![]() ![]() Paresthesias in the web space between the first and second toes is also an early indicator of compartment syndrome. Pain is often described as a dull, deep, aching worsened by passive stretching of the involved muscles in the lower extremity or dorsiflexion of the foot. Pain that is disproportionate to injury must trigger a workup for compartment syndrome. The classic signs of acute compartment syndrome include the six “Ps”: pain, paresthesia, poikilothermia (differing temperatures between limbs with affected side being cooler), pallor, paralysis, and pulselessness. No matter the mechanism of injury, prompt diagnosis and treatment of compartment syndrome is essential. Lower extremity gunshot wounds, stab wounds, fractures as a result of blunt injuries, and prolonged pressure on an extremity are common causes of lower extremity compartment syndrome in trauma patients. † Physicians now agree that compartment syndrome occurs when pressure within a closed space increases past a critical pressure (typically greater than 30 mmHg), resulting in decreased perfusion to the components of the compartment and the sequelae following such an insult (muscle edema, ischemia, and necrosis). Volkmann first introduced the concept of compartment syndrome when he described post-traumatic ischemic muscle injury leading to paralytic limb contractures, which he termed Volkmann’s Contracture in 1881.* The more modern definition from Carter et al describes muscle swelling within a fixed muscular compartment impairing distal blood supply leading to necrosis. ![]() The definition of compartment syndrome has evolved over the last two centuries. ![]()
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