1. Any anatomic structure or external device that limits the ability of tissues to swell can cause compartment syndrome.

2. Compartment syndromes due to trauma are typically described in extremities (leg, arm, thigh), abdomen (see Chapter 102), face (eye), and head (see Chapter 111).

3. Anatomically, extremity compartments are formed by fascial layers surrounding muscle groups.

4. As compartment pressure increases, nerves, followed by muscles, lose function (if treatment is delayed).

5. Extremity compartment syndrome can occur in the calf, thigh, buttock, forearm, arm, hand, or foot. The most frequent compartment affected is the anterior compartment of the calf.

6. With trauma to the face, retrobulbar hemorrhage or edema may jeopardize the optic nerve.

7. In closed head injury, unrelieved elevated intracranial pressures may be amenable to decompressive craniectomy before permanent brain damage occurs.

1. Extremity compartment syndrome: crush, ischemia, arterial injury, vascular ligation (including vena cava, common iliac, common femoral, or popliteal veins), fracture (open or closed), direct blunt trauma (with hematoma or edema), prolonged external pressure, electrical injury, or contrast injection/extravasation.

2. Secondary extremity/ocular compartment syndrome: hypotension and/or massive volume resuscitation leads to whole-body tissue edema, including the muscles of the various compartments. This may be the result of massive burns or other large physiologic insults, and is part of the postresuscitation systemic inflammatory response syndrome (SIRS).

1. Injury and/or resuscitation causes a hematoma and/or edema of the muscles.

2. In the face of a fixed compartment volume, pressure increase follows muscle edema.

3. At some point, pressure in the compartment exceeds capillary perfusion pressure (approximately 30 mm Hg), and the capillaries collapse.

4. Tissue ischemia results in nerve (initial) and muscle damage (late).

1. High index of suspicion is the key, especially in the neurologically compromised patient.

2. Lower extremity clinical examination.

a. Four compartments:

i. Anterior: peroneal nerve: dorsiflex foot and toes.

ii. Posterior: plantar flex the foot.