A 35-year-old woman with a tibial shaft fracture develops compartment syndrome of the leg. Regarding the management and complications of compartment syndrome, all of the following statements are correct EXCEPT:

Explanation

## Compartment Syndrome Management and Complications ### Timing of Fasciotomy: The Critical Window **Key Point:** Fasciotomy is a time-sensitive surgical emergency. The window for salvage is narrow and irreversible damage begins early. | Timeframe | Outcome | |-----------|----------| | 0–4 hours | Muscle usually salvageable with fasciotomy | | 4–8 hours | Increasing muscle necrosis; some salvage possible | | 8–12 hours | Extensive necrosis; fasciotomy may prevent systemic complications | | >24 hours | Irreversible muscle necrosis; fasciotomy unlikely to restore function | **High-Yield:** Fasciotomy performed within 6–8 hours of symptom onset offers the best chance of preventing irreversible muscle necrosis. After 12 hours, muscle damage is largely irreversible [cite:Campbell's Operative Orthopaedics 13e Ch 50]. ### Systemic Complications: Rhabdomyolysis **Clinical Pearl:** Compartment syndrome releases myoglobin and potassium from necrotic muscle, causing: 1. **Acute kidney injury (AKI)** — Myoglobin precipitates in renal tubules, causing acute tubular necrosis. 2. **Hyperkalemia** — Released intracellular K^+^ can cause fatal arrhythmias. 3. **Disseminated intravascular coagulation (DIC)** — Tissue factor release triggers coagulation cascade. **Management of rhabdomyolysis:** - Aggressive IV fluid resuscitation (target urine output 200–300 mL/h) - Urine alkalinization with sodium bicarbonate (pH >6.5) to prevent myoglobin precipitation - Monitoring of serum K^+^, CK, creatinine, and urine myoglobin ### Compartment Pressure Measurement **Key Point:** When clinical diagnosis is unclear, compartment pressure measurement guides decision-making: - **Threshold for fasciotomy:** ICP ≥30 mmHg OR ICP within 30 mmHg of diastolic BP (e.g., if diastolic BP = 70 mmHg, fasciotomy indicated if ICP ≥40 mmHg) - Methods: Wick catheter, slit catheter, or handheld tonometer ### Why Delayed Fasciotomy Beyond 24 Hours Is NOT Beneficial **Warning:** This is the **incorrect statement**. Delayed fasciotomy (>24 hours) does **NOT** prevent irreversible muscle necrosis because muscle damage is already complete by this time. **What delayed fasciotomy CAN do:** - Prevent secondary infection of necrotic tissue - Reduce systemic complications from ongoing rhabdomyolysis (though most myoglobin release occurs early) - Allow drainage and debridement **What delayed fasciotomy CANNOT do:** - Restore muscle function lost to necrosis - Prevent contracture formation (this results from scar tissue replacing dead muscle) - Reverse irreversible ischemic damage **Clinical Pearl:** The goal of fasciotomy is **prevention of necrosis**, not treatment of established necrosis. Once muscle is dead, fasciotomy cannot restore it; the focus shifts to preventing infection and managing systemic complications.