous outflow from muscle compartment Buildup of venous blood in capillaries & venules further ↑ pressure in compartment Arterioles collapse as they are unable to withstand higher pressure ↑ Pressure in capillaries prevents/slows blood flow from arterioles to capillaries, reducing tissue perfusion ↓ Oxygen delivery to muscles Muscle & nerve necrosis Ability for somatic sensory fibres to transmit information to the brain is impaired Fluids intended for IV space leak into surrounding tissues Tissue damage triggers release of inflammatory mediators increasing vascular permeability Accumulation of fluids ↑ pressure within a muscle compartment Stimulation of nociceptors in muscle Pain out of proportion to injury Edema in muscle compartment Muscle feels hard on palpation Swelling Reduced arterial pulses (late finding) Pallor Muscle feels cold on palpation Muscle weakness Paresthesia Sensory deficits Rigid eschar prevents compartment expansion Ischemic muscle releases inflammatory mediators Constrictive bandage/cast applied before swelling subsides External compression prevents muscle compartment from expanding to accommodate intra-compartment swelling Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Feb 4, 2014, Updated Nov 19, 2024 on www.thecalgaryguide.com