Diagnosis and management of compartmental syndromes.

TLDR

Patients at risk for compartmental syndromes pose diagnostic and therapeutic challenges, with suboptimal outcomes often stemming from delayed diagnosis, incomplete decompression, and post‑operative limb management difficulties. Careful clinical assessment diagnoses most compartmental syndromes, but tissue pressure measurement and direct nerve stimulation aid ambiguous cases; a four‑compartment parafibular leg approach and an ulnar forearm approach achieve efficient decompression, while fracture stabilization facilitates post‑operative limb management.

Abstract

Patients at risk for compartmental syndromes challenge both the diagnostic and the therapeutic abilities of the physician. Suboptimum results may be due to delays in diagnosis and treatment, to incomplete surgical decompression, and to difficulties in the management of the limb after decompression. Although careful clinical assessment permits the diagnosis of a compartmental syndrome in most patients, we have found measurement of tissue pressure and direct nerve stimulation to be helpful for resolving ambiguous or equivocal cases. In our experience, the four-compartment parafibular approach to the leg and the ulnar approach to the volar compartments of the forearm provide efficient and complete decompression of potentially involved compartments. The skeletal stabilization of fractures associated with compartmental syndromes may facilitate management of the limb after surgical decompression.