treatment
Last reviewed 01/2018
Urgent decompression is required to prevent severe ischaemia. All potentially constricting dressings, casts and splints must be removed - merely splitting a plaster is not enough. The compartment pressure should be measured. Open fasciotomy is indicated if it is above 40 mm Hg. Otherwise, the limb should be closely observed until improvement is apparent clinically. If no improvement occurs, perform a fasciotomy, which in the leg, may mean opening all four compartments.
Following fasciotomy, the wound should be left open for 5 days. Debridement may be indicated if muscle necrosis is apparent, otherwise, healing may be encouraged by suturing, or skin graft, or the wound simply left to heal by itself.
A high index of suspicion is required in the unconscious patient following major trauma. The weight of the entire body may have been applied to one limb. Early orthopaedic referral and continuous instrumented pressure monitoring is necessary.