Compartment Syndrome: Diagnosis, Management, and Unique Concerns in the Twenty-First Century

Abstract

BackgroundCompartment syndrome is an elevation of intracompartmental pressure to a level that impairs circulation. While the most common etiology is trauma, other less common etiologies such as burns, emboli, and iatrogenic injuries can be equally troublesome and challenging to diagnose. The sequelae of a delayed diagnosis of compartment syndrome may be devastating. All care providers must understand the etiologies, high-risk situation, and the urgency of intervention.Questions/PurposesThis study was conducted to perform a comprehensive review of compartment syndrome discussing etiologies, risk stratification, clinical progression, noninvasive and invasive monitoring, documentation, medical-legal implication, and our step-by-step approach to compartment syndrome prevention, detection, and early intervention.MethodsA literature search was performed using the PubMed Database and the following search terms: “Compartment syndrome AND Extremity,” “Compartment syndrome AND Gluteal,” and Compartment syndrome AND Paraspinal.” A total of 2,068 articles were identified. Filters allowed for the exclusion of studies not printed in English (359) and those focusing on exertional compartment syndrome (84), leaving a total of 1,625 articles available for review.ResultsThe literature provides details regarding the etiologies, risk stratification, clinical progression, noninvasive and invasive monitoring, documentation, medical-legal implication, and our step-by-step approach to compartment syndrome prevention, detection, and early intervention. The development and progression of compartment syndrome is multifactorial, and as complexity of care increases, the opportunity for the syndrome to be missed is increased. Recent changes in the structure of in-hospital medical care including resident work hour restrictions and the incorporation of midlevel providers have increased the frequency of “signouts” or “patient handoffs” which present opportunities for the syndrome to be mismanaged.ConclusionThe changing dynamics of the health care team have prompted the need for a more explicit algorithm for managing patients at risk for compartment syndrome to ensure appropriate conveyance of information among team members.Electronic supplementary materialThe online version of this article (doi:10.1007/s11420-014-9386-8) contains supplementary material, which is available to authorized users.

Gluteal compartment syndrome developing after nephrectomy and incisional hernia surgery

“…Yüksek risk taşıyan hastalarda uzun süreli blokajdan ve epidural kateterden kaçınılmalıdır. [6,7,16,18] Gluteal kompartman sendromunun tanısında en önemli kanıt klinik bulgulardır. Bunun yanında tanıyı desteklemesi ve fasyotomiye karar verme açısından kompartman içi basınç ölçümü yapılabilir, ancak diğer kompartmanlarda olduğu gibi hangi basınç değerlerinde fasyotomi yapılması gerektiği tam olarak bilinmemektedir.…”

The effect of two different surgical methods on intracompartmental pressure values in tibial shaft fractures: An experimental study in a rabbit model

“…[1][2][3][4][5][6] Development of ACS may be related to treatment modal-minimal morbidity and without disrupting the fracture hematoma. ICF also provides opportunity for closed reduction and repositioning of bone fragments, and causes minimal disruption of soft tissues in region of fracture with preservation of blood supply.…”

Gluteal compartment syndrome caused by traumatic rupture of the superior gluteal artery

“…The local ischemia produced by a compartment syndrome must be relieved by decompressing the muscle compartment [1,2].…”