Acute compartment syndrome.

Abstract

Acute compartment syndrome (ACS) is characterized by increased pressure within an anatomic space surrounded by non-expandable structures. ACS can develop in various body regions, including the extremities and the visceral cavity. In ACS of the extremities, in more than two-thirds of the cases, the forearm or the lower leg is affected. ACS has been described to occur in patients with open and closed fractures or in the absence of an underlying fracture. The treatment consists of emergent dermatofasciotomy regardless the cause. The goal of the treatment is to release the intramuscular pressure in the affected compartments. Timely surgery is of upmost importance, as inadequate or delayed surgical release may result in further tissue damage and substantial local (e.g., Volkmann‘s contracture, amputation) or systemic complications (e.g., organ failure, death). Therefore, awareness for the development of ACS and its early diagnosis are of major significance [1, 2]. Clinical examination including patient’s history and physical examination is crucial but may lead to delayed diagnosis and treatment of ACS particularly in certain subsets of patients (e.g., children, geriatric or unconscious patients). In these cases, needle compartment pressure measurement has been recommended for objective compartment pressure determination with a high sensitivity and specificity [3]. However, the recommendations regarding standardized diagnostic procedures as well as indications about intracompartmental pressure threshold levels are inconclusive. They may vary according to the patients condition (alert, oriented versus intubated and on vasopressors) [1]. In the current issue of the European Journal of Trauma and Emergency Surgery, we have therefore tried to compile the current evidence regarding experimental and clinical evidence of this on-going challenge. It appears that the standardized diagnostic and therapeutic algorithms are needed which should include answers to the following questions: