![]() If the compartment is not surgically decompressed, the pressure-induced ischemia results in tissue and cellular necrosis and irreversible damage. Eventually, when tissue and venous pressure compromises capillary perfusion, muscle and nerve ischemia ensues. Consequently, there is continual rise in edema within the compartment enclosed in an inexpendable fascia, leading to tighter compartments and higher ICP. Bleeding that may be present from an injury further contributes to the build-up of pressure within the compartment. 1, 3, 6, 11 If not intervened upon, this cycle self-propagates and contributes to further increased ICP. This leads to a series of events to ensue, including increased inflammation, arterial spasm, disrupted capillary flow, increased osmotic pressure, proteinaceous exudate, muscle fiber swelling, and edema. 3, 6 The APG principle proposes that ACS occurs when blood flow does not meet the metabolic demands of affected tissues subsequently resulting in tissue ischemia. 2, 8Īlthough the pathophysiology of ACS remains unclear, a primary hypothesis behind the development of compartment syndrome is the Arteriovenous Pressure Gradient theory (APG). Despite this, ACS is one of the most highly litigated conditions in orthopedic surgery with awards as high as 14 million dollars for failure to diagnose and adequately manage ACS. 9- 11 Last, prompt intervention and treatment with fasciotomy will ultimately prevent permanent damage to the extremity. 1, 7, 8 In addition, accurate intra-compartmental pressure (ICP) measurement and serial monitoring of changes in ICP levels within the muscle compartment is necessary to confirm ACS. 3 Early recognition of ACS is critical and requires a high index of clinical suspicion based on a thorough knowledge of risk factors, pathophysiology and clinical manisfestations. ![]() 1, 3, 6 Fracture, caused by trauma, accounts for approximately 75% of ACS cases. The average annual overall incidence of ACS is 3.1 per 100,000 people, and is found higher in males than females. 1 Importantly, delay in diagnosis or treatment can result in irreversible damage to these components with devastating and permanent complications such as contractures, paralysis, amputation, sepsis with multi-organ failure, and even death. 1- 3 In addition to muscle, key structures within the fascial compartment that are affected by increased compartment pressures include nerves and vasculature. Lower leg ACS is a condition in which increased pressure within a muscle compartment surrounded by a closed fascial space leads to a decline in tissue perfusion and compromises motor and sensory function. Acute compartment syndrome (ACS) of the lower leg is a limb-threatening condition and a surgical emergency.
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