Acute compartment syndrome occurs when there is an increased pressure within the closed osteofascial compartment which results in impaired circulation within a few hours of the inciting event. Richard von Volkmann, a German surgeon, was the first person to describe compartment syndrome and did so in 1881.


  • Ischemia
  • Trauma
    • Crush injuries
    • Severely comminuted or segmental fractures → tibial fractures (most common)
    • Widely displaced joint or fracture pieces
    • High-energy injuries with impaired sensation
  • Burn injuries
  • Tight dressing or cast


  • Inciting event (i.e., ischemia, trauma, burn injury) occurs and causes a decreased intracompartmental space and increased intracompartmental fluid volume due to the inability of the fascia to expand
  • No equilibrium between venous outflow and arterial inflow is permitted
  • Venous pressure and venous capillary pressure increases which leads to the intracompartmental pressure to increase
  • Decreased oxygenation of tissues occurs as a result of decreased arterial inflow and venous outflow, leading to ischemia
  • Usually manifests within a few hours, but can be up to 48 hours later


  • Tense, tender leg muscles
  • Leg numbness
  • Dysesthesias

Physical Exam

  • Tense, tender muscles → “wood-like” feeling
  • Pain on passive motion (early)
  • Impaired motor function
  • Pain out of proportion
  • Intracompartmental pressure > 30 mmHg (normal pressure is < 10 mmHg)
  • Pulses may be present! Presence or absence of a pulse isn’t definitive.
  • 5Ps: pain, pulselessness, paresthesia, paralysis, pallor


  • CPK (creatinine phosphokinase): may be elevated; suggestive of muscle breakdown from ischemia, damage, or rhabdomyolysis


  • Radiograph if fracture is present
  • Intracompartmental pressure
  • Delta pressure: difference between diastolic blood pressure and intracompartmental pressure


  • Surgical emergency!
  • Flow restoration
    • Thrombectomy
    • Embolectomy
    • Bypass
    • Thrombolytic therapy
  • Lower extremity fasciotomy
    • If intra-compartmental pressure is > 30 mmHg

Relevant Information

  • Fascia
    • Thin, inelastic connective tissue 
    • Surrounds muscle compartments and has a limited capacity for expansion
  • Compartment syndrome is most likely to occur in the lower extremity, likely as a result of ischemia or restoration of flow after a period of ischemia
  • Superficial branch of the peroneal nerve: lies adjacent to the intermuscular septum between anterior and lateral compartments 
  • Compartments of the leg
    • Anterior → most common location for compartment syndrome
      • Tibialis anterior
      • Peroneus tertius
      • Extensor hallucis longus
      • Extensor digitorum longus 
    • Lateral
      • Peroneus longus
      • Peroneus tertius
    • Superficial posterior
      • Gastrocnemius
      • Soleus
      • Plantaris
    • Deep posterior
      • Tibialis posterior
      • Popliteus 
      • Flexor hallucis longus
      • Flexor digitorum longus


  • Contractures
  • Pain
  • Rhabdomyolysis
  • Nerve damage, associated numbness/weakness
  • Infection
  • Renal failure
  • Death

Differential Diagnoses

  • Deep vein thrombosis
  • Cellulitis
  • Gas gangrene
  • Rhabdomyolysis
  • Peripheral vascular injuries