Kompartmentsyndrome

Kompartmentsyndrom, or compartment syndrome, is a medical emergency characterized by elevated pressure within a closed fascial compartment, leading to impaired tissue perfusion and potential necrosis of muscle and nerves.

It most commonly affects the leg or forearm after fractures, crush injuries, severe contusions, burns, or reperfusion after ischemia. Contributing factors include tight casts or dressings, swelling, and external compression. The condition can occur in any limb and, less commonly, in other body regions.

Classic symptoms include severe, out-of-proportion pain and pain on passive stretch, along with numbness or tingling. The limb may be tense and swollen. Many patients have reduced sensation or motor weakness; signs such as pallor, diminished pulses, and paralysis are late and unreliable indicators.

Diagnosis is primarily clinical, supported by measurement of intracompartmental pressure when the presentation is uncertain. Pressure monitoring uses a needle manometer or catheter. A delta pressure (diastolic blood pressure minus intracompartmental pressure) of 30 mmHg or less, or an absolute pressure above 30–40 mmHg, suggests the need for urgent treatment.

Treatment is emergent fasciotomy to decompress all affected compartments. Immediate removal of restrictive casts or dressings, limb positioning at or slightly below heart level, and adequate analgesia are important adjuncts. Delays increase the risk of irreversible muscle and nerve damage, rhabdomyolysis with renal injury, infection, and long-term functional impairment. After fasciotomy, wound management may require staged closure or grafting.