An early sign of anterior compartment syndrome in the calf is:
|A||Absence of pulses in the foot|
|B||Firm calf muscle|
|D||Paresthesia between the great and second toes|
(Ref: Schwartz :Principles of surgery 8th edition page no.1969-70)
a. Anterior compartment syndrome can produce all the signs, but the presence of paresthesia between great and the second toe is an early sign, which mandates surgical intervention.
b. The paresthesia is caused by pressure on the deep peroneal nerve and it is relieved by decompressing the compartment.
c. After fractures, soft tissue injury , prolonged limb compression, arterial operations progressive muscle ischemia occur in any of the fascial compartments of the limb.
d. In upper extremity this includes anterior compartment of forearm.
e. In lower extremity fascial anterior and posterior compartment ischemia occur.
f. The mechanism involved is unrelieved swelling in the tight osseofacial compartments.
g. Patients should also be observed for ischemic pain (severe pain at rest) or pain not responding to analgesics.
h. Distal pulses of the extremity are usually present early in the course and may persist until complete and irreversible necrosis has occurred.
i. Prevention of sequelae depends upon early recognition and surgical decompression of the individual compartments.
j. Compartment pressure can be determined by Wick catheters.
k. Decompression is immediately advised.