Compartment syndrome

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Compartment syndrome

  1. 1. Dr. Tamer Mohammed Aly Orthopedic and spine surgeon
  2. 2. <ul><li>What is a compartment? </li></ul><ul><li>Closed area of muscles group, nerves & bl.vs surrounded by fascia </li></ul><ul><li>Pressure: 5-15 mmhg </li></ul>
  3. 3. <ul><li>What is a compartment syndrome ? </li></ul><ul><li>intra comp. pressure </li></ul><ul><li>(35-40 mmhg ) </li></ul><ul><li>capillaries collapse </li></ul><ul><li>Blood flow to muscles and nerves </li></ul><ul><li>Bl.Vs collapse </li></ul>
  4. 6. Why is it dangerous? <ul><li>Nerves: </li></ul><ul><ul><li>neuropraxia: will regenerate </li></ul></ul><ul><ul><li>Ischemia: cell death </li></ul></ul><ul><li>Muscles: contracture (Volkmann's ischemic contracture) </li></ul><ul><li>Gangrene </li></ul>
  5. 7. Causes <ul><li>Fracture of a long bone </li></ul><ul><li>(Supracondylar humerus, </li></ul><ul><li>forearm, hand,tibia and foot) </li></ul>
  6. 10. Drilling & reaming Dissection Tourniquet
  7. 12. <ul><li>Tight cast </li></ul>swelling Bluish discoloration numbness
  8. 13. <ul><li>Severe bruised muscle </li></ul><ul><li>(even if there is no fracture) </li></ul><ul><li>Don’t take contusion lightly </li></ul>
  9. 17. SYMPTOMS <ul><li>Severe pain inappropriate to the injury(not relieved even with morphia) </li></ul>
  10. 18. <ul><li>Burning of the affected limb </li></ul><ul><li>Tight muscle(rigid) </li></ul><ul><li>Numbness: bad sign </li></ul>
  11. 19. SIGNS & DIAGNOSIS <ul><li>Passive stretching of fingers or toes (muscle stretch)will lead to severe pain (diagnostic sign) </li></ul><ul><li>Never wait for signs of ischemia (5 Ps): irreversible damage </li></ul>
  12. 21. Whiteside maneuver Wick hand held instrument syringe 3 way stopcock mmhg mano. electrode Direct reading
  13. 23. Don’t wait so long
  14. 24. <ul><li>Non surgical management: </li></ul><ul><li>Remove any tight bandage, tubigrip or soaked dressing </li></ul><ul><li>Cast should be removed completely </li></ul><ul><li>Elevation </li></ul>
  15. 25. <ul><li>Surgical management: </li></ul><ul><li>( FASCIOTOMY ) </li></ul><ul><li>Open skin and fascia down to a compartment </li></ul>
  16. 28. <ul><li>Close skin by 2ry sutures after oedema subsides </li></ul>
  17. 29. It may need skin graft
  18. 30. <ul><li>Compartment syndrome is a serious syndrome, Which needs </li></ul><ul><li>to be diagnosed early. </li></ul><ul><li>Palpable pulse doesn’t exclude compartment syndrome </li></ul><ul><li>If diagnosis and fasciotomy were done within 24 hrs, the </li></ul><ul><li>prognosis is good. </li></ul><ul><li>If delayed, complications will develop. </li></ul><ul><li>The earlier you diagnose, the safer you are </li></ul>
  19. 32. Thank you

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