Compartment syndrome occurs when increased pressure within a closed muscle compartment reduces blood flow, potentially causing tissue death. It is caused by factors that increase swelling such as fractures. Symptoms include pain disproportionate to the injury that worsens with stretching of muscles. Diagnosis involves measuring compartment pressure. Early fasciotomy, in which fascia is cut to release pressure, can prevent complications if performed within 6-8 hours of onset. Later surgery risks muscle death and contractures.

1. DR ASHWANI PANCHAL
P.G IN ORTHOPAEDICS
JSS HOSPITAL
MYSORE

2.  What is a compartment?
 Closed area of muscles
group, nerves & blood
vessels surrounded by
fascia
 Pressure: 5-15 mmhg

3. Definition:
An increased pressure within enclosed
osteofascial space that reduces capillary
perfusion below level necessary for
tissue viability;
the underlying mechanism is:
- increased volume within space
- decreased space for contents
- combination of both

4.  What is a compartment
syndrome?
 intra comp. pressure
(35-40 mmhg)
 capillaries collapse
 Blood flow to muscles
and nerves
 Bl.Vs collapse

6. Pathophysiology:
Increased compartment pressure
leads to increased venous pressure
which decreases A-V gradient
resulting in muscle and nerve
ischemia.

8. Consequences –vicious cycle

9. Why is it dangerous?
 Nerves:
neuropraxia: will
regenerate
Ischemia: cell death
 Muscles: contracture
(Volkmann's ischemic
contracture)
 Gangrene

10. Compartment Syndrome- CAUSES
Causes
Fractures
 Contusions
 Surgery
 Post Ischemic swelling after arterial occlusion
 Major vascular trauma
 Crush injuries
 Burns
 Prolonged limb compression


11. Causes
 Fracture of a long bone
(Supracondylar humerus,
forearm, hand,tibia and
foot)

13. CAUSES

14. Drilling &
reaming
Tourniquet
Dissection

15. CAUSES
swelling
Tight cast
numbness
Bluish
discoloration

16. CAUSES
 Severe bruised muscle
(even if there is no fracture)
 Don’t take contusion lightly

17. COMPARTMENT SYNDROME

18. Signs and Symptoms
Increased Pressure and Tightness
Progressive pain out of proportion to initial
injury
Markedly swollen area
Progressive neurologic deficit
Seven P’s
 Pain
 Pressure
 Pain with passive stretch
 Parethesia
 Paresis/ Paralysis
 Pulses
 Pallor

19. SYMPTOMS
 Severe pain
inappropriate to the
injury(not relieved even
with morphia)

20. SYMPTOMS
 Burning of the affected limb
 Tight muscle(rigid)tightness feeling
 Numbness: bad sign

21. SIGNS & DIAGNOSIS
 Passive stretching of fingers or toes (muscle
stretch)will lead to severe pain (diagnostic sign)
 Never wait for signs of ischemia (5 Ps):irreversible
damage

22. STRECH TEST
It is possible to strech
the affected muscles by
passively moving the
joints in direction
opposite to that of the
damaged muscles,s
action (( e.g. ::: passive
extension of fingers
produces pain in flexor
compartment of forearm

23. Technique
STRYKER TECHNIQUE
MERCURY
MANOMETER
Wick hand held
instrument

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

25. Stryker Stic System
Easy to use
Can check multiple compartments
Different areas in one compartment

26. Complications related to CS
Late Sequelae
Volckmann’s contracture
 Weak dorsiflexors
 Claw toes
 Sensory loss
 Chronic pain
 Amputation


27. COMPARTMENT SYNDROME

28. Management
 Non surgical management:
 Remove any tight bandage, tubigrip or soaked
dressing
 Cast should be removed completely
 Elevation

29. •management
 Surgical management:
(FASCIOTOMY)
Open skin and fascia
down to a compartment
It is a surgical procedure
where the fascia is cut to
relieve tension or
pressure commonly to
treat the resulting loss of
circulation to the tissue

30. Fasciotomy Principles
Make early diagnosis
Long extensile incisions
Release all fascial compartments
Preserve neurovascular structures
Debride necrotic tissues
Coverage within 7-10 days

31. Compartment Syndrome
Indications for Fasciotomy
Unequivocal clinical findings
Pressure within 15-20 mm hg of DBP
Rising tissue pressure
Significant tissue injury or high risk pt
> 6 hours of total limb ischemia
Injury at high risk of compartment syndrome
CONTRAINDICATION -
Missed compartment syndrome (>24-48
hrs)

32. Forearm Fasciotomy
Volar-Henry
approach
Include a carpal
tunnel release
Release lacertus
fibrosus and fascia
Protect median
nerve, brachial artery
and tendons after
release

33. Gastroc-soleus
Flexor digitorum
longus

34. Intermuscular septum
Superficial peroneal ner

35. Fasciotomy of Hand
10 separate osteofascial
compartments
dorsal interossei (4)
palmar interossei (3)
thenar and hypothenar
(2)
adductor pollicis (1)

37. Close skin by 2ry sutures
after oedema subsides

38. It may need skin graft

39. Wound Management
Wound is not closed at initial surgery
Second look debridement with consideration for
coverage after 48-72 hrs
Limb should not be at risk for further swelling
Pt should be adequately stabilized
Usually requires skin graft
DPC possible if residual swelling is minimal
Flap coverage needed if nerves, vessels, or bone
exposed
Goal is to obtain definitive coverage within 7-10
days

40. Wound Management
After the fasciotomy, a bulky compression dressing and
a splint are applied.
“VAC” (Vacuum Assisted Closure) can be used
 Foot should be placed in neutral to prevent equinus
contracture.
Incision for the fasciotomy usually can be closed after
three to five days

41. Complications Related to
Fasciotomies
Altered sensation within the margins of the wound (77%)
Dry, scaly skin (40%)
Pruritus (33%)
Discolored wounds (30%)
Swollen limbs (25%)
Tethered scars (26%)
Recurrent ulceration (13%)
Muscle herniation (13%)
Pain related to the wound (10%)
Tethered tendons (7%)
Fitzgerald, McQueen Br J Plast Surg 2000

42. Compartment syndrome is a serious syndrome, Which needs
to be diagnosed early.
Palpable pulse doesn’t exclude compartment syndrome
If diagnosis and fasciotomy were done within 24 hrs, the
prognosis is good.
If delayed, complications will develop.
The earlier you diagnose, the safer you are