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CONDITION/DISORDER SYNONYMS

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  • Chronic compartment syndrome (CCS)

  • Chronic exertional compartment syndrome (CECC)

  • Limb compartment syndrome

  • Myofascial compartment syndrome

  • Anterior compartment syndrome of the lower leg

  • Lateral/peroneal compartment syndrome of the lower leg

  • Deep posterior compartment syndrome of the lower leg

  • Superficial posterior compartment syndrome of the lower leg

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ICD-9-CM CODES1

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  • 729.72 Nontraumatic compartment syndrome of lower extremity

  • 958.92 Traumatic compartment syndrome of lower extremity

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ICD-10-CM CODES2

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  • M62.2 Ischemic infarction of muscle (nontraumatic compartment syndrome)

  • M79.A2 Nontraumatic compartment syndrome of lower extremity

  • T79.6 Traumatic ischemia of muscle

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PREFERRED PRACTICE PATTERN3

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

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PATIENT PRESENTATION

A 29-year-old man with a recent tibial shaft fracture presents with severe unilateral lower leg pain. He indicates that his fracture was sustained during a crush injury and he is currently experiencing tingling and “tightness” in the area. Distal pulses and capillary refill are diminished. He is having weakness throughout the foot. There is increased pain with squeezing of the calf muscle.

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KEY FEATURES

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Description
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  • Bleeding or edema leads to increased pressure within the fascial compartment and compromises circulation within that space as well as the function of tissues in that area causing ischemia

  • Arteriolar compression occurs and causes muscle andnerve ischemia

    • Acute, sensory changes develop after 30 minutes of ischemia

    • Acute, irreversible nerve damage in 12 to 24 hours

    • Acute, irreversible muscle changes (i.e., necrosis) in 3 to 8 hours

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FIGURE 219-1

Schematic illustration of fascial compartments of the lower extremity. (From Brunicardi FC, Andersen D, Billiar T, et al., eds. Schwartz’s Principles of Surgery. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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Essentials of Diagnosis
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  • Diagnosis is typically made by clinical examination and compartment pressure measurement

  • Acute compartment syndrome

    • Medical emergency

    • Immediate surgery, fasciotomy

  • Subacute compartment syndrome

    • Less of an emergency, usually surgery, fasciotomy

  • Chronic exertional compartment syndrome

    • Conservative treatment first

    • Secondary surgery, fasciotomy

    • Begins after the start of exercise

    • Stops about 30 minutes following exercise

    • Symptoms can become progressively worse to constant

  • Severe pain that is not alleviated by elevation or pain medication

    • Pain increases with passive/active range of motion and compression

  • Distal pulses are diminished/absent

  • Strength and sensation are diminished

  • Edema in affected limb

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General Considerations
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  • Require emergency surgery to prevent permanent damage with pressure measurements of 30 mm Hg or higher

  • Lower leg has four compartments

    • Anterior

    • Lateral

    • Deep posterior

    • Superficial posterior

  • Classic P’s

    • Pain

    • Pallor

    • Pulselessness

    • Paresthesias

    • Paralysis

  • Complications

    • Infection

    • Contractures

    • Deformity

    • Amputation

    • Acidosis

    • Hyperkalemia

    • Myoglobinuria

    • Acute renal failure and shock

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Demographics
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