Acute compartment syndrome is caused by increased pressure within the confined space of a muscle compartment, restricting blood flow and often resulting from trauma such as fractures or crush injuries. Diagnosis involves assessing disproportionate pain and pressure measurements. Treatment involves surgical fasciotomy to release the fascia and decompress the compartment if pressure is within 30 mmHg of diastolic or above 45 mmHg. Proper wound care after fasciotomy and stabilization of any fractures is needed to prevent complications like contracture, infection, and paralysis.

1. ACUTE COMPARTMENT
SYNDROME

2. HISTORY
 Raised pressure in a closed space
 Richard von Volkmann
 Hilderbrand
 Rowlands
 Murphy

3. PATHOPHYSIOLOGY
 Raised pressure within a confined space
 Increased volume of compartment

4.  Ischemia reperfusion injury
 MAJOR VESSEL RARELY OBSTRUCTED
 Difference between compartment and diastolic
pressure
 Crush syndrome
 Anesthetized / sedated / intubated patient
 Prolonged surgery
 Tight cast / constrictive dressing / pneumatic anti
shock garment

5. ETIOLOGY
 Decreased compartment size
Constrictive dressings and casts
Closure of fascial defects
Thermal injuries and frostbite
Localized external pressure
Pneumatic tourniquet
Increased compartment contents
Primary edema accumulation
Postischemic swelling
Arterial injuries
Arterial thrombosis or embolism
Reconstructive vascular and bypass
surgery
Replantation
Prolonged tourniquet time
Arterial spasm
Cardiac catheterization and
angiography
Ergotamine ingestion
Prolonged immobilization with
limb compression
Drug overdose with limb
compression
General anesthesia with limb
compression
 Increased capillary pressure or
permeability
Exercise
Venous obstruction
Thermal injuries and frostbite
Exertion, seizures, and eclampsia
Venous disease
Intraarterial injection
Venomous snake bite
Infection
 Primarily hemorrhage accumulation
Hereditary bleeding disorders (e.g.,
hemophilia)
Anticoagulant therapy
Vessel laceration
Combination of edema and
hemorrhage accumulation
Fractures
Supracondylar elbow
Both-bone forearm
Distal radius
Soft tissue injury
Crush
Severe muscle tear, contusion
Gunshot wounds
Iatrogenic (i.e., postoperative
bleeding, inflammation)
Miscellaneous
Intravenous infiltration (e.g., blood,
saline)
High-pressure injection

6. DIAGNOSIS : CLINICAL ASSESSMENT
 Symptoms may be masked by other injuries
 ?? Open fracture
 Disproportionate pain
 In regional/epidural anesthesia
 Numbness / tingling
 Signs
 Compartment
 Stretch pain
 Sensory deficit
 Paresis

7.  Pulse / capillary refill
 Differential – artery occlusion, nerve injury, crush
syndrome
 ?? Delay in diagnosis of major arterial injury
 Arterial pressure index
 Nerve injury – diagnosis of exclusion
 Crush syndrome

8. TISSUE PRESSURE MEASUREMENT
 Incipient vs. fulminant
 Ideally after every fracture
 Polytrauma patient
 Chemical overdose / head injury + long bone
fracture
 Arterial repair

9. MEASUREMENT TECHNIQUES
1. Needle manometer
• Landerer
• 18 gauge needle, 20ml syringe, column of saline and
air, mercury manometer

10. 2. Wick catheter
• Scholander
• Polyglycolic acid suture, polyethylene tubing
• Disadvantage

11. 3. Slit catheter
• Rorabeck
• Polyethylene tubing with 5
3mm slits in end

12. 4. STIC catheter
• Hand held device
5. Micro capillary infusion
6. Arterial transducer measurement
7. Tc 99m-methoxyisobutylisonitrile
8. Doppler flow measurement
9. Near infrared spectroscopy

13. PRESSURE THRESHOLD FOR FASCIOTOMY
 Within 10-30 mm Hg of diastolic pressure
(Whitesides)
 Above 45mm Hg (Matsen)
 30mm Hg difference between compartment and
diastolic pressure (Mc Queen)
 40mm Hg difference between mean arterial pressure
and compartment pressure (Heppenstall)

14. TREATMENT OF INCIPIENT COMPARTMENT
SYNDROME
 Incipient compartment syndrome
 Remove tight dressings and casts
 Limb position at the level of heart
 Oxygen support
 Hydration
 ESTABLISHED COMPARTMENT SYNDROME
Surgical decompression

15. HAND
 Clinical feature
 Crush injury / carpal
fracture
 Longitudinal dorsal
incisions

16. FOREARM
 Fracture / soