Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XIX: Wounds and Injuries of Bones and Joints

Compartment Syndrome

United States Department of Defense

Compartment syndrome in the leg and forearm is a potentially devastating complication. The pathophysiology is at the microvascular level, and failure of early recognition of the syndrome can led to severe functional loss or amputation. The surgeon must have a high index of suspicion. An open fracture does not necessarily decompress the compartments and in fact, because of the high energy associated with the injury, may increase the risk of such a syndrome. The classic findings of pain, paralysis, pulselessness, and paresthesia usually present is too late to successfully intervene. Patients with significant trauma, who have been treated and splinted but continue to have unremitting pain in the involved extremity, particularly with passive motion of the digits, should be considered to have a compartment syndrome until proven otherwise. Compartment syndromes are progressive problems that may develop insidiously, thereby requiring repetitive examinations of the extremity. Diagnosis is clinical and the treatment is decompression, i.e., surgical fasciotomy. Appropriately-timed fasciotomy makes the difference between amputation and a viable extremity.

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Operational Medicine 2001

Health Care in Military Settings

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