Physiology

• Increased compartmental pressure → closing of micro-vasculature (not affecting big vessels) → ischemia and hypoxia

  

Causes

• Internal
  • Fractures
  • Crush injury
  • Coagulopathy
  • Re-perfusion syndrome
  • Pus or tumor (uncommon)
• External
  • Casting (Immobolization)
  • Circumferential Burn eschar

Diagnosis (Clinical) → Signs and Symptoms

1. Pain OUT OF PROPORTION
2. Pain on passive stretch (antagonistic movement of compartment of suspicion)
3. Tense compartment upon palpation

• *IT IS NOT
• Intra-compartmental Pressure Measurement indicated ONLY when

Management

1. If caused by Casting (Immobolization), remove all casting, elevate limb → Re-assess Q15 min
2. If failure to improve: urgent Fasiotomy of ALL COMPARTMENTS within 6 hrs of pain onset
   • 2-incision, 4-compartment release
3. Debride necrotic muscle
4. Stabilize fracture (often ex-fix first)

Consequences

• if untreated (> 6 hrs), irreversable muscle necrosis → permanent contracture

  

• If Fasiotomy , severe cosmetic Sequela