Journal of Surgical Education
Volume 64, Issue 3 , Pages 178-186 , May 2007

Acute Limb Compartment Syndrome: A Review

  • Stavros Gourgiotis, MD

      Affiliations

    • Second Surgical Department, 401 General Army Hospital of Athens, Athens, Greece
    • Corresponding Author InformationCorrespondence: Inquiries to Stavros Gourgiotis, MD, PhD, 41 Zakinthinou Street, Papagou, Athens, 15669 Greece; fax: 30 210 6525802
    • ,
  • Constantinos Villias, MD

      Affiliations

    • Second Surgical Department, 401 General Army Hospital of Athens, Athens, Greece
    • ,
  • Stylianos Germanos, MD

      Affiliations

    • Upper GI and General Surgery, Leighton Hospital, Crewe, United Kingdom
    • ,
  • Athanasios Foukas, MD

      Affiliations

    • Wrightington Hospital, Wigan, United Kingdom
    • ,
  • Marco Pericoli Ridolfini, MD

      Affiliations

    • Department of Surgical Sciences, ‘A. Gemelli’ University Hospital, Rome, Italy

References 

  1. Mars M, Hadley GP. Raised intracompartmental pressure and compartment syndromes. Injury. 1998;29:403–411
  2. Volkmann R. Die ischaemischen Muskellahmungen und Kontrakturen. Centralbl Chir. 1881;8:801–803
  3. Rorabeck CH. The treatment of ccompartment syndromes of the leg. J Bone Joint Surg Br. 1984;66:93–97
  4. Jepson PN. Ischemic contracture: experimental study. Ann Surg. 1926;84:785–795
  5. Watson-Jones R. Fractures and Joint Injuries. 4th ed.. Edinburgh: Livingstone ES; 1952;
  6. Whitesides TE, Harada H, Morimoto K. Compartment syndromes and the role of fasciotomy, its parameters and techniques. In: Instructional Course Lectures. St. Louis, MO: Mosby CV; 1977;p. 179–196American Academy of Orthopaedic Surgeons
  7. McQueen MM, Christie J, Court-Brown CM. Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg Br. 1996;78:95–98
  8. McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures (The pressure threshold for decompression). J Bone Joint Surg Br. 1996;78:99–104
  9. Tiwari A, Haq AI, Myint F, Hamilton G. Acute compartment syndromes. Br J Surg. 2002;89:397–412
  10. Köstler W, Strohm PC, Südkamp NP. Acute compartment syndrome of the limb. Injury. 2004;35:1221–1227
  11. Choudhary RK, Waseem M, Thalva R, Dunlop DG. Acute compartment syndrome: diagnosis and immediate care. Hosp Med. 2003;64:296–298
  12. Blick SS, Brumback RJ, Poka A, Burgess AR, et al. Compartment syndrome in open tibial fractures. J Bone Joint Surg Am. 1996;68:1348–1353
  13. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome (Who is at risk?). J Bone Joint Surg Br. 2000;82:200–203
  14. Mullet H, Al Abed K, Prasad CV, O’Sullivan M. Outcome of compartment syndrome following intramedullary nailing of tibial diaphyseal fractures. Injury. 2001;32:411–413
  15. Tornetta P, French BG. Compartment pressures during nonreamed tibial nailing without traction. J Orthop Trauma. 1997;11:24–27
  16. Shah PM, Wapnir I, Babu S, et al. Compartment syndrome is combined arterial and venous injuries of the lower extremity. Am J Surg. 1989;158:136–140
  17. Nair R, Abdool-Carrim AT, Robbs JV. Gunshot injuries of the popliteal artery. Br J Surg. 2000;87:602–607
  18. Abouezzi Z, Nassoura Z, Ivatury RR, et al. A critical reappraisal of indications for fasciotomy after extremity vascular trauma. Arch Surg. 1998;133:547–551
  19. Thomas DD, Wilson RF, Wiencek RG. Vascular injury about the knee: improved outcome. Am Surg. 1989;55:370–377
  20. Shah DM, Bock DE, Darling RC, et al. Beneficial effects of hypertonic mannitol in acute ischemia-reperfusion injuries in humans. Cardiovasc Surg. 1996;4:97–100
  21. Clagett GP, Valentine RJ, Hagino RT. Autogenous aortoiliac/femoral reconstruction from superficial femoral-popliteal veins: feasibility and durability. J Vasc Surg. 1997;25:255–266
  22. Field CK, Senkowsky J, Hollier LH, et al. Fasciotomy in vascular trauma; is it too much, too often?. Am Surg. 1994;60:409–411
  23. Hamilton G, Platts A. Deep venous thrombosis. In:  Beard JD,  Gaines PA editor. Vascular and Endovascular Surgery. London: Saunders WB; 1998;p. 351–396
  24. Wood KE, Reedy JS, Pozniak MA, Coursin DB. Phlegmasia cerulean dolens with compartment syndrome: a complication of femoral vein catheterization. Crit Care Med. 2000;28:1626–1630
  25. Ouellette EA, Kelly R. Compartment syndromes of the hand. J Bone Joint Surg Am. 1996;78:1515–1522
  26. Aprahamian C, Gessert G, Bandyk DF, et al. MAST-associated compartment syndrome (MACS): a review. J Trauma. 1989;29:549–545
  27. Chase J, Harford F, Pinzur M, Zussman M. Intraoperative lower extremity compartment pressures. Dis Colon Rectum. 2000;43:678–680
  28. Perez RO, Pecora RA, Giannini CG, et al. Lower limb compartment syndrome associated with Lloyd-Davies/lithotomy position in colorectal surgery. Hepatogastroenterology. 2004;51:100–102
  29. Nadeem RD, Clift BA, Martindale JP, et al. Acute compartment syndrome of the thigh after joint replacement with anticoagulation. J Bone Joint Surg Br. 1998;80:866–868
  30. Dumontier C, Sautet A, Man M, et al. Entrapment and compartment syndromes of the upper limb in haemophilia. J Hand Surg Br. 1994;19:427–429
  31. Seiler JG, Valadie AL, Drvaric DM, et al. Perioperative compartment syndrome (A report of four cases). J Bone Joint Surg Am. 1996;78:600–602
  32. Rooser B, Bengtson S, Hagglund G. Acute compartment syndrome from anterior thigh muscle contusion: a report of eight cases. J Orthop Trauma. 1991;5:57–59
  33. Perron AD, Brady WJ, Keats TE. Orthopaedic pitfalls in the ED: acute compartment syndrome. Am J Emerg Med. 2001;19:413–416
  34. Franc-Law JM, Rossignol M, Vernec A, et al. Poisoning-induced acute atraumatic compartment syndrome. Am J Emerg Med. 2000;18:616–621
  35. Matsen FA, Krugmire RB. Compartmental syndromes. Surg Gynecol Obstet. 1978;147:943–949
  36. Matsen FA. Compartment syndrome: a unified concept. Clin Orthop. 1975;113:8–14
  37. Whitesides TE, Harada H, Morimoto K. The response of skeletal muscle to temporary ischemia: an experimental study. J Bone Joint Surg Am. 1971;53:1027–1028
  38. Perry MO. Compartment syndromes and reperfusion injury. Surg Clin North Am. 1988;68:853–864
  39. Beyersdorf F. Protection of the ischemic skeletal muscle. Thorac Cardiovasc Surg. 1991;39:19–28
  40. Grace PA. Ischaemia-reperfusion injury. Br J Surg. 1994;81:637–647
  41. Duran W, Takenaka H, Hobson R. Microvascular pathophysiology of skeletal muscle ischaemia-reperfusion. Semin Vasc Surg. 1998;11:203–214
  42. Jensen SL, Sandermann J. Compartment syndrome and fasciotomy in vascular surgery (A review of 57 cases). Eur J Vasc Endovasc Surg. 1997;13:48–53
  43. Leach R, Hammond G, Stryker W. Anterior tibial compartment syndrome (Acute and chronic). J Bone Joint Surg. 1967;49:451–462
