Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets and reassess frequently.
- Plan definitive source control or disease‑specific therapy when indicated; document follow‑up and patient education.
Algorithm
- Recognize clinical signs; remove constrictive dressings; keep limb at heart level.
- If suspicion high or ΔP ≤30 → emergent fasciotomy.
- Monitor for rhabdomyolysis and infection; plan wound management and reconstruction.
Clinical Synopsis & Reasoning
Severe pain out of proportion, pain with passive stretch, and tense compartments suggest compartment syndrome. Do not delay for imaging. Measure compartment pressures if uncertain; delta pressure ≤30 mmHg indicates fasciotomy. Remove constrictive dressings and keep limb at heart level.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced/procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|
| Serial neurovascular exams | Diagnosis | Sensory/motor changes | Do not wait for pulses to drop |
| Compartment pressure measurement | Confirmation | ΔP ≤30 mmHg | Use if exam equivocal |
| Labs (CK, renal function) | Complications | Rhabdomyolysis, AKI | Monitor |
High-Risk & Disposition Triggers
| Trigger | Why it matters | Action |
|---|
| Pain out of proportion and pain with passive stretch | Early hallmark | Emergent fasciotomy; do not delay |
| Delta pressure ≤30 mmHg | Ischemia threshold | OR now |
| Anticoagulation/crush injury/reperfusion | Severe swelling | Early consult; prepare OR |
| Neurologic deficit/pulselessness | Late signs | Do not wait for pulses to drop |
| Delay >6 hours | Irreversible damage | Urgent action |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|
| Immediate fasciotomy of all involved compartments | Definitive | Immediate | Prevent necrosis | Do not delay |
| Analgesia and fluid resuscitation | Supportive | Hours | Pain and rhabdo prevention | — |
| Remove casts/dressings; avoid elevation above heart | Adjunct | Immediate | Optimize perfusion | — |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- Orthopedic trauma consensus on compartment syndrome — Link