Related articles: Compartmental syndrome
Definition
The compartment syndrome is a pathological condition due to the increase in tissue pressure within a closed anatomical space, which evolves into a local ischemia.
The compartment syndrome is due to a cascade of events, which begin with the onset of tissue edema after a traumatic event (it is associated, for example, with the swelling of soft tissues or the formation of a hematoma). If this process occurs within a fascial compartment (typically in the anterior or posterior muscular loggia of the leg), there is little room for tissue expansion, so interstitial pressure increases and cell perfusion decreases.
As the local ischemia progresses, the muscles necrotize, sometimes leading to rhabdomyolysis and infections; these complications can cause loss of limbs and, if left untreated, death.
The compartment syndrome is most frequently found in the case of serious muscle fractures and contusions. Sometimes, the disorder depends on immobilization with braces, tight bandages and other rigid aids that limit swelling, thus increasing the compartmental pressure. Rarely, however, the compartment syndrome is the consequence of snake bites, drug overdoses (eg heroin or cocaine) and severe strain.
Most common symptoms and signs *
- Bruise
- Muscle cramps
- Muscle pains
- Sore legs
- Swollen legs
- Legs tired, heavy legs
- Pallor
- Paresthesia
- Rhabdomyolysis
Further indications
The earliest symptom of the compartment syndrome is represented by a strong burning pain, generally of a disproportionate magnitude compared to the severity of the visible lesion. Subsequently, other characteristic signs of tissue ischemia manifest themselves: numbness, paresthesia, loss of motor function of the affected limb and paralysis.
The diagnosis is based on the measurement of the compartmental pressure (in normal conditions it is ≤ 20 mmHg).
Treatment must be started before pallor or pulsation develops (indexes of necrosis). This involves a conservative approach with analgesic drugs, limb elevation, application of ice and use of splints. Compartmental pressures above 40 mmHg usually require an immediate fasciotomy.
If the muscles necrotize, amputation of the affected limb may be necessary.
