Acute Compartment Syndrome of the Lower Leg: A Review

Published:November 21, 2015DOI:


      • Acute compartment syndrome (ACS) of the lower leg is a time-sensitive, limb-threatening surgical emergency.
      • Late findings of ACS can lead to limb amputation, contractures, paralysis, multiorgan failure, and death.
      • Diagnosis is based on clinical suspicion, assessment of the 6 P’s (pain, poikilothermia, pallor, paresthesia, pulselessness, and paralysis), and intracompartmental pressure (ICP).
      • ICP measurement above 30 mm Hg requires emergent surgical decompression.
      • The gold standard of ACS treatment is full fasciotomy.


      Acute compartment syndrome (ACS) of the lower leg is a time-sensitive orthopedic emergency that relies heavily on precise clinical findings. Late findings of ACS can lead to limb amputation, contractures, paralysis, multiorgan failure, and death. Hallmark symptoms of ACS include the 6 P's: pain, poikilothermia, pallor, paresthesia, pulselessness, and paralysis. Suspicion of ACS is confirmed by measurement of intracompartmental pressure of the affected compartment. The definitive treatment of ACS is timely fasciotomy. We review the pathophysiology, common causes, diagnosis, and treatment of this potentially devastating condition.


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        • Donaldson J.
        • Haddad B.
        • Khan W.S.
        The pathophysiology, diagnosis and current management of acute compartment syndrome.
        Open Orthop J. 2014; 8: 185-193
        • Bowyer M.W.
        Compartment Syndrome.
        in: Gahtan V. Costanza M.J. Essentials of Vascular Surgery for the General Surgeon. Springer, New York, NY2014: 55-69
        • Mauser N.
        • Gissel H.
        • Henderson C.
        • Hao J.
        • Hak D.
        • Mauffrey C.
        Acute lower-leg compartment syndrome.
        Orthopedics. 2013; 36: 619-624
        • Blanchard S.
        • Griffin G.D.
        • Simon E.L.
        Atraumatic painless compartment syndrome.
        Am J Emerg Med. 2013; 31: 1723.e3-1723.e4
        • Shuler F.D.
        • Dietz M.J.
        Physicians' ability to manually detect isolated elevations in leg intracompartmental pressure.
        J Bone Joint Surg Am. 2010; 92: 361-367
        • Konstantakos E.K.
        • Dalstrom D.J.
        • Nelles M.E.
        • Laughlin R.T.
        • Prayson M.J.
        Diagnosis and management of extremity compartment syndromes: an orthopaedic perspective.
        Am Surg. 2007; 73: 1199-1209
        • Wardi G.
        • Gortz S.
        • Snyder B.
        A case of delayed presentation of thigh compartment syndrome.
        J Emerg Med. 2014; 46: e145-e148
        • Raza H.
        • Mahapatra A.
        Acute compartment syndrome in orthopedics: causes, diagnosis, and management.
        Adv Orthop. 2015; 2015: 543412
        • Shadgan B.
        • Menon M.
        • Sanders D.
        • et al.
        Current thinking about acute compartment syndrome of the lower extremity.
        Can J Surg. 2010; 53: 329-334
        • Vegari D.N.
        • Rangavajjula A.V.
        • Diiorio T.M.
        • Parvizi J.
        Fasciotomy following total knee arthroplasty: beware of terrible outcome.
        J Arthroplasty. 2014; 29: 355-359
        • Murdock M.
        • Murdoch M.M.
        Compartment syndrome: a review of the literature.
        Clin Podiatr Med Surg. 2012; 29 (viii): 301-310
        • Dover M.
        • Memon A.R.
        • Marafi H.
        • Kelly G.
        • Quinlan J.F.
        Factors associated with persistent sequelae after fasciotomy for acute compartment syndrome.
        J Orthop Surg (Hong Kong). 2012; 20: 312-315
        • Thompson J.C.
        in: Thompson J.C. Netter's Concise Orthopaedic Anatomy. 2nd ed. Saunders Elsevier, Philadelphia, PA2010: 285-336
        • Hailer N.P.
        • Adalberth G.
        • Nilsson O.S.
        Compartment syndrome of the calf following total knee arthroplasty–a case report of a highly unusual complication.
        Acta Orthop. 2007; 78: 293-295
        • Tang W.M.
        • Chiu K.Y.
        Silent compartment syndrome complicating total knee arthroplasty: continuous epidural anesthesia masked the pain.
        J Arthroplasty. 2000; 15: 241-243
        • Iannotti J.P.
        • Parker R.D.
        Etiology of compartment syndrome.
        in: Iannotti J.P. Parker R.D. The Netter Collection of Medical Illustrations: Musculoskeletal System, Volume 6, Part III-Biology and Systemic Diseases. 2nd ed. Elsevier, Philadelphia, PA2013: 284-290


      Joanne Pechar, MSN, AGACNP-BC, ANP-C, is an acute care nurse practitioner with the Department of Penn Orthopedics at Pennsylvania Hospital in Philadelphia and can be reached at [email protected].


      M. Melanie Lyons, PhD, MSN, ACNP-BC, is a National Institutes of Health T32 postdoctoral research fellow at the Center for Sleep and Circadian Neurobiology at Perelman School of Medicine and School of Nursing, University of Pennsylvania.