Aetiology
The most common causes of acute compartment syndrome are fractures, soft-tissue injury, vascular compromise as a result of trauma, extremity compression, reperfusion of chronically ischaemic extremities, and burn injuries to extremities. Fractures account for 69% of all cases of acute compartment syndrome.[3] Up to 40% of all cases of acute compartment syndrome involve a tibial shaft fracture, and approximately 4% to 5% of all tibial fractures result in acute compartment syndrome.[4] Acute compartment syndrome can also be associated with intravenous fluid extravasation or aggressive fluid resuscitation, as well as constricting casts or wraps, laparoscopic colorectal surgery, secondary to prolonged Lloyd-Davies operating position with exaggerated Trendelenburg tilt.[10][11][12] Exercise-induced rhabdomyolysis may progress to compartment syndrome.[13][14][15] The less common gluteal compartment syndrome is usually a result of prolonged immobilisation and post-arthroplasty analgaesia.[16]
Chronic exertional compartment syndrome is most frequently encountered among long-distance runners.
Pathophysiology
Elevated interstitial pressure in a closed osteofascial compartment may be secondary to several different factors. Haemorrhage within the compartment, direct trauma to the muscles, or tissue ischaemia and reperfusion can lead to increased intracompartmental pressure. As interstitial pressure increases, adequate perfusion to tissue is decreased.[17] This increases venous capillary pressure.[7] This results in tissue necrosis secondary to oxygen deprivation. Interstitial oedema develops from tissue necrosis and further worsens compartmental swelling.[7]
Classification
Acute compartment syndrome[2]
Associated with a variety of injuries. Fractures account for 69% of all cases of acute compartment syndrome.[3] Up to 40% of all acute compartment syndrome episodes involve a tibial shaft fracture, and approximately 4% to 5% of all tibial fractures result in acute compartment syndrome.[4]
Direct bony structure trauma and soft-tissue injury are the 2 most frequent predisposing conditions.
The increased pressure can be due to oedema and/or haemorrhage.
Acute exertional compartment syndromes are uncommon in sports.
Chronic exertional compartment syndrome[5]
Chronic or recurrent.
Difficult to diagnose clinically.
Seen in about 3% of all patients evaluated at a sports medicine clinic (due to intense muscular activity).
Objective pressure measurement is the definitive test for diagnosis.
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