This 1996 narrative review by Whitesides and Heckman synthesizes experimental and clinical data to define the diagnostic criteria, pressure thresholds, and surgical timing for acute compartment syndrome, addressing when and how to intervene to prevent irreversible muscle and nerve damage.
When you see pain out of proportion to injury — especially with passive stretch — measure compartment pressures at the fracture level and use the delta pressure (diastolic minus intracompartmental) as your fasciotomy trigger: act when that gap narrows to 20 mm Hg or less, before paralysis or pulselessness appear.
In obtunded or anesthetized patients where pain cannot be assessed, serial pressure measurements are your only objective tool — avoid epidural and nerve blocks in any patient at risk.
This 1996 narrative review by Whitesides and Heckman synthesizes experimental and clinical data to define the diagnostic criteria, pressure thresholds, and surgical timing for acute compartment syndrome, addressing when and how to intervene to prevent irreversible muscle and nerve damage.
When you see pain out of proportion to injury — especially with passive stretch — measure compartment pressures at the fracture level and use the delta pressure (diastolic minus intracompartmental) as your fasciotomy trigger: act when that gap narrows to 20 mm Hg or less, before paralysis or pulselessness appear.
In obtunded or anesthetized patients where pain cannot be assessed, serial pressure measurements are your only objective tool — avoid epidural and nerve blocks in any patient at risk.