ESCompartment Syndrome
Compartment syndrome is a very serious cause of severe disability and even amputation if left untreated. To understand more about compartment syndrome, we need to briefly discuss the musculature in our bodies. Muscles in our legs and arms are surrounded by a layer of tissue known as fascia that you can equate to the casing of a sausage. There is very little flexibility or give in the facia, so when a muscle is injured, particularly due to a crushing blow, significant swelling of the muscle can occur. As the muscle pushed into the fascia, this can lead to a great deal of pressure which, in turn, eventually leads to reduced oxygen levels, tissue necrosis, nerve damage and death of the muscle.
Compartment syndrome happens most often in the extremities – the arms and the legs. In adults, most cases occur in the lower leg. Specifically, compartment syndrome under the knee (tibial area) is more common than above the knee (femoral). Children often experience compartment syndrome in the arms as well as the legs. Beyond crushing force, other causes of compartment syndrome can include injected drug use, bleeding disorders and focused soft tissue trauma. Multiple fractures in the same area of the leg can increase the risk of as well. An open fracture, contrary to traditional thinking, does not eliminate the possibility of compartment syndrome, even though the fascia has been torn.
Unfortunately, due to misconceptions about the onset and severity of compartment syndrome, it is sometimes identified too late. During medical school, clinicians are taught about the five Ps including:
- Pain
- Paresthesia (tingles or numbness)
- Pulselessness
- Paralysis
- Pallor
However, once the patient begins to experience the last three symptoms, it may be too late to save the muscle from disability. At this point, we need to minimize the likelihood of severe disability or even amputation.
Treatment for Compartment Syndrome
Treating compartment syndrome begins with appropriate identification at the source of the trauma. Even what seems to be a relatively minor injury can lead to compartment syndrome and it is difficult to predict how an injury will progress. However, parents, caretakers and hospital staff should be on the lookout for one of the most common signs of compartment syndrome – disproportionate pain in relation to the injury itself. For example, the patient may have what looks like a relatively minor injury, but they are experiencing excruciating pain. This is a possible sign of compartment syndrome. Similarly, while virtually every tissue injury will cause some swelling, that swelling should be compressible – relatively soft. If the swollen area is extremely hard, this is another sign of possible compartment syndrome.
While the effects of untreated compartment syndrome can be severe, the condition is very treatable if caught early enough. Treatment revolves around removing pressure from the fascia and the muscles therein. To do so, your orthopedic surgeon will make an incision over the musculature, cutting through the fascia and allowing the muscle to expand uninhibited. A vacuum wound healing device is then used to close the wound and promote healing. After a day or two, your surgeon will revisit the wound to see if it can be closed. Wounds that cannot be closed will need skin grafting.
Ultimately, ensuring that a routine injury does not turn into a compartment syndrome requires an entire care team working together, including the patient themselves, their caretakers, and their medical team. Premier Orthopaedic is composed of many highly skilled orthopedic surgeons that can diagnose and treat emergent conditions such as compartment syndrome. Of course, for any significant injuries, or other medical emergencies, immediately go to your nearest emergency room or dial 911.