Compartment syndrome

1. Compartment
Syndrome

2. What is Compartment Syndrome?
 a condition in which the circulation within a
closed compartment is compromised by an
increase in pressure within the compartment,
causing necrosis of muscles, nerves, and
eventually the skin because of excessive swelling

4. Forearm

5. Calf Cross - Section
Von Keudall, Arvind G et al. (September, 2015). Diagnosis and Treatment of
Acute Extremity Compartment Syndrome. The Lancet, Volume 386, Issue 100000,
pg 1299-1320. dio: http://dx.doi.org/10.1016/S0140-6736(15) 00277-9

6. Thigh Cross –Section
Von Keudall, Arvind G et al. (September, 2015). Diagnosis and Treatment of
Acute Extremity Compartment Syndrome. The Lancet, Volume 386, Issue 100000,
pg 1299-1320. dio: http://dx.doi.org/10.1016/S0140-6736(15) 00277-9

7. Etiology
 Fracture (tibia, radius)
 Circumferential burns
 Tight dressings
 Crush injuries
 Bleeding (minor injury while anticoagulated)
 Reperfusion injury
 Extravasation: caused by irritants or by excess fluid that has been erroneously
administrated intramuscularly and can increase the intracompartmental pressure

9. Pathophysiology
Muscle Perfusion Pressure =
Diastolic Blood Pressure - Intra-Muscular
Pressure
Two General Principles :
DECREASED space within compartment
INCREASE within compartment content
Colton, C. (2012). Compartment Syndrome. [Digital Image]
Retrieved from : https://www2.aofoundation.org /

10. Pathophysiology
Compartment Pressure
Venous Outflow Obstruction
Increased Capillary
Permeability
Increased Intracompartmental
Pressure
Decreased Arterial Perfusion
Multiple pathways leading to final
common pathway: cellular anoxia  ISCHEMIA
death of the muscle within compartment.

12. Clinical Features
 Early signs
 Tight
 Escalating pain
 Pain with passive stretch of the involved muscle
 Late signs -6P
 Pain
 Pallor
 Pulselessness
 Paresthesia
 Paralysis
 Poikilothermia
Pain is the key symptom. It occurs
early, is persistent, tends to be
disproportionate compared with the
original injury and is not relieved by
immobilisation.

13. Diagnosis
 By measuring the intracompartmental pressures;
 A split catheter is introduced into the compartment and the pressure is measured close
to the level of the fracture.
 A differential pressure (ΔP) – the difference between the general diastolic pressure and
the compartment pressure – of less than 30 mmHg (4.00 kP) is an indication for
immediate compartment decompression.
 Impending tissue ischemia may be considered when the tissue pressure reaches between
30 and 20 mm Hg below the diastolic blood pressure.
Normal
compartment
pressure 5-
15mmHg

14. Management (non-surgical)
 The threatened compartment (or compartments) must be promptly decompressed.
 Casts, bandages and dressings must be completely removed
 Maintain limb at level of the heart as elevation reduces the arterial inflow and the
arterio-venous pressure gradient on which perfusion depends

15. Management
 If three or more of the ‘classical’ signs are present, the diagnosis is almost certain.
 Fasciotomy - Prophylactic release of pressure before permanent damage occurs
 Fasciotomy principles
 Make early diagnosis
 Long extensile incisions
 Release all fascial compartments
 Preserve neurovascular structures
 Debride necrotic tissues
 Coverage within 7-10 days

16.  The wounds should be left open and inspected 2 days later: if there is muscle
necrosis, debridement can be done; if the tissues are healthy, the wound can be
sutured (without tension), or skin grafted.
 Aftercare
 A bulky compression dressing and splint are applied
 “VAC” – vacuum assisted closure
 Foot should be placed in neutral to prevent equines contracture
 Incision can closed after 3-5 days

17. Complication
 Permanent nerve damage
 Ischemic contracture and loss of function
 Gangrene or loss of limb viability requiring amputation
 Rhabdomyolysis and renal failure