Bradley R. Merk

1. Acute compartment syndrome of the leg

2. Major arterial disruption of the lower extremity with ischemia times greater than 4 to 6 hours prior to revascularization

3. Full thickness extremity burns at initial presentation

4. Chronic exertional compartment syndrome

1. None

1. Initial stabilization by ATLS protocols

2. Anteroposterior (AP) and lateral radiographs of the knee, tibial shaft, and ankle

3. Careful documentation of preoperative neurovascular status

4. Careful assessment of soft tissue injuries (obvious or occult); administer appropriate antibiotics and tetanus prophylaxis in the event of an open fracture.

5. Noncircumferential splinting of fractures allows extremity access for serial examinations.

6. If the compartment syndrome diagnosis is equivocal, measure intracompartmental pressure in all four compartments (pressures greater than 30 mm Hg or within 20 mm Hg of diastolic blood pressure is suggestive of compartment syndrome).

1. Supine position on the operating room table

2. Consider using a radiolucent table in fracture cases.

3. General anesthesia or regional techniques are acceptable. However, regional anesthesia may cloud postoperative neurologic evaluation.

4. Basic orthopedic surgical tray

5. Concomitant soft tissue or skeletal injury dictates additional instruments.

1. In patients at risk for compartment syndrome, constant vigilance with regard to diagnosis and treatment must be maintained.

2. The earliest and most reliable signs of compartment syndrome is pain out of proportion to the injury, firm or tense swelling of the involved compartment, and pain with passive stretch of the involved musculotendinous units.

3. Paresthesias are a later finding. Unreliable signs of compartment syndrome are skin color and pedal pulses. Commonly, the foot remains pink with intact pulses during a compartment syndrome.

4. Avoid circumferential casts and tight dressings in patients with high-risk injuries.