Overview
Definition
A surgical emergency where increased pressure within a confined fascial space compromises tissue perfusion, leading to muscle and nerve ischemia.
Epidemiology
Most commonly occurs after a severe injury, such as a long bone fracture.
Etiology & Risk Factors
- Fractures (especially tibial shaft fractures - #1 cause)
- Crush injuries, severe burns, tight casts or dressings
- Reperfusion injury after acute ischemia
Clinical Symptoms
- The 6 Ps: Pain (out of proportion to the injury, especially with passive stretch - earliest and most sensitive sign)
- Paresthesias (tingling/numbness - early nerve ischemia)
- Pallor, Poikilothermia (cool limb)
- Paralysis and Pulselessness (very LATE and ominous signs)
Clinical Approach
Diagnosis
- Clinical diagnosis is paramount
- Stryker needle: Directly measures intra-compartmental pressure. A Delta Pressure (Diastolic BP minus Compartment Pressure) of < 30 mmHg confirms the diagnosis
Management
- Immediate removal of all constrictive dressings or casts
- EMERGENT Fasciotomy (surgical incision through the fascia to relieve the pressure)
- Delaying fasciotomy > 6 hours can lead to irreversible muscle necrosis and nerve damage
Complications
- Volkmann's ischemic contracture (permanent muscle contracture/claw hand in the forearm)
- Rhabdomyolysis and subsequent Acute Kidney Injury
- Amputation