  44. Willy C, Sterk J, Volker HU, et al. Acute compartment syndrome (Results of a clinico-experimental study of pressure and time limits for emergency fasciotomy). Unfallchirurg. 2001;104:381–391
  45. Heckman MM, Whitesides TE, Grewe SR, Rooks MD. Compartment pressure in association with closed tibial fractures. J Bone Joint Surg Am. 1994;76:1285–1292
  46. Whitesides TE, Haney TC, Harada H, et al. A simple method for tissue pressure determination. Arch Surg. 1975;110:1311–1313
  47. Mubarak SJ, Hargens AR, Owen CA, et al. The wick catheter technique for measurement of intramuscular pressure. J Bone Joint Surg Am. 1976;58:1016–1020
  48. Rorabeck C, Castle G, Hardie R, Logan J. Compartmental pressure measurements: an experimental investigation using the slit catheter. J Trauma. 1981;21:446–449
  49. Barnes MR, Gibson MJ, Scott J, et al. A technique for the long term measurement of intracompartmental pressure in the lower leg. J Biomed Eng. 1985;7:35–39
  50. Awbrey BJ, Stenkiewicz PS, Mankin HJ. Chronic exercise induced compartment pressure elevation measured with a miniaturized fluid pressure monitor: a laboratory and clinical study. Am J Sports Med. 1988;16:610–615
  51. Ovre S, Hvaal K, Holm I, et al. Compartment pressure in nailed tibial fractures (A threshold of 30mmHg for decompression gives 29% fasciotomies). Arch Orthop Trauma Surg. 1998;118:29–31
  52. Arbabi S, Brundage SI, Gentilello LM. Near-infrared spectroscopy: a potential method for continuous, transcutaneous monitoring for compartment syndrome in critically injured patients. J Trauma. 1999;47:829–833
  53. Abraham P, Leftheriotis G, Saumet JL. Laser doppler flowmetry in the diagnosis of chronic compartment syndrome. J Bone Joint Surg Br. 1998;80:365–369
  54. Edwards PD, Miles KA, Qwens SJ, et al. A new non-invasive test for the detection of compartment syndromes. Nucl Med Commun. 1999;20:215–218
  55. Heckman MM, Whitesides TE, Grewe SR, et al. Histologic determination of the ischemic threshold of muscle in the canine compartment syndrome model. J Orthop Trauma. 1993;7:199–210
  56. Whitesides TE, Haney TC, Morimoto K, Hirada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop. 1975;113:43–51
  57. Vollmar B, Westermann S, Menger MD. Microvascular response to compartment syndrome-like external pressure elevation: an in vivo fluorescence microscopic study in the hamster striated muscle. J Trauma. 1999;46:91–96
  58. Cohen MS, Garfin SR, Hargens AR, Mubarak SJ. Acute compartment syndrome (Effect of dermotomy on fascial decompression in the leg). J Bone Joint Surg Br. 1991;73:287–290
  59. Chidgey LK, Szabo RM, Kolack B. Effects of elevation on nerve function in an acute upper extremity nerve compression model. J Orthop Res. 1989;7:783–791
  60. Allen MJ, Stirling AJ, Crawshaw CV, Barnes MR. Intracompartmental pressure monitoring of leg injuries: an aid to management. J Bone Joint Surg Br. 1985;67:53–57
  61. Hargens AR, Romine JS, Sipe JC, et al. Peripheral nerve-conduction block by high muscle-compartment pressure. J Bone Joint Surg Am. 1979;61:192–200
  62. Mars M, Hadley GP. Raised compartmental pressure in children: a basis for management. Injury. 1998;29:183–185
  63. Heppenstall RB, Sapega AA, Izant T, et al. Compartment syndrome: a quantitative study of high-energy phosphorus compounds using 31P-magnetic resonance spectroscopy. J Trauma. 1989;29:1113–1119
