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Compartment Syndrome and Crash Injury

After the recent trauma case provided by my brother-in-law’s fortunately uneventful pedestrian versus automobile injury, I feel I should discuss my initial relief when I saw his foot. With a “crush injury,” the result of something crushing the foot, there is always a concern for compartment syndrome, which he was lucky to avoid.

Compartment System

There are compartments?
There are several compartments in the foot formed by the connection of muscles, bone, and connective tissue. After a severe injury, swelling causes the compartments in the foot to be filled with fluid, increasing pressure in the compartments and on the blood vessels. The pressure from the swelling on the blood vessels clamps down on the blood supply in the swollen area. Without adequate blood supply, the process of tissue necrosis, or death, commences. Without treatment, an acute compartment syndrome can lead to irreversible muscle or nerve damage in as little as 12 hours.

The Six P’s of Compartment Syndrome
The following are symptoms of compartment syndrome:
1. Pain out of proportion to a stimulus which doesn’t normally produce pain, meaning, the area hurts way more than it should, and a light touch feels comparable to a severe blow. This is the most significant finding in the early stages.
2. Pulselessness – there is no pulse in the area
3. Pressure due Tense Swelling. This is consistently found in the early stages.
4. Pain with passive stretch. Even gently moving your foot causes intense pain.
5. Paralysis – muscle weakness
6. Paresthesia – a sensation of tingling, tickling, prickling, pricking, or burning

Compartment Syndrome

Treatment
Compartment syndrome is a surgical emergency. An incision in the skin and into the fascia, called a fasciotomy, releases the pressure of the compartments. Depending on surgeons preference, either two or three incisions are made. The incision is then packed with special gauze and inspected again 36-48 hours, changed daily after that, and then finally closed 5-7 days after the fasciotomy.

References:
1. Southerland JT, Boberg JS, Downey MS, Nakra A, Rabjohn LV. McGlamry’s Comprehensive Foot and Ankle Surgery, 4th ed. Lippincott Williams & Wilkins. Philadelphia 2013.
2. www.southfloridasportsmedicine.com

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