Editorials

Acute compartment syndrome of the leg

BMJ 2002; 325 doi: http://dx.doi.org/10.1136/bmj.325.7364.557 (Published 14 September 2002) Cite this as: BMJ 2002;325:557

Fasciotomies must be performed early, but good surgical technique is important

  1. Michael F Pearse, consultant orthopaedic surgeon,
  2. Lorraine Harry, research fellow,
  3. Jagdeep Nanchahal, senior lecturer in plastic and reconstructive surgery (j.nanchahal@ic.ac.uk)
  1. Department of Musculoskeletal Surgery, Imperial College School of Medicine, Charing Cross Hospital Campus, London W6 8RF

    Acute limb compartment syndrome is a surgical emergency characterised by raised pressure in an unyielding osteofascial compartment. Sustained elevation of tissue pressure reduces capillary perfusion below a level necessary for tissue viability, and irreversible muscle and nerve damage may occur within hours. Causes include trauma, revascularisation procedures, burns, and exercise. Regardless of the cause, the increased intracompartmental pressure must be promptly decompressed by surgical fasciotomy. Missed diagnosis and late decompression are associated with significant morbidity due to irreversible ischaemic necrosis of the muscles and nerves in the compartment. Increased awareness of the syndrome and the advent of measurements of intracompartmental pressure have raised the possibility of early diagnosis and treatment. Recent publications have, however, highlighted some of the problems associated with measurements of intracompartmental pressure.1 2Furthermore, late or poorly performed fasciotomies may contribute to morbidity.

    The essential clinical feature of compartment syndrome in conscious patients is severe pain out of proportion to the injury, aggravated by passive muscle stretch. …

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