Compartment syndrome in the polytrauma patient

Diagnosing compartment syndrome in the multiple trauma patient is difficult. High-energy injury to the limbs, coupled with multiple predisposing factors found in this patient population, create an ideal environment for the development of compartment syndrome. Patients sustaining closed intracranial injury or undergoing general anesthesia cannot cooperate with physical examination, hindering the diagnosis and placing greater confirmatory importance on serial compartment pressure determinations. Awareness of the potential for this complication to occur, followed by repeated examination of the limb, is mandatory to assure the diagnosis. Once an increasing trend in the compartment pressures has been identified, early fasciotomy will help minimize soft tissue necrosis and loss of limb function. It is unclear whether intramedullary nailing of the tibia increases the incidence of compartment syndrome. Nonreamed nailing is suggested for treatment of a tibia fracture accompanied by compartment syndrome.