  64. Hoover TJ, Siefert JA. Soft tissue complications of orthopaedic emergencies. Emerg Med Clin N Am. 2000;18:115–139
  65. van Essen GJ, McQueen MM. Compartment syndrome of the lower limb. Hosp Med. 1998;59:294–297
  66. Styf J, Wiger P. Abnormally increased intramuscular pressure in human legs: comparison of two experimental models. J Trauma. 1998;45:133–139
  67. Mabee JR. Compartment syndrome: a complication of acute extremity trauma. J Emerg Med. 1994;12:651–656
  68. Köstler W, Strohm PC, Südkamp NP. Acute compartment syndrome of the limb. Injury. 2004;35:1221–1227
  69. Mubarak S, Owen C. Double-incision fasciotomy of the leg for decompression in compartment syndromes. J Bone Joint Surg Am. 1977;59:184–187
  70. Cooper G. A method of single-incision, four compartment fasciotomy of the leg. Eur J Vasc Surg. 1992;6:659–661
  71. Pearse MF, Nanchahal J. Acute compartment syndrome of leg. Br Med J. 2002;325:557–558
  72. Schepsis AA, Gill SS, Foster TA. Fasciotomy for exertional anterior compartment syndrome: is lateral compartment release necessary?. Am J Sports Med. 1999;27:430–435
  73. Patman RD. Compartmental syndromes in peripheral vascular surgery. Clin Orthop. 1975;113:103–110
  74. Leversedge FJ, Casey PJ, Seiler JG, Xerogeanes JW. Endoscopically assisted fasciotomy: description of technique and in vivo assessment of lower leg compartment decompression. Am J Sports Med. 2002;30:272–278
  75. Wiger P, Tkaczuk P, Styf J. Secondary wound closure following fasciotomy for acute compartment syndrome increases intramuscular pressure. J Orthop Trauma. 1998;12:117–121
  76. Caruso DM, King TJ, Tsujimura RB, Weiland DE, Schiller WR. Primary closure of fasciotomy incisions with a skin-stretching device in patients with burn and trauma. J Burn Care Rehabil. 1997;18:125–132
  77. McKenney MG, Nir I, Fee T, et al. A simple device for closure of fasciotomy wounds. Am J Surg. 1996;172:275–277
  78. Simpson NS, Jupiter JB. Delayed onset of forearm compartment syndrome: a complication of distal radius fracture in young adults. J Orthop Trauma. 1995;9:411–418
  79. Bermudez KM, Knudson MM, Nelken NA, et al. Long-term results of lower-extremity venous injuries. Arch Surg. 1997;132:963–967
  80. Heemskerk J, Kitslaar P. Acute compartment syndrome of the lower leg: retrospective study on prevalence, technique and outcome of fasciotomies. World J Surg. 2003;27:744–747
  81. Reis ND, Michaelson M. Crush injury to the lower limbs: treatment of the local injury. J Bone Joint Surg Am. 1986;68:414–418
  82. Sheridan GW, Matsen FA. Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg Am. 1976;58:112–115
  83. Finklestein JA, Hunter GA, Hu RW. Lower limb compartment syndrome: course after delayed fasciotomy. J Trauma. 1996;40:342–344
  84. Bae DS, Kadiyala RK, Waters PM. Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome. J Pediatr Orthop. 2001;21:680–688
  85. Howard JL, Mohtadi NGH, Wiley JP. Evaluation of outcomes in patients following surgical treatment of chronic exertional compartment syndrome in the leg. Clin J Sports Med. 2000;10:176–184
  86. Lagerstrom CF, Reed RL, Rowlands BJ, Fischer RP. Early fasciotomy for acute clinically evident posttraumatic compartment syndrome. Am J Surg. 1989;158:36–39

PII: S1931-7204(07)00107-9

doi: 10.1016/j.jsurg.2007.03.006

Journal of Surgical Education
Volume 64, Issue 3 , Pages 178-186 , May 2007

Article Tools

* Image Usage & Resolution