Diagnosis and treatment of acute lower limb compartment syndrome

The muscle groups of the limbs are divided into many compartments formed by strong fascial membranes. Acute compartment syndrome (ACS) occurs when there may be a rise in tissue pressure in a closed fascial space, resulting in impaired circulation and tissue function on this space (Hammerberg, 2023). Delayed diagnosis and treatment of compartment syndrome has devastating consequences and might result in significant nerve dysfunction, muscle loss, and muscle necrosis, resulting in rhabdomyolysis, acute renal failure, and irreversible ischemic endpoints including foot drop, irreversible nerve damage, or paralysis (Klingensmith et al., 2008).

Causes of ACS include long bone fractures, tight dressings, critical limb ischemia with reperfusion, burns or crush injuries, spontaneous hematomas, soft tissue injuries, non-traumatic muscle necrosis/myositis/rhabdomyolysis, or volume resuscitation (Hammerberg, 2023). ).

ACS is an emergency condition requiring surgical operation and patients prone to ACS must be identified early and assessed steadily. Early surgical intervention (ideally inside 4 hours of symptom onset) is crucial because it will probably save the limb. Assessment and identification of the “five P’s” are commonly used to assist in diagnosis. These include:

• The commonest symptom of ACS is pain disproportionate to the injury and accompanying passive movement of the affected muscle. The patient can have an increasing or disproportionate need for narcotics and a poor response to appropriate doses of painkillers.
• Another early symptom of ACS is paresthesia on the nerves passing through the affected compartment.

Additional clinical features of ACS include a decent/rigid compartment, increased limb circumference, acidosis or hyperkalemia after limb reperfusion, and clinical signs of rhabdomyolysis (Hammerberg, 2023).

ACS is a clinical diagnosis based on the patient’s history, trauma, clinical presentation, and clinical suspicion. In some cases, when the clinical picture and/or physical examination are uncertain or in a patient who’s unresponsive, compartment pressures could also be measured to help in making the diagnosis. Compartment pressures are frequently measured with a hand-held pressure gauge and must be measured in each compartment. A blood pressure reading inside 30 mmHg of diastolic blood pressure with an equivocal physical examination warrants surgical intervention (Klingensmith et al., 2008).

ACS is an emergency condition requiring surgical operation and if clinical suspicion is raised, it is best to urgently seek a surgical consultation and go to the operating room to perform a fasciotomy. All external pressure on the affected limb must be removed, including casts, splints, and other restrictive coverings. The only recognized treatment for ACS is four-compartment fasciotomy; involves surgical incision of all 4 compartments of the lower limb to permit for decompression (Modrall, 2023).

ACS is an emergency condition requiring immediate diagnosis and treatment to cut back morbidity and the necessity for amputation.

Hammerberg, M. (2023, March 9). . https://www.uptodate.com/contents/acute-compartment-syndrome-of-the-extremities

Klingensmith, M., Chen, L. E., Glasgow, S., Goers, T., & Melby, S. (2008). (fifth ed., p. 593). Lippincott Williams and Wilkins.

Modrall, J. G. (2023, January 10). . https://www.uptodate.com/contents/lower-extremity-fasciotomy-techniques