[Compartment syndrome. Frequently missed, with severe sequelae].

Experience and late results in patients with a compartment syndrome which was either missed or diagnosed too late are reported. In the case of 14 patients we were consulted after a delay of 24 h, in another three patients 48 h after the causative event. At that time the diseased extremity was severely swollen, blistered and extremely painful. Ten patients presented with loss of sensitivity; in eight the peripheral pulses were not palpable. CPK was elevated in nine patients (up to 30,000); in six patients CPK was not determined. Causative factors included vascular occlusion (n = 6), paravenous infusions or injections (n = 4), compression in heroin or alcohol abusers (n = 4) and infections secondary to i.m. injections, sepsis or snake bites (n = 4). One patient developed a compartment syndrome after the closure of a muscular hernia. The late results were sobering: eight limbs had to be amputated, another 13 showed muscle necrosis necessitating necrosectomy, and both transitory and persistent median, ulnar, radial and peroneal nerve damage was observed. Our experience shows that dermatofasciotomy should be done on a more generous scale, because it obviously prevents sequelae and because the late complications following inadequately treated compartment syndromes are grave.