What is compartment syndrome resulting from tibia and fibula fracture and how is it managed?

Updated: Nov 30, 2017
  • Author: Jeffrey G Norvell, MD, MBA, RDMS; Chief Editor: Trevor John Mills, MD, MPH  more...
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Answer

Compartment syndrome can develop in fractures of the lower leg. [23, 24, 25, 26, 27]

Signs of compartment syndrome include crescendo symptoms, pain with passive movement of involved muscles, paresthesias, and pallor, and a very late finding is pulselessness. Increased compartment pressure is present during compartment syndrome; therefore, external palpation frequently aids in the diagnosis. However, a soft extremity on palpation does not rule out compartment syndrome.

Serial examinations should be performed on patients with high-risk injuries or patients with equivocal symptoms.

If compartment syndrome is suspected, obtain an emergent orthopedic consult and measure compartment pressures. Compartment syndrome must be treated promptly with an emergency surgical fasciotomy. If untreated, the increased compartment pressures can cause ischemia and necrosis of the structures within that facial compartment and permanent disability. [12, 28, 23, 24, 25]

Risk factors for compartment syndrome of the lower leg include tibial diaphysis fracture, soft-tissue injury, and crush injury. [12]

Open fractures in pediatric patients have a significantly increased risk of developing compartment syndrome. [12]

In one study, the authors ascertained whether all children under the age of 12 years with fractures of the tibia warranted admission because of the risk of acute compartment syndrome. The mean age of the patients was 5.8 years. According to the authors, patients who have minimally displaced tibial fractures, whose pain is adequately controlled, and who can safely be moved with parental supervision may be discharged from the emergency department. None of the children younger than 12 years developed acute compartment syndrome; however, the authors noted that certain features, such as a history of high-energy injury, displaced fractures, or coexisting fibular fractures, should raise concern that compartment syndrome may occur and, thus, admission and observation may be considered. [28]


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