Compartment Syndrome Images

Arm Fasciotomy

• Compartments: anterior (biceps,brachialis); posterior (triceps)
• Lateral longitudinal incision from deltoid insertion to lateral epicondyle
• Identify intermuscular septum
• Release fascia anterior and posterior to the septum.
• Danger: radial nerve as it passes from the posterior to anterior compartments just below the fascia.

Forearm Fasciotomy

• 3 Compartments: volar, dorsal and mobile wad.
• Dorsal longitudinal incision between radius & ulna.
• Longitudinal fascial incision to release extensors
• Fascial incision over mobile wad
• Volar incision starting between thenar and hypothenar mounds releasing carpal tunnel; proceed proximally parallel to the wrist crease and then along the ulnar border of the distal forearm (danger:palmar cutaneous branch of median nerve).  Cross to radial side at the midforearm (to allow median nerve coverage), curve ulnarly proximally.
• Release superficial and deep compartments.  Consider individual epimysiotomy if muscle remain avascular.
• Incision can be extended proximally along the course of the brachial artery for arm release.

• 10 compartments: 4 dorsal interossei, 3 volar interossei, thenar, hypthenar, adductor pollicis
• Longitudinal incision over radial side of thumb metacarpal releases thenar compartment
• Dorsal incision over index metacarpal; dissect deeply on both sides to reach adductor pollicis, volar interossei
• Dorsal incision over ring metacarpal: dissect deeply on both sides to reach volar interossei
• Longitudinal incision ulnarly along small finger metacarpal release hypothenar compartment.

• Two incisions (Lateral, Anteromedial (rare))
• Three compartments (Anterior (quadriceps), Medial (adductor; rarely released, Posterior (hamstrings))
• Lateral incision (greater trochanter to femoral condyle)
• Identify intermuscular septum
• Longitudinal fascial incisions anterior & posterior to septum
• Or incise IT band and reflect vastus lateralis of the intermuscular septum, then relaese the intermuscular septum staying away from perforators near the bone.
• Palpate medial compartment
• Release as necessary
• (Schwartz JT Jr, JBJS 1989;71A:392-400.)

Two incision technique (Mubarak and Owen JBJS 1977)

• Anterolateral incision 2 cm anterior to fibular shaft
• find anterior intermuscular septum
• release anterior compartment longitudinally ½ way between intermuscular septum and tibia
• release lateral compartment in line with fibula (danger:  Superficial peroneal nerve)
• Posteromedial incision 2 cm posterior to posteromedial edge of tibia
• at depth of fascia, undermine anteriorly to posterior tibial margin
• incise posterior superficial compartment
• release posterior deep compartment
• may need to release soleus origin from tibia proximally
• prevent retraction of skin edges with gently tensioned vessel loops weaved through staples at skin edges
• See also One Incision Technique.

• 5 compartments: Interosseous, lateral, central, medial, calcaneal.
• Dorsal incisions over 2nd MT and 4th MT.
• Dissect on both sides of the MT in each incision to release compartments.
• (Manoli J Orthop Trauma 6:223;1992)