Post-traumatic compartment syndrome of the leg (author's transl)

Fifteen compartment syndromes seen in the first few hours have been collected. Fourteen occurred after tibial fracture and one after a simple contusion. In typical cases it is emphasised that ischaemia affects the contents of the compartment in an insular fashion so that distal ischaemia is not present. The main arteries are sound and demonstrated by distal pulses, the vascularity of the foot, Doppler studies and arteriography. The diagnosis is difficult but must be made at the earliest opportunity by repeated clinical examination. Measurement of the compartment pressure may be useful because the decision for fasciotomy has to be made with some urgency. The critical delay for the anterior compartment is about 12 h following trauma but it is much longer for the posterior compartment. We believe that it is advisable to always perform both anterior and posterior fasciotomy. Seven cases had combined involvement. Necrotic muscle is excised, particularly if it is present in the posterior compartment, because of the risk of contracting fibrosis. In the anterior compartment, the fibrosis can be helpful and reduce the effects of foot drop. Cases in the literature have most often been associated with conservatively treated fractures. We have measured compartment pressures during intramedullary nailing. An increase in pressure is often recorded when the nail is introduced but returns to normal in a few minutes.