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Dr. Ebraheim’s educational animated video describes the condition of compartment syndrome.
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Acute and Chronic Leg Compartment Syndrome
Compartment syndrome is a condition in which increased pressure within a closed space compromises the circulation to the tissues contained within that space. The condition of compartment syndrome can affect any muscle compartment within the body, however it most commonly affects the lower leg. Almost any injury can cause compartment syndrome, including injury resulting from vigorous exercises, however the most common cause of compartment syndrome is due to fracture and soft tissue injuries. Edema and hemorrhage cause fluid accumulation, which elevates the compartment pressure and this causes occluding of the blood vessels and compression on the nerves. With clinical suspicion of the compartment syndrome, the compartment pressure is measured. An absolute pressure of 30mmHg or higher, or within 30 mmHg of the diastolic blood pressure is considered to be diagnostic of acute compartment syndrome. Without urgent decompression, tissue ischemia, necrosis, and functional impairment will occur. Anatomy is crucial in the treatment of compartment syndrome. The four compartments of the leg include anterior compartment, lateral compartment, superficial posterior compartment, and deep posterior compartment. Fasciotomy is the treatment of choice for compartment syndrome. Complete decompression of the lower leg is accomplished through a double incision, four compartment fasciotomies. The first incision is placed half way between the fibular shaft and the tibial crest. The fascia, anterior and posterior to the septum is opened transversely. The anterior compartment is released first, followed by release of the lateral compartment. Release the anterior compartment and the lateral compartment. Care should be taken not to injure the superficial peroneal nerve located within the lateral compartment. The second incision is made medial to the previous incision 2 cm posterior to the posterior tibial margin. Care should be taken not to injure the saphenous nerve and vein. The fascia, anterior and posterior to the septum, is opened transversely. The superficial posterior compartment is released first, followed by release of the deep posterior compartment. The double incision, four compartment fasciotomy is now complete. Chronic exertional compartment syndrome (CECS) is an exercise induced condition that is different from acute compartment syndrome. In CECS patients, the resting intra-compartmental pressure is usually greater than 15mmHg. Pain begins within 20 minutes of exercise. Burning, cramping, or aching pain and tightness develops, leading to cessation of the activity. Pain, swelling, claudication, and paresthesia occurs after exercise. Compartment pressure that remains over 30mmHg one minute after the end of exercise or pressure that remains over 20mmHg for longer than 5 minutes after the end of exercise is considered diagnostic of CECS. While initial treatment can be conservative, a fasciotomy is probably the only proven successful treatment.