## Compartment Syndrome: Diagnosis & Management ### Clinical Presentation & Diagnosis **Key Point:** Compartment syndrome is a surgical emergency. The "5 P's" (Pain, Pressure, Pallor, Paresthesia, Pulselessness) are late findings; **pain out of proportion to clinical findings** is the earliest and most sensitive sign. ### Diagnostic Approach | Finding | Significance | |---|---| | **Pain with passive stretch** | Most sensitive early sign | | **Compartment pressure >30 mmHg** | Concerning; consider fasciotomy | | **Pressure >40 mmHg above diastolic BP** | Indication for fasciotomy | | **Pressure measurement** | Useful when clinical diagnosis is unclear | ### Why Option 3 is Incorrect **High-Yield:** Elevation of the limb ABOVE heart level is **contraindicated** in compartment syndrome because it reduces perfusion pressure to the compartment and may worsen ischemia. The limb should be kept at **heart level** (neutral position) or slightly below to maintain perfusion gradient. **Warning:** This is a common trap. Students often confuse compartment syndrome management with venous insufficiency or lymphedema (where elevation is beneficial). In compartment syndrome, elevation worsens the problem. ### Correct Options Explained **Option 1 (Pressure measurement):** When clinical diagnosis is equivocal (e.g., obtunded patient, polytrauma), compartment pressure measurement using a needle manometer or slit catheter is indicated. Pressure >30 mmHg is concerning; >40 mmHg above diastolic BP mandates fasciotomy. [cite:Rockwood & Green's Fractures in Adults Ch 1] **Option 2 (Fasciotomy threshold):** The classic threshold is compartment pressure ≥40 mmHg above diastolic blood pressure. This accounts for perfusion pressure and guides the decision for surgical intervention. Waiting for higher pressures risks irreversible muscle necrosis. **Option 4 (Two-incision fasciotomy):** Lower leg has four compartments (anterior, lateral, deep posterior, superficial posterior). Two incisions (anterolateral and posteromedial) allow access to all four compartments and are the standard surgical approach. **Clinical Pearl:** The "golden period" for fasciotomy is within 6–8 hours of symptom onset. Delays beyond 12 hours result in irreversible muscle necrosis and permanent disability. Do not wait for pressure measurements if clinical suspicion is high.
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.