summary Leg Compartment Syndrome is a devastating lower extremity condition where the osseofascial compartment pressure rises to a level that decreases perfusion to the leg and may lead to irreversible muscle and neurovascular damage. Diagnosis is made with the presence of severe and progressive leg pain that worsens with passive ankle motion. Firmness and decreased compressibility of the compartments is often present. Needle compartment pressures are diagnostic in cases of inconclusive physical exam findings and in sedated patients. Treatment is usually emergent fasciotomies of all 4 compartments. Epidemiology Anatomic location compartment syndrome may occur anywhere that skeletal muscle is surrounded by fascia, but most commonly login to view 8 more bullets Etiology Pathophysiology etiology login to view 11 more bullets pathoanatomy login to view 6 more bullets Risk factors diaphyseal fractures young age (highest prevalence in 12-19 year olds) open fracture segmental or comminuted fracture pattern higher BMI (in pediatric patients) Anatomy 4 compartments of the leg anterior compartment login to view 7 more bullets lateral compartment login to view 6 more bullets deep posterior compartment login to view 6 more bullets superficial posterior compartment login to view 6 more bullets Presentation Symptoms pain out of proportion to the clinical situation is usually the first symptom login to view 3 more bullets Physical exam pain w/ passive stretch login to view 1 more bullet paresthesia and hypoesthesia login to view 1 more bullet paralysis login to view 2 more bullets palpable swelling peripheral pulses absent login to view 2 more bullets Imaging Radiographs obtain to rule-out fracture Studies Compartment pressure measurements indications login to view 3 more bullets relative contraindication login to view 1 more bullet technique login to view 16 more bullets Diagnosis Clinical based primarily on physical exam in patient with intact mental status continuous intramuscular compartment pressure monitoring is highly sensitive and specific for the diagnosis of acute compartment syndrome in obtunded or intubated patients login to view 4 more bullets Treatment Nonoperative observation login to view 3 more bullets bi-valving the cast and loosening circumferential dressings login to view 3 more bullets hyperbaric oxygen therapy login to view 1 more bullet Operative emergent fasciotomy of all four compartments login to view 8 more bullets Special considerations pediatrics login to view 2 more bullets hemophiliacs login to view 1 more bullet Techniques Emergent fasciotomy of all four compartments dual medial-lateral incision login to view 20 more bullets single lateral incision login to view 14 more bullets