Acute compartment syndrome of the leg: Pressure measurement and fasciotomy

Compartment syndrome involves a conflicting situation between an unyielding space, the compartment, and its increasing tissue content secondary to traumatic ischemia. Rapidly irreversible damages occur without treatment. Although the diagnosis approach to leg compartment syndrome is clinical in priority, pressure measurements should be systematically produced: first to confirm the presence of this condition and define optimal surgical strategies and second to provide the only objective available criteria in case of a debatable diagnosis. In practice, two schematic situations can be distinguished, which do not cover the many different cases: leg compartment syndrome without a fracture in which the four leg compartments are affected and which requires a fasciotomy using two surgical approaches, the lateral and the medial; leg compartment syndrome associated with a fracture: fasciotomy of the four compartments may be performed by a single lateral approach distant from the fracture site and its fixation hardware. It should be noted that this approach is easy, effective and safe. (C) 2010 Published by Elsevier Masson SAS.