What are the causes of compartment syndrome?

From the Guidelines

Compartment syndrome is primarily caused by increased pressure within a confined anatomical space, leading to compromised blood flow and potential tissue damage, with the most common causes including trauma, reperfusion after prolonged ischemia, and other factors that restrict circulation and increase compartment pressure. The causes of compartment syndrome can be categorized into several key areas, including:

• Trauma, particularly fractures (especially tibial and forearm fractures), crush injuries, and severe soft tissue injuries 1
• Reperfusion after prolonged ischemia, such as following vascular surgery or restoration of blood flow after arterial occlusion, which can trigger compartment syndrome 1
• Tight casts, bandages, or prolonged limb compression that restrict circulation and increase compartment pressure 1
• Burns, snake bites, and excessive exercise (especially in untrained individuals) that can cause tissue swelling leading to compartment syndrome 1
• Bleeding disorders or anticoagulant therapy that may contribute by causing hemorrhage into a compartment 1 The underlying mechanism involves increased pressure within the fascial compartment that exceeds capillary perfusion pressure, resulting in tissue ischemia, nerve damage, and potentially irreversible muscle necrosis if not promptly treated 1. This vicious cycle worsens as ischemia causes more swelling, further increasing compartment pressure. According to the most recent and highest quality study, reperfusion injury can occur in patients with acute limb ischemia (ALI), leading to elevated compartment pressures and the development of clinical compartment syndrome 1.

From the Research

Compartment Syndrome Causes

• Compartment syndrome is a limb-threatening and occasionally life-threatening injury that occurs when the 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.
• Other causes of compartment syndrome include:
  • Increased compartment content, such as hematoma, edema, exertion, and intoxication 3.
  • Decreased compartment size, such as constrictive dressings and casts, and closure of fascial defects 3.
  • Ischemia-reperfusion injury, which can cause recurrent compartment syndrome even after adequate fasciotomy 4.
• Compartment syndrome can also be iatrogenic, meaning it can be caused by medical treatment, such as the placement of a cast or splint around a damaged extremity 2.

Risk Factors

• Motorcyclists who suffer lower-extremity injuries in accidents are a high-risk group for compartment syndrome 2.
• Patients with underlying connective tissue disorders are also at risk for recurrent compartment syndrome 4.
• Any patient who has suffered a severe injury, such as a fracture or crush injury, is at risk for compartment syndrome 5, 6.
• Even relatively minor injuries can cause compartment syndrome, and patients should be educated to seek care if they experience symptoms such as numbness, deep pain, and coolness to the distal extremity 2.