Acute compartment syndrome

1. What happens in acute compartment syndrome (ACS) and what is the timeline?
2. What is the most common cause of ACS? What area is usually affected?
3. What are the complications of untreated ACS?
4. What are the symptoms of ACS?
5. How is ACS diagnosed?
6. How is ACS treated?

Answers:
1. Intracompartmental tissue pressure becomes elevated and venous pressure elevates to obstruct outflow. Necrosis can occur in 4-8 hrs.
2. Trauma associated with fractures of the long bones of the leg or forearm. It usually affects the volar forarm or anterior compartment of leg.
3. Volkmann's ischemic necrosis, which results in claw hand or foot caused by contractures of ischemic muscle.
4. Pain, paresthesias, and paralysis distal to the involved compartment. There is extreme pain on stretching of long muscles, but pulses are usually normal.
5. Manometry: diastolic pressure - intracompartmental pressure < 20 mmHg.
6. Fasciotomy.