2. Definition
Compartment syndrome is a condition that
occurs when injury causes generalized
painful swelling and increased pressure
within a compartment to the point that blood
cannot supply the muscles and nerves with
oxygen and nutrients leading to muscle and
nerve death due to ischemia
Compartment is a closed area of muscle
groups nerves and blood vessels
surrounded by fascia.
Normal Pressure :5-15 mmhg
Compartment syndrome pressure 35-40
mmhg
3.
4. pathophysiology
Areas that are subjected to sudden ischemia
followed by revascularisation,oedema is
likely,muscles swell within the fixed fascial
compartments which itself can be the cause
of ischemia with both local muscle necrosis
and nerve damage due to pressure.Edema of
the soft tissue within the compartment further
raises the intra-compartment pressure, which
compromises venous and lymphatic drainage
of the injured area. Pressure, if further
increased in a reinforcing vicious circle, can
compromise arteriole perfusion, leading to
further tissue ischemia
5.
6. Types of compartment
syndrome
Acute compartment syndrome Chronic compartment syndrome
IT occurs after a
traumatic injury such as a car
crash. The trauma causes a
severe high pressure in
the compartment which results
in insufficient blood supply to
muscles and nerves. Acute
compartment syndrome is a
medical emergency that
requires surgery to correct. If
untreated, the lack of blood
supply leads to permanent
muscle and nerve damage
and can result in the loss of
function of the limb.
IT is an exercise-induced
condition in which the
pressure in the muscles
increases to extreme levels
during exercise. The
pressure creates a
decrease in blood flow to
the affected area which
leads to a deprivation of
oxygen to the muscles. The
symptoms are a sensation
of extreme tightness in the
affected muscles followed
by a burning sensation if
exercise is continued
7. Etiology/origin
Fractures-closed
and
open(M.common)
Blunt trauma
Temp vascular
occlusion
Cast/dressing
Closure of fascial
defects
Burns/electrical
Exertional states
IV lines
Hemophiliac/coag
Intraosseous
IV(infant)
Snake bite
Arterial injury
9. Diagnosis of compartment
syndrome in traumatized patient
six ps:
Pain(early finding) with swelling:
pain is most important and when it is out of proportion
to injury, when seen on passive stretching and pain on
palpation of involved compartment.
Pressure(early finding).
Parenthesis(early finding).pins and needles
Pallor and pulselessness(late usually).shiny skin with
bruises
Paralysis.
poikilothermia
Burning of affected limb
Rigid tight muscle
Numbness(bad sign)
10. Clinical evaluation
“Pain and the aggravation of pain by
passive stretching of the muscles in
the compartment in question are the
most sensitive (and generally the only)
clinical finding before the onset of
ischemic dysfunction in the nerves
and muscles.”
12. Management(Don’t wait for
long!)
Non surgical treatment:
Remove any tight bandage, soaked
dressing
Cast should be removed completely
Elevation
Surgical treatment:
Fasciotomy - prophylactic release of
pressure before permanent damage
occurs. Will not reverse injury from
trauma.
13. Indications for fasciotomy
Rising tissue pressure,constantly
greater than 30mmhg or above
Significant tissue injury or high risk pt
> 6 hours of total limb ischemia
CONTRAINDICATION - Missed
compartment syndrome (>24-48
hrs)
14. Fasciotomy principles
Make early diagnosis
Long extensile incisions on lateral side
to get access to all compartments
Release all fascial compartments
Preserve neurovascular structures
Debride necrotic tissues.
16. Complications of compartment
syndrome
Late Sequelae
Volkmann’s contracture
necrosis
Claw toes
Sensory loss
Chronic pain
Amputation
Rhabdomyolysis
Renal failure
17. VOLKMANN’S
CONTRACTURE
Volkmann's contracture,
also known as Volkmann's
ischemic contracture, is a
permanent flexion contractu
re of the hand at the wrist,
resulting in a claw-like
deformity of the hand and
fingers. It is more common
in children. Passive
extension of fingers is
restricted and painful. On
examination the fingers are
white or blue and cold and
the radial pulse is absent.
Any fracture in elbow region or
upper arm may lead to
Volkmann's ischemic
contracture but commonly
caused due to supracondylar
fracture of the humerus
18. Rhabdomyolysis
Rhabdomyolysis is
a condition in which
damaged skeletal
muscle tissue breaks
down rapidly.
Breakdown products
of damaged muscle
cells are released
into the bloodstream;
some of these, such
as the
protein myoglobin
are harmful to
the kidneys and may
lead to kidney failure
