Acute compartment syndrome occurs when fluid from excessive swelling around a muscle group exceeds what that muscle group or “compartment” can hold. It most often occurs after a severe injury like a broken bone or a gunshot wound.
“It’s rare, but when it does happen, it needs to be diagnosed and addressed quickly,” says Cleveland Clinic orthopedic trauma surgeon Cesar Cereijo, DO. “It’s one of the few true orthopedic emergencies that we have.”
What Is Compartment Syndrome?
Compartment syndrome is an extremely painful condition that happens when excess swelling builds pressure around a group of muscles, nerves, and blood vessels called a compartment.
“Our limbs have compartments in them, which I think about as hallways,” Dr. Cereijo explains. “If you get enough swelling in one of those compartments, eventually that compartment can’t expand anymore. The walls are just filled to the brim with swelling and fluid, and therefore the only way for more fluid to enter is if everything else just gets crushed.”
The pressure reduces the flow of blood to the area and damages nerves and tissue within the compartment. Suspected compartment syndrome is a common reason why orthopedic surgeons are called to the emergency department when someone has excessive swelling and pain after a severe injury. If not identified and treated properly, it can lead to muscle death, loss of the limb, paralysis, or even death.
Compartment syndrome is rare and occurs in fewer than 10 people per 100,000. Males are at higher risk than females, and some fractures of the leg are more likely to produce compartment syndrome. Dr. Cereijo estimates that even the busy trauma center where he works sees only a handful of cases of true compartment syndrome each year, but he and his orthopedic colleagues evaluate many more suspected cases because the consequences of not treating them quickly are severe.
Compartment Syndrome Symptoms
One of the key symptoms of compartment syndrome is extreme swelling of the limb.
“The swelling limb becomes very firm and hard, and it’s almost like knocking on a table when palpating the affected limb,” Dr. Cereijo says. “Sometimes, there can be blistering, too. You can sometimes see a change in skin color. If it’s in your lower leg area, sometimes your toes and your foot can go white. You get numbness or tingling to the limb and toes or fingers, as well.”
He most commonly sees compartment syndrome in the lower leg or lower arm after a severe fracture. It’s also possible to have compartment syndrome in other places, including the hand, foot, upper arm, or thigh.
Diagnosing Compartment Syndrome
Most orthopedic surgeons will make the diagnosis clinically through an exam of the area and understanding of the injury and symptoms. A device similar to a tire-pressure gauge can measure the pressure in a compartment, but this painful procedure is usually reserved in cases of uncertainty in the clinical diagnosis.
Compartment Syndrome Treatment
Once Dr. Cereijo identifies compartment syndrome, he immediately offers the person emergency surgery. Treatment requires a fasciotomy within eight to 10 hours to release the pressure in the compartment and prevent permanent damage.
“On the lower leg, a fasciotomy would be a 12-inch-long incision on the inside and outside of the calf, which releases all four compartments in the lower leg,” Dr. Cereijo says. “We place a wound vacuum, which is a sterile suction device. We ice and elevate the leg with the wound vac in place and allow the swelling to go down slowly over the next few days.”
The person will have more surgery a few days later to treat the injury and close the incisions after the swelling goes down. Sometimes, the injury requires several trips to surgery, and large incisions carry an ongoing risk of infection. If the incisions are unable to be closed, then plastic surgery providers may be called on for skin grafting and more complex soft-tissue closures over the incisions.
Recovering from Compartment Syndrome
Recovery from compartment syndrome is long, but full recovery is possible if it is treated in time. Multiple surgeries may be needed to treat the compartment syndrome and underlying injury, followed by months of physical therapy and limited use of the limb.
