Compartment syndrome

Compartment syndrome - is increased tissue pressure within a tight fascial compartment, resulting in tissue ischemia.
- commonly occurs in the anterior lower leg.

Pathology:
- compartment syndrome is the self progressive cascade of events, begin with tissue edema that usually occur following injury.
- when edema occur in anterior or posterior fascial compartment, there is limit room for tissues expansion and compartment/interstitial  pressure increase.
- when compartment pressure exceeded 20 mmHg, tissue perfusion decrease or cease.
- because 20 mmHg is very low than arterial blood pressure, cellular flow can be occluded before pulse loss.
- as a result of occluded blood flow tissues ischemia develop and further worsening edema in a vicious cycle.

Aetiology:
Common cause of compartment syndrome include,
- fractures
- severe contusion
- rarely spiders and snakes bites

Symptoms :
- the early symptom are the progressive pain, worse in leg muscles stretching.
- later symptoms of ischemia are "5 P's" which includes ,

• Pain
• Paresthesias 
• Paralysis 
• Pallor 
• Pulselessness

Diagnosis:

- measure compartment pressure ( normal is <_ 20mmHg ) by using wick catheter.

Treatment:

- for <40 mmHg raised compartment  pressure, Antipain drugs, elevation and spilnting  can be done. 

- for >40 mmHg increased  compartment pressure, immediate fasciotomy is done to relieve pressure. 

- in some cases pulselessness or pallor develop, indicating necrosis. Amputation is needed in cases of necrosis. 

Complications:

- necrosis 

- infection 

- amputation 

- rhabdomyolysis. 

Thanks