Elevated pressure within a closed osseofascial compartment compromising perfusion — surgical emergency.
Clinical features
- • Pain out of proportion
- • Pain on passive stretch
- • Paraesthesia
- • Late: pallor, paralysis, pulselessness
Investigations
- • Compartment pressure (>30 mmHg or ΔP <30)
- • CK, U&E (rhabdo)
Differential diagnosis
- • Vascular injury
- • DVT
- • Cellulitis
Management
- • Remove constrictive dressings
- • Limb at heart level
- • Urgent fasciotomy within 6 h
- • Treat rhabdomyolysis
Drug therapy
- • IV crystalloid for rhabdo
- • Mannitol / bicarbonate per renal advice
Complications
- • Volkmann contracture
- • AKI from rhabdo
- • Limb loss
Clinical pearls
- • Diagnosis is clinical — never wait for pulses to be lost
Related in WardRound
Educational — verify locally.
