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DIAGNOSIS CHRONIC COMPARTMENT SYNDROME
TABLE 1: VARIOUS NAMES GIVEN TO ACUTE COMPARTMENT SYNDROME
n Volkmann’s ischaemia n Impending ischaemia n Crush syndrome n Local ischaemia
n Acute ischaemia infarction n Anterior tibial syndrome n Calf hypertension
identical characteristics can be caused by bandages which are too tight, and thus cause constant constriction of the limbs” (3). He was defining the acute form of compartment syndrome. Acute compartment syndrome (ACS) is a significant clinical problem, causing major functional losses following a wide variety of traumatic, vascular, neurological, surgical, pharmacological, renal and iatrogenic conditions. When it occurs, it is a surgical emergency. Initially, confusing terminology was used to describe various sub-entities (Table 1) of ACS, masking the common aspects of the acute syndrome. Increased tissue pressure is the central pathogenic factor in compartment syndrome. This may result either from a decrease in the size of the compartment or from an increase in the volume of its contents (Table 2).
TABLE 2: AETIOLOGICAL FACTORS IN COMPARTMENT SYNDROME
Decreased compartment size n Closure of fascial defects n Tight dressings n Localised
Increased compartment content n Bleeding: major vascular damage n Bleeding disorder
n Increased capillary permeability n Post-ischaemic swelling n Exercise (seizures, eclampsia) n Trauma (other than vascular) n Burns n Intra-arterial drugs n Orthopaedic surgery
n Increased capillary pressure n Exercise n Venous obstruction (long leg brace) n Muscle hypertrophy n Infiltrated infusion n Nephrotic syndrome
n Compartment syndrome n Rhabdomyolysis n Exercise ischaemia
n Traumatic tension ischaemia in muscles n Ischaemic necrosis contracture n Peroneal nerve palsy
n Phlegmasia cerulean dolens
Childs collected 14 cases of acute forms of compartment syndromes from the literature, added one of his own and published the finding in the Annals of Surgery (4). This prompted several authors in the mid- and late 1940s to report on ACS. It is now a well- documented condition.
Chronic compartment syndrome Although ACS was relatively well known, the chronic form was overlooked. Edward Wilson, a medical officer to Scott’s Antarctic expedition in 1912, unwittingly gave the first account of what was probably an exertion-related anterior compartment syndrome. The account of his own and Scott’s diary was written in 1910 and recovered from the expedition in which he perished (5). It was not until 1956 that Mavor first reported on the chronic form of compartment syndrome (6). This was in a young professional footballer who presented with a 2-year history of pain in the front of both legs, mainly occurring on exercise. Having exhausted all the conservative means, Mavor performed a successful fasciectomy of the fascia overlying the anterior tibial muscle. The postoperative phase was uneventful and the footballer returned to a successful career in the First Division.
Since the 1960s there has been
a steady flow of cases reported in the world literature coinciding with an upsurge of interest in this field. Reneman reported 61 cases in his series (7). Before this, nine other cases were reported in the literature. In addition, there was a significant development in the techniques for measuring intracompartment pressure (ICP). Thus, laboratory documentation of the diagnosis and pathophysiology of CCS became established. Matsen is worthy of note here,
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