Matsen (1980) — Diagnosis and Management of Compartmental Syndromes.

Diagnosis and Management of Compartmental Syndromes.

·J Bone Joint Surg Am·1980·696 citations·Shoulder & Elbow

This paper presents a practical five-year clinical approach to diagnosing and treating extremity compartment syndromes. It asks how to resolve ambiguous cases and how to decompress the leg and forearm completely. Much of the emphasis is on when tissue-pressure measurement and nerve stimulation add value beyond the clinical exam.

Key Findings

Compartment syndrome is primarily a clinical diagnosis based on pain out of proportion, pain on passive stretch, hypoesthesia, and tense compartments. If these signs do not resolve after removing circumferential dressings and placing the limb at heart level, fasciotomy is usually indicated.
Every patient with a maximum pressure ≤45 mmHg avoided fasciotomy and had no residua, while everyone >55 mmHg sustained significant neuromuscular loss. Between these values outcomes were mixed, which is why the authors treat pressure as one data point, not a verdict.
Individual tolerance for pressure varies, so the authors reject the idea of a single fixed critical pressure. Thirteen patients with pressures above 30 mmHg but benign exams were watched rather than operated on, and none had sequelae.
Duration of pressure elevation matters as much as its magnitude, so continuous monitoring reveals the trend and catches pressures that are benign briefly but harmful if sustained.
Direct nerve stimulation separates compartment syndrome from a proximal nerve injury. A strong muscle response means the paralysis is neural, since the ischemia-sensitive myoneural junction would fail first in a true compartment syndrome.
The four-compartment parafibular approach decompressed all 14 legs satisfactorily. Because two earlier patients developed deep posterior sequelae after anterior-only release, all four compartments are opened when any one is involved.
In 6 of 6 tibial fractures, adding skeletal fixation at the time of decompression produced united fractures with satisfactory function, since release removes the air-splint effect that had stabilized the limb.

Board PearlCompartment syndrome is a clinical diagnosis; pressure >45 mmHg is a relative fasciotomy indication, but no single critical pressure fits every patient.

Clinical Relevance

Treat compartment syndrome as a clinical diagnosis first. When the exam is clear, remove circumferential dressings, place the limb at heart level, and reassess. If signs persist, decompress.

The key teaching point is that there is no magic pressure number. Pressures at or below 45 mmHg were reliably safe and those above 55 mmHg were reliably harmful, but the zone between is patient-dependent. Use pressure only when the exam is equivocal or the patient cannot be examined.

Direct nerve stimulation solves a common trap: the obtunded or nerve-injured patient who cannot move the toes. A strong response to stimulation points to a proximal nerve lesion, not ischemia, and can spare an unnecessary fasciotomy.

When you do release the leg, open all four compartments. Prompt, complete decompression drives good outcomes, and skeletal fixation stabilizes the fracture once the air-splint effect of swelling is gone.

Core

Diagnosis and Management of Compartmental Syndromes.

Matsen, Krugmire, et al.·J Bone Joint Surg Am·1980·696 citations·Shoulder & Elbow

Diagnosis and Management of Compartmental Syndromes.

Key Findings

Clinical Relevance

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Diagnosis and Management of Compartmental Syndromes.

Key Findings

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Diagnosis and Management of Compartmental Syndromes.

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Diagnosis and Management of Compartmental Syndromes.

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