1. Dr. Md.Abdul Mannan Chowdhury
Northern Medical College, Rangpur

2. Early complications of
Fractures
1.visceral injury
2.vascularinjury
3.compartment syndrome
4.nerve injury
5.infections
6.hemarthrosis
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There is no accepted time fora complication to be
considered ‘early’, but
the term is usually applied to complications
that occurduring the acute phase of
treatment.

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4. Definition
An elevation of theinterstitial
pressurein aclosed
osteofascial compartment
that resultsin microvascular
compromise.
4
It isaTrue
Orthopedic Emergency

5. Elevated tissuepressurewithin
aclosed fascial space
ReducesTissuePerfusion-
Ischemia
Result in cell Death--Necrosis
TrueOrthopedic Emergency

6. Compartments:
Closed areaof musclesgroup,
nerves& blood veseles surrounded
by fascia
What isacompartment?
Muscles are arranged in different
compartments and surrounded by
one fascia , this arrangement
called osteofascial compartment.

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9. LowerExtremity
Gluteal
Thigh
LowerLeg
Foot
Where it occurs?
UpperExtremity
Deltoid
Arm
Forearm
Hand

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Normal compartment pressure: 5 – 15 mmHg
Intra-compartmental pressurerisesto
35-40 mm hg
Capilariesarecollapsed
Blood flow to muscle& nervesare
reduced

11. Types of compartment syndrome
Acute compartment syndrome (ACS(
medical emergency
caused by asevereinjury
can lead to permanent muscledamage.
Chronic compartment syndrome (CCS(
known asexertional compartment syndrome
not amedical emergency
most often caused by athletic exertion.
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Compartment syndrome
Elevated tissuepressure
Within aclosed fascial space
Reduced Tissueperfusion Ischaemia
Results in cell Death (Necrosis(

13. Types of compartment syndrome
Acute compartment syndrome (ACS(
medical emergency
caused by asevereinjury
can lead to permanent muscledamage.
Chronic compartment syndrome (CCS(
known asexertional compartment syndrome
not amedical emergency
most often caused by athletic exertion.
13

15. Decrease compartment size
Increasecompartment contents
Any condition that reducesthevolume
of acompartment or increasesthe
content of acompartment can lead to an
acutecompartment syndrome

16. Compartment Syndrome:Aetiology
Reduced compartment size:
Tight Bandage,
Dressing,
Cast
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Increased Compartment Pressure:
Fracture
Bleeding

17. Why doesit occur?(aetiology(
Tight Cast or Splint
Circumferential constricting dressing
Closureof fascia
Military antishock trousers(MA ST(
3rd
degreeBurns(circumferential(
Lithotomy position
ReducetheVolume

18. Etiology of ACS
Tight dressingsand
Bandage/closureof
fascial defect
External pressures:
casts, splints, burn
eschar, lying on limb
for long period,
lithotomy position
Decrease compartment size

19. Compartment Syndrome: Aetiology
Increased Compartment Pressure:
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Fracture
Bleeding
Vascular Injury

20. Tissue
SurvivalMuscle 3-4hour: Reversible Change
6hours : Variable Damage
8hours :Irreversible Changes
Nerves 2hours-Looses nerve conduction
4hours – Neuropraxis
8hours – Irreversible Changes
Delayed Diagnosis
Permanent sensory &motor
deficit
Contractures
Infections &Amputations

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23. Viciouscircle:
Compartment syndrome:
Fracture of the arm and leg can give rise to
severe ischemia even if there is no damage to
major vessel.
Bleeding or edema will increase the pressure
within one of the osteofascial compartments,
this lead to decrease in capillary blood flow
which in turn leads to muscle ischemia,
further edema, still greater pressure, and yet
more profound ischemia….vicious circle.

24. Compartmental syndrome
may lead to
the Volkmann's
ischaemia:

25. After 12 hours or less, this vicious
circle ends in necrosis of nerves and
muscles within the compartment.
Nerve are capable of regeneration,
but the muscle once infarcted can
never recover and are replaced by
fibrous tissue.
This condition is called volkmann s
ischemic contracture.

28. Compartment syndromeis
aclinicaldiagnosis
High level of
suspicion

29. Compartment syndrome
Early signs
Tight
Escalating pain
Pain with passive stretch of
the involved muscle

30. Clinical Evaluation of ACS
Clinical presentations:
Swelling/ Tightnessof compartment
Inappropiateand uncontrolled pain
Severepain at rest or passive
stretching
Pallor/Cyanosis
Hyperesthesia/Paresthesia
Paralysis: full recovery israre
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31. Presentation of
Compartment Syndrome
–
Signs of ischemia (5
P's:(
Pain,
Paraesthesia,
Pallor,
Paralysis,
Pulselessness(

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Acute Compartment Syndrome

33. Whiteside maneuver Wick hand held instrument
syringe
3way stopcock
mmhg
mano.
electrode
Direct
reading

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35. Clinical Evaluation of ACS
Clinical presentations:
Swelling/ Tightnessof compartment
Inappropiated and uncontrolled pain
Severepain at rest or passivestretching
Pallor/Cyanosis
Hyperesthesia/Paresthesia
Paralysis: full recovery israre
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37. diagnostic sign:
Neverwait forsigns of
ischemia (5Ps): irreversible damage
Severepain inappropriateto theinjury(not
relieved even with morphia(
Passivestretching of fingersor toes
(musclestretch(will lead to severepain

38. Complications of
Compertment Syndrome
Acute renal failure
secondary to rhabdo-
myolysis
Volkmann's contracture
(where infarcted muscle is
replaced by inelastic fibrous
tissue(

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Complications:
Latesequelae: valkmann contracture
Week
Dorsiflexion
Claw hand
Sensory loss
Uselesshand

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Don’t wait for the obvious sings of ischemia to appear. If you suspect
An impending compartment syndrome, start treatment straightaway

41. MANAGEMEN
T

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ImmediateAction
Cut & Spread Plaster and cotton wool
RemovePlaster and
other external Splints& Bandage
Limb Elevation?
decreasesCompartment Pressure BUT BP
in elevated Limb isDecreased
53%decreased in Perfusion Pressure
DON’T
ElevatetheLimb

43. Treatment
Non Surgical Treatment:
(Immediatetreatment before Operation(
Removal of all tight bandage, Cast.
Surgical management:
(FASCIOTOMY(
Open skin and fascia
down to acompartment

44. Surgical incision to thefasciato relieve
tension or pressure.
Completeopening of all fascial envelopes.
Thewound should beleft open and
inspected 2 dayslater.
If thereismusclenecrosis
debridement.
If thetissuesarehealthy, thewound can be
-sutured (without tension) OR
-skin-grafted OR

45. Treatment of ACS:
Operativetreatment (Procedure(:
Single incision Fasciotomy
Double incision Fasciotomy
After Operation: Wound isleft open
Secondary suture
skin-graft

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Surgical Treatment
Fasciotomy
Fasciotomy
Fasciotomy –all compartment!!!

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AfterOperation: Wound is
left open
Secondary suture
skin-graft

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Keep thewound open

55. Closeskin by
Secondary
suturesafter
oedemasubsides

56. It may need skin graft

57. Conclusion:
Compartment syndromeisaserious syndrome,
which needs to bediagnosed early.
Palpablepulsedoesn’t exclude compartment
syndrome
If diagnosis and fasciotomy weredonewithin
24 hrs, theprognosisisgood.
If delayed, complicationswill develop.
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The earlieryou diagnose, the safer
you are

58. Thank You
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