Acute compartment syndrome: reducing the risk

Clin Risk 2008;14:114-118
doi:10.1258/cr.2008.080019
© 2008 Royal Society of Medicine Press

 

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Acute compartment syndrome: reducing the risk

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Mr Michael F Pearse and
Professor Jagdeep Nanchahal

Email: linda{at}avma.org.uk

Acute limb compartment syndrome is a surgical emergency characterizedby raised pressure within an unyielding tissue compartment.Although there is commonly a history of trauma there are a numberof causes of compartment syndrome, which includes iatrogenicinsults. The key clinical feature of a compartment syndromein the conscious patient is severe pain out of proportion tothe injury and aggravated by passive muscle stretch. Intracompartmentalpressure measurements remain the only objective method of diagnosingan acute compartment syndrome. Although it is subject to falsepositives, interpreting the pressures in relation to the systemicblood pressure helps confirm the diagnosis when the clinicalfindings are equivocal and provides essential information inunconscious or uncooperative patients. Successful treatmentof an acute compartment syndrome involves prompt, early diagnosisfollowed by an adequate surgical decompression of all four compartmentsof the leg by fasciotomies. Delay in diagnosis is almost invariablyassociated with a poor outcome and loss of limb function. Asacute compartment syndromes typically occur in young patientswith an average work–life expectancy of up to 30 years,a poor outcome results in severe loss of productivity.

Acute compartment syndrome: reducing the risk
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