Acute Compartment Syndrome

Compartment syndrome is a well-known pathophysiologic phenomenon following trauma or ischemia, but despite that fact, it is notoriously difficult to diagnose and the only effective treatment is surgical fasciotomy. Classically, compartment syndrome is considered a clinical diagnosis, yet the clinical findings are easily attributed to other aspects of the injury, and the absence of clinical findings is more reliable in excluding compartment syndrome than in determining patients at risk. Measurement of intramuscular pressure is useful as an adjunct to the clinical examination in equivocal cases or in unconscious patients, but there is no consensus on what pressures indicate an absolute need for fasciotomy. Compartment is also a significant medico-legal concern for physicians, and many unnecessary fasciotomies are done in order to avoid a case of missed compartment syndrome. In this chapter, the literature is reviewed regarding risk factors for compartment syndrome, the usefulness of clinical exam findings, and the proper role of intramuscular pressure measurement.