12. Severe bruised muscle
(even if there is no fracture)
Don’t take contusion lightly
13.
14. SYMPTOMS
Severe pain
inappropriate to the
injury(not relieved even
with morphia)
Pain that out of proportion
15. Burning of the affected limb
Tight muscle(rigid)
Numbness: bad sign
16. SIGNS & DIAGNOSIS
Passive stretching of fingers or toes (muscle
stretch)will lead to severe pain (diagnostic sign)
Never wait for signs of ischemia (5 Ps):irreversible
damage
17. 5 P’s
1.Pain
2. Paraesthesia
3. Pallor
4. Paralysis
5. Pulselessness
Signs :
1. tight swelling
2. Loss of strength
3. Loss of sensation
4. Blister
(presence of a pulse does not exclude the diagnosis)
18. The earliest sign : PAIN
Pain that out of proportion to the injury
Describe as ‘bursting’ sensation
Pain that is not responsive to the normal dosage of
pain medication
Severe pain with passive stretch
Passive stretching is a
form of static stretching
in which an external
force exerts upon the
During passive stretch of a muscle, there is increased limb to move it into the
intramuscular pressure. new position
Pressure in a volume-loaded compartment increases more
during passive stretching than in a normally hydrated
compartment.
19. HigH risk
Tibia fractures
Tibia plateau fractures
Patients casted after injury
Polytrauma patients
Drug overdose/unconscious patients
20. For obtunded, intubated, or unreliable patients who have a
swollen extremity but who otherwise cannot be evaluated
Confirmed by
measuring
intracompartmental
pressures
21. Whiteside maneuver Wick hand held instrument
Direct
syringe reading
mmhg
mano.
3 way stopcock
electrode
22. A split catheter is introduced
into the compartment & the
pressure is measured closed
to the level of the fracture.
Differential pressure (∆P)
=diastolic pressure – compartment
pressure
= < 30mmHg
Immediate
compartment
decompression
23. Complications
Leads to muscle death
Leads to nerve death
Contracture
Paralysis
Chronic pain
Numbness
sequele
Acute renal failure secondary to rhabdomyolysis
Disseminated intravascular coagulation
Volkmann’s contracture (where infarcted muscle is
replaced by inelastic fibrous tissue)
Amputation
26. Non surgical management
COMPLETELY remove the casts, bandages and
dressings.
Cast should be removed completely
The limb should be nursed FLAT.
( elevating the limb further in end capillary
pressure aggravates the muscle ischaemia)
28. Surgical incision to the fascia to relieve tension or
pressure.
Complete opening of all fascial envelopes.
The wound should be left open and inspected 2 days
later.
If there is muscle necrosis debridement.
If the tissues are healthy, the wound can be
- sutured (without tension) OR
- skin-grafted OR
- allowed to heal by secondary intention
29. If no facilities for
compartmental
pressure
measurement, the
If ∆P < 30mmHg decision to operate
will make on clinical
grounds
Examine the limb at 15
minutes intervals. If no
improvement within 2
hours of removing the
dressings
Muscle will
be dead after
FASCIOTOM
4-6 hours of
total
ischemia
Y
36. Compartment syndrome is a serious syndrome, Which
needs
to be diagnosed early.
Palpable pulse doesn’t exclude compartment syndrome
If diagnosis and fasciotomy were done within 24 hrs, the
prognosis is good.
If delayed, complications will develop.
The earlier you diagnose, the safer you are
Four compartments of the leg contain these names muscles and corresponding arteries and nerves. Complete release of all four compartments is mandatory. Physical exam based on sensory loss may be useful in exercise induced CS. The nerves are the most sensitive to ischemic changes.