compartment syndrome by kanwal noor final year mbbs

1. Compartment syndrome
By
KANWAL NOOR
FINAL YEAR MBBS

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

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

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

8. Tight cast Snake bite

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.”

11. Diagnosis confirmed with
 Whiteside
maneuver
 Wick hand held
instrument

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.

15. Fasciotomy complications
 Dry, scaly skin
 Pruritus
 Discolored wounds
 Swollen limbs
 scars
 ulceration
 Muscle herniation
 Pain related to the wound
 Tethered tendons

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