17.

1 ,AUIOlOM' fOR ACUTE COMPARTMEN'SYNDROMESOJ THIUPPERANDlOWER liMBS Definitionof(ompartmentsyndrome Apersistentrisein thepressure"'1minaconfinedfibro osseouscompaTlmcntthaI leads to panialorcomplete infarction andfibrosis ofthe vilalcomponenlSoflhat companmcnt.(See p.269for fasciolomy for compart mentsyndromeofthefOOl.) Aetiology Bleeding. Ischaemiaandrcpcrfusion. Crush. Elcctricalburns. Posture. Iatrogenic. Injection. Indilations Clinicalsuspicionis them,linindicator. Raised compartment pressure measurements(see belowunderClinicalassessment). 30IllmHgfor8hoursorfor anunknownperiod. 20IllIllHgbelowdiastolicpressure. Clinicalsuspicion plus comparlment pressureof 30rnmHg. Rcv:lscularizationof:llimb lalwa}'s). Clinicalassessment

 Clinicalsuspicionis themainindicator. PulsesareNOTausefulsign- peripheral\'3scularit}' doesNOTcorrelatewithcompartmentstatus. ThedegreeofdistalischaemiaisVARIABLEwithcom partmentS)'Ildrome. Comparunentpressuremeasurementistheontyuseful im-estigation. Damagev-drieswithpressuredifferemialandlime. Symptoms PAIN: Severe. Un(l'lie\'edb}'analgesiaOookatdrugchart). PersistenL Progressive. Passivesl.rctchexacerbates. Unrelievedb}'immobilization. Signs Limbfeelstense. Painonpassivestretch. Reducedsensibilityin distributionofnervesthat pass Illrougillhecompartment. Weaknessofmusclesin compartlllent. Presenceofpulse docs NOTexclude compartment s}'ndromu. Investigations Directcompartment pressure measurementis the mostusefulim'est.igation. Thereis noplacefor an}'

otherimagingin themanagementofacutecompart mentsyndrome. Instruments: