Compartment syndrome, lower leg

• Chronic compartment syndrome (CCS)
• Chronic exertional compartment syndrome (CECC)
• Limb compartment syndrome
• Myofascial compartment syndrome
• Anterior compartment syndrome of lower leg
• Lateral/peroneal compartment syndrome of lower leg
• Deep posterior compartment syndrome of lower leg
• Superficial posterior compartment syndrome of lower leg

• 729.72 Nontraumatic compartment syndrome of lower extremity
• 958.92 Traumatic compartment syndrome of lower extremity

• M79.A2 Nontraumatic compartment syndrome of lower extremity
• M62.2 Nontraumatic ischemic infarction of muscle
• T79.6 Traumatic ischemia of muscle

• 4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation

Description

• Bleeding or edema that 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 and nerve 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

Essentials of Diagnosis

• 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

General Considerations

• Emergency surgery required to prevent permanent damage with 30 mm Hg or higher
• Lower leg has four compartments
  • Anterior
  • Lateral
  • Deep posterior
  • Superficial posterior
• Classic Ps
  • Pain
  • Pallor
  • Pulselessness
  • Paresthesias
  • Paralysis
• Complications
  • Infection
  • Contractures
  • Deformity
  • Amputation
  • Acidosis
  • Hyperkalemia
  • Myoglobinuria
  • Acute renal failure and shock

Demographics

• Younger age, high-energy/high-velocity trauma and systemic hypotension associated with increased risk of traumatic accident
• High risk patients include
  • Males <35 years old with tibial fractures
  • Soft tissue injury in males <35 years old with bleeding disorders or receiving anticoagulants
  • Crush injury patients
  • Patients with prolonged limb compressions
• Individuals using circumferential wraps, restrictive dressings, casts or immobilizers are at increased risk

Signs and Symptoms

• First signs
  • Decreased sensation, numbness
  • Tingling, paresthesias
• Paresis
• Decreased palpable pulses
• Pallor of skin overlying compartment, paleness of skin
• Severe pain that does not go away with pain medicine or raising affected area
• Weakness
• In severe cases, foot drop is seen
• Pain when the area is squeezed
• Extreme pain when moving affected area
  • Deep, throbbing pressure out of proportion to that expected from the injury
• Swelling in affected area

Functional Implications

• Pain out of proportion to that expected ...