Compartment syndrome: challenges and solutions
Compartment syndrome is defined as increased pressure within a fibro-osseous space resulting in decreased tissue perfusion to structures within that space. Hence, early identification is critical for successful outcomes. There are two types of compartment syndrome – acute and chronic. Out of the two, acute compartment syndrome (ACS) is more worrying and needs urgent attention. ACS can be caused by a number of factors. These can be broadly classified as factors causing increased volume within a closed space, or those that restrict the compartment from expanding. The mainstay of diagnosis is a high index of clinical suspicion particularly in high risk cases. The three main findings that point toward compartment syndrome which clinicians rely on are 1) pain out of proportion to expectation, 2) stretch pain, ie, pain exacerbated by passive movement/stretch of muscles within the compartment, and 3) tense swelling. Though there are no reproducible and reliable tests for compartment syndrome, measurement of intracompartmental syndrome is required in cases where diagnosis is unclear. Traditionally a measurement of 30 mmHg was taken as a cut off value above which fasciotomy was necessary...