■ With open venous injuries, prevent venous air embolism with direct pres-
sure and Trendelenburg position.SOFT-TISSUE TRAUMAA 24-year-old male presents with severe pain in his left calf after leg
run was over by a car. The calf appears tense. The X-ray is normal. What
diagnosis should be considered? Compartment syndrome.Compartment SyndromeOccurs when a compartment pressure gets high enough to prevent adequate
perfusionMECHANISMS
■ Constriction around the compartment
■ Cast or external wrapping
■ Prolonged compression
■ Deep circumferential burns
■ Swelling within the compartment
■ Hemorrhage
■ Fractures(tibia, forearm, supracondylar)
■ Crush injury
■ Drug or medication injections
■ Ischemic and/or reperfusion injuryANATOMY
Compartment syndrome is most commonly associated with long-bone fractures
of the tibia, but may result from isolated soft-tissue injuries and involve any
extremity compartment.
■ Two arm compartments: Anterior, posterior
■ Two forearm compartments: Dorsal, volar
■ Four hand compartments: Thenar, hypothenar, central, interossei
■ Three gluteal compartments: Gluteus maximus, gluteus medius and
minimus, and tensor fascia latae.
■ Three thigh compartments: Anterior, medial, posterior
■ Four leg compartments: Anterior, lateral, superficial posterior, and deep
posterior.
■ Four foot compartments: Medial, lateral, central, interosseousPATHOPHYSIOLOGY
■ Normal compartment pressure is 0–10 mmHg. At 20 mmHg capillary blood
flow is affected, and at >30–40 mmHg muscles and nerves can undergo
ischemic necrosis.
■ Nerves are the first structure to be affected by compartment syndrome.
■ Even at elevated compartment pressures arteries and arterioles are often
not affected and therefore loss of pulse is a late finding.SYMPTOMS/EXAM
■ Tense compartment/extremity
■ Pain out of proportion to injury or physical findings
■ Pain with passive stretch of muscleTRAUMA
Loss of pulse is a late
findingin compartment
syndrome. Do not exclude the
diagnosis based on the
presence of a pulse.