Clinical meaning
Compartment syndrome represents a surgical emergency driven by the interplay between intracompartmental pressure, tissue perfusion pressure, and the duration of ischemia. Normal compartment pressure is 0-8 mmHg. As pressure rises above 30 mmHg (or within 30 mmHg of diastolic blood pressure), capillary perfusion fails. The ischemia-reperfusion cascade causes further edema through endothelial injury and inflammatory mediator release, creating a self-perpetuating cycle. Irreversible myonecrosis begins at 4-6 hours, and complete necrosis occurs by 12 hours. Rhabdomyolysis from muscle death releases myoglobin, potassium, phosphate, and creatine kinase, potentially causing acute kidney injury, cardiac arrhythmias, and DIC. The clinician must make rapid clinical decisions, differentiate from other causes of limb pain, order compartment pressure monitoring, coordinate emergent fasciotomy, and manage the complex systemic sequelae.