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Injury. 2009 Feb;40(2):220-2. doi: 10.1016/j.injury.2008.07.023. Epub 2009 Feb 8.

The 'silent' compartment syndrome.

Author information

1
Department of Trauma and Orthopaedics, Derbyshire Royal Infirmary, Derby Road Derby, Derby, Derbyshire DE1 2QY, United Kingdom. sachin.badhe@gmail.com

Abstract

Intractable pain out of proportion to the injury sustained is considered to be the earliest and most reliable indicator of a developing compartment syndrome. We report 4 cases where competent sensate patients developed compartment syndromes without any significant pain. The first patient developed a painless compartment syndrome in the well leg following surgery for femoral fracture on the other side. The second patient developed the silent compartment syndrome post-operatively following a tibial nailing for a tibial fracture. The third patient presented with the painless compartment syndrome following a tibial plateau fracture. Our prevailing culture of a high-index of clinical suspicion and surveillance prompted us to perform compartment pressure measurements. The surgical findings at immediate fasciotomy confirmed the diagnoses. Our experience indicates that pain is not a reliable clinical indicator for underlying compartment syndrome, so in a competent sensate patient the absence of pain does not exclude compartment syndrome. We believe that a high index of clinical suspicion must prevail in association with either continuous compartment pressure monitoring or frequent repeated documented clinical examination with a low threshold for pressure measurement.

PMID:
19203751
DOI:
10.1016/j.injury.2008.07.023
[Indexed for MEDLINE]

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