The Pathophysiology, Diagnosis and Current Management of Acute Compartment Syndrome

James Donaldson*, 1, Behrooz Haddad 2, Wasim S Khan 2
1 Holland Orthopaedic and Arthritic Centre, Toronto, Canada
2 UCL Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, UK

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© Donaldson et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the 62 Hunter Street, Toronto, M4J 1C2, Canada; Tel: +1 416-967-8500; Fax: +1 416-967-8501; E-mail:


Acute compartment syndrome (ACS) is a surgical emergency warranting prompt evaluation and treatment. It can occur with any elevation in interstitial pressure in a closed osseo-fascial compartment. Resultant ischaemic damage may be irreversible within six hours and can result in long-term morbidity and even death. The diagnosis is largely clinical with the classical description of ‘pain out of proportion to the injury’. Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt. Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and optimizing tissue perfusion by keeping the limb at heart level. If symptoms persist, definitive treatment is necessary with timely surgical decompression of all the involved compartments. This article reviews the pathophysiology, diagnosis and current management of ACS.

Keywords: Compartment pressure monitoring, compartment syndrome, fasciotomy, ischaemic contracture, myofascial compartment..