**5. Complications of musculoskeletal injury**

#### **5.1. Acute compartment syndrome (ACS)**

A prolonged elevation of interstitial tissue pressure within an enclosed fascial compartment leading to impaired tissue perfusion and damage. Associated with increased vessel permeability and plasma leak into the intercellular space causing further pressure on muscles and nerves (**Figure 25**); it might result in death if not treated before 8–12 h [14–18].

strongly encourage every physician to take this chapter and consider it as a base and build

Musculoskeletal Injuries: Types and Management Protocols for Emergency Care

http://dx.doi.org/10.5772/intechopen.81939

191

[1] Rogers F. Musculoskeletal System [Internet]. National Library of Medicine. PubMed Health. 2017 [cited May 13, 2017]. Available from: https://www.ncbi.nlm.nih.gov/pubmedhealth/

[2] Marieb E. Human Anatomy & Physiology. 3rd ed. Redwood City: Benjamin Cummings;

[3] Villa-Forte A. Muscles—Bone, Joint, and Muscle Disorders [Internet]. MSD Manual Consumer Version. 2018 [cited June 14, 2018]. Available from: https://www.merckmanuals. com/home/bone-joint-and-muscle-disorders/biology-of-the-musculoskeletal-system/

[4] Beekley A, Starnes B, Sebesta J. Lessons learned from modern military surgery. Surgical

[6] Buschmann J, Bürgisser G. Biomechanics of Tendons and Ligaments. Duxford: Matthew

[7] King RB et al. Evaluation of possible tourniquet systems for use in the Canadian forces.

[8] Brumitt J, Cuddeford T. Current concepts of muscle and tendon adaptation to strength and conditioning. International Journal of Sports Physical Therapy. 2015;**10**(6):748-759

[9] Warby SA et al. The effect of exercise-based management for multidirectional instability of the glenohumeral joint: A systematic review. Journal of Shoulder and Elbow Surgery.

[10] Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: An overview of systematic reviews with meta-analysis. British

[5] Mammal Anatomy. New York: Marshall Cavendish Corporation; 2010

\* and Mazin Subhy Alsheikhly2

upon it with further reading and practice.

1 Weill Cornell Medical College, Qatar

2 Hamad Medical Corporation, Doha, Qatar

\*Address all correspondence to: ahmadmomz@yahoo.com

Clinics of North America. 2007;**87**(1):157-184

The Journal of Trauma. 2006;**60**(5):1061-1071

Journal of Sports Medicine. 2017;**51**:113

Deans; 6 February 2017. pp. 1-22

2014;**23**(1):128-142

**Author details**

**References**

1995

muscles

Ahmad Subhy Alsheikhly<sup>1</sup>

PMHT0027058/

This serious and critical musculoskeletal complication can be caused by direct blow or contusion, crush injury, burns, snake bites, fractures, hematoma, and prolonged pressure from splinting.

It is characterized by severe pain especially with stretching, tense compartment, tight and shiny skin. Late findings can be paresthesia, loss of pulses, and pain out of proportion.

#### *5.1.1. Management of ACS*

Treatment of ACS is urgent surgical exploration with fasciotomy (**Figure 26**).

It should be noted that any case with prolonged ACS of more than 8–12 h can have permanent deformity and limb viability may possibly be lost.

During management, every effort should be used to release all compartments; the main focus is on reducing the dangerous pressure in the body compartment. Dressings, casts, or splints that are constricting the affected body part must be removed. Early recognition and diagnosis, pain control, keeping the body part with ACS below the level of the heart (to improve blood flow into the compartment), treatment of shock, prevention of metabolic acidosis and acute kidney injury (AKI) are all mandatory and crucial to save the patient limb [18–20].
