What are the key considerations in managing compartment syndrome?

From the Guidelines

Managing compartment syndrome requires prompt recognition and intervention to prevent permanent tissue damage, with the most critical consideration being early diagnosis through clinical assessment and measurement of compartment pressures, and the definitive treatment being emergent fasciotomy to decompress the affected compartment, as indicated by the most recent guidelines 1. The key considerations in managing compartment syndrome include:

• Early diagnosis through clinical assessment of pain, paresthesia, pallor, paralysis, poikilothermia, and pulselessness, although pulses may remain present until late stages
• Measuring compartment pressures when clinical suspicion exists, with absolute pressures >30 mmHg or delta pressures (diastolic blood pressure minus compartment pressure) <30 mmHg indicating the need for intervention
• Emergent fasciotomy to decompress the affected compartment, which should be performed within 6 hours of onset to prevent irreversible muscle and nerve damage, as supported by recent studies 1
• Post-fasciotomy care, including leaving the wound open initially with delayed primary closure or skin grafting performed 3-5 days later
• Supportive measures, such as removing all restrictive dressings or casts, maintaining the affected limb at heart level (not elevated), ensuring adequate hydration, and managing pain
• Continuous monitoring of compartment pressures and neurovascular status is essential in high-risk patients, as emphasized by the guidelines 1 Complications of missed or delayed treatment include permanent nerve damage, muscle necrosis, contractures, infection, and potentially limb loss, making timely intervention crucial, as highlighted by the recent studies 1. Some of the key points to consider in the management of compartment syndrome include:
• The importance of early diagnosis and intervention, as delayed treatment can lead to irreversible damage and poor outcomes
• The role of compartment pressure measurement in guiding treatment decisions, as supported by the guidelines 1
• The need for prompt fasciotomy in patients with clinical evidence of compartment syndrome, as emphasized by the recent studies 1
• The importance of post-fasciotomy care and supportive measures in optimizing outcomes, as highlighted by the guidelines 1
• The potential complications of missed or delayed treatment, and the need for timely intervention to prevent these complications, as emphasized by the recent studies 1.

From the Research

Key Considerations in Managing Compartment Syndrome

• Compartment syndrome is a limb-threatening and occasionally life-threatening injury that occurs when tissue pressure within a closed anatomic space is greater than the perfusion pressure 2.
• It can occur within any muscle group located in a compartment, and is most common following an event that severely damages a muscle, such as a crushing or twisting injury 2.
• Mechanisms of injury that involve circumferential burns, ischemia, and tourniquets can also cause compartment syndrome 2.
• The first compromised function within the compartment is the flow of lymph and venous blood, followed by numbness, tingling, and pain associated with compartment syndrome 2.
• Artificial ways of producing a compartment syndrome include placing a cast or splint around a damaged extremity, compressing it 2.

Diagnosis and Treatment

• The diagnosis of compartment syndrome is largely clinical, with the classical description of 'pain out of proportion to the injury' 3.
• Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt 3.
• Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension, and optimizing tissue perfusion by keeping the limb at heart level 3.
• Definitive treatment is necessary with timely surgical decompression of all the involved compartments if symptoms persist 3.
• Hyperbaric oxygen therapy can be a useful intervention in the management of compartment syndrome, reducing edema and improving tissue viability 4, 5, 6.

Adjunctive Treatment

• Hyperbaric oxygen therapy has been effectively used in the treatment of compartment syndrome, especially in cases where surgical decompression is not possible or is delayed 4, 5, 6.
• It can reduce the need for fasciotomy and improve patient outcomes, as seen in cases of acute isocyanate inhalation and CrossFit-induced compartment syndrome 5, 6.
• Hyperbaric oxygen therapy can be used as an adjunctive treatment to surgical decompression, and has been shown to improve patient outcomes and reduce the risk of long-term morbidity 4, 5, 6.