Compartment Syndrome

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  • Anatomy
• Compartment syndrome

  Where the pressure within a fascial compartment is abnormally elevated, cutting off the blood flow to the contents of that compartment
• Fascial compartments


  Involve muscles, nerves, and blood vessels surrounded by fascia, a sheet of strong, fibrous connective tissue that encases the contents of the compartment and is not able to stretch or expand
• Acute compartment syndrome

  Orthopaedic emergency requiring surgery (fasciotomy) to relieve the pressure within the compartment and restore blood flow, without prompt treatment can lead to tissue necrosis and permanent damage
• Types of compartment syndrome

  • Acute
  • Chronic
• Acute compartment syndrome is usually associated with an acute injury, where bleeding or tissue swelling increases the pressure within the compartment
• Acute compartment syndrome most often affects fascial compartments in the legs, but can also affect the forearm, feet, thigh, and buttocks
• Acute compartment syndrome presents with the 5 P’s: Pain “disproportionate” to the underlying injury, Paresthesia, Pale, Pressure (high), Paralysis (a late and worrying feature)
• Pulseless is not a feature of acute compartment syndrome, differentiating it from acute limb ischaemia. The pulses may remain intact depending on which compartment is affected
• Compartment syndrome

  • Disproportionate pain is a key characteristic
  • Pain so severe that pain medications are not effective
• Management of acute compartment syndrome

  1. Primarily a clinical diagnosis based on clinical signs and symptoms

  2. Needle manometry can be used to measure compartment pressure

  3. Initial management involves escalating to the orthopaedic registrar or consultant, removing external dressings or bandages, elevating the leg to heart level, maintaining good blood pressure, and avoiding hypotension

  4. Emergency fasciotomy is the definitive management, ideally done as soon as possible after injury (e.g., within 6 hours)
• Fasciotomy


  1. Surgical operation to cut through the fascia, down the entire length of the compartment, and release the pressure

  2. The compartment is explored to identify and debride any necrotic muscle tissue

  3. The wound is left open and covered with a dressing

  4. Patients require repeated trips to theatre every few days to explore the compartment for necrotic tissue, which needs to be debrided

  5. As the swelling improves, the wound can be gradually closed, which can take several weeks

  6. A skin graft may be required if the wound cannot be closed around the compartment
• Chronic compartment syndrome

  • Associated with exertion
  • Pressure within the compartment rises during exertion, restricting blood flow and causing symptoms
  • Symptoms are isolated to a specific location at the affected compartment, including pain, numbness, or paresthesia (pins and needles)
  • Symptoms worsen with increasing activity and resolve quickly with rest
• Treatment of chronic compartment syndrome

  1. May be treated with a fasciotomy

  2. Needle manometry can be used to measure compartment pressure before, during, and after exertion to confirm the diagnosis
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• The Zero to Finals Medical Revision Podcast
• Compartment Syndrome Audio Player
• Episode covers compartment syndrome
• Written notes can be found at https://zerotofinals.com/surgery/orthopaedics/compartmentsyndrome/ or in the orthopaedic section of the Zero to Finals surgery book
• The audio in the episode was expertly edited by Harry Watchman