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The Five P's of Acute Compartment Syndrome

Pain. Pressure. Paresthesia (numbness). Paralysis. Pulselessness. These are the five warning signs of acute compartment syndrome (ACS), a medical emergency. In this article doctors from Duke University review the causes and effects of ACS. They offer orthopedic surgeons ways to watch for this serious complication of lower extremity injury.

ACS is defined by rising pressure between the bone and fascia of the lower leg. The compartment formed by these two structures loses its blood supply. The tissue starts to die. Gangrene is a real danger. That's why it's such a serious condition.

ACS occurs after a variety of injuries and medical conditions. Fractures, contusions, bleeding disorders, burns, trauma, and gunshot wounds are a few of the most common causes. Traction for the leg after a fracture, a cast that's too tight, and ankle position are other risk factors for ACS.

The authors advise doctors to do repeated exams in patients at risk for ACS. The presence of the five Ps and changes over time are red flags. The most common methods of measuring compartment pressures are described. Early measurements are recommended so that early changes can be recognized and treated right away.

References: Steven A. Olson, MD, and Robert R. Glasgow, MD. Acute Compartment Syndrome in Lower Extremity Musculoskeletal Trauma. In Journal of the American Academy of Orthopaedic Surgeons. November 2005. Vol. 13. No. 7. Pp. 436-444.

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