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INTRODUCTION

Compartment syndrome occurs when increased pressure within a limited space compromises the circulation and function of the muscles and nerves within that space. It was first described in 1881 by Richard Van Volkmann, a German physician who noted that paralysis and contractures were the late sequelae of an interruption of the blood supply to the muscles in the forearm.

A high degree of clinical suspicion, coupled with timely surgery, can be used to save function of the muscles and nerves that are at risk of permanent damage from elevated compartment pressures.

ANATOMY

The borders of a confined space are often made up of bone or tissue that offers minimal capacity to stretch. Any increase in volume within that compartment results in an elevated intracompartmental pressure. In the lower extremity, the most common site is at the level of the tibia and fibula, where 40% of compartment syndromes occur. The lower leg has four compartments: anterior, lateral, superficial posterior, and deep posterior (Figure 278-1). (Also see Figure 275-1 in Chapter 275, “Leg Injuries.”)

FIGURE 278-1.

The four compartments of the lower leg.

The upper leg has three compartments: anterior, posterior, and medial. Due to the larger size of these compartments and their interconnectivity, they are less predisposed to elevated tissue pressures. The foot and buttock region of the leg also have a lower incidence of compartment syndrome.

In the upper extremity, the forearm has three compartments: flexor, extensor, and mobile wad (Figure 278-2). These are the high-risk areas in the arm. The hand (Figure 278-3) and upper arm (Figure 278-4) are less likely to develop a compartment syndrome.

FIGURE 278-3.

Hand compartments: transverse section through the right hand.

FIGURE 278-4.

The biceps brachialis (anterior) and triceps (posterior) compartments of the right arm.

The size of the compartment increases through youth into early adulthood. It then remains the same size through the subsequent years. The amount of muscle mass in a compartment also increases in size until the early 20s, but after age 35 years, it begins to diminish. Thus, after age 35 years, a patient is less likely to develop compartment syndrome.1

PATHOPHYSIOLOGY

Tissue perfusion is created by a gradient between the arterial pressure (diastolic in particular) and the venous capillary pressure. Ischemia may occur when the tissue pressure within a compartment exceeds the venous capillary pressure. The normal pressure within a ...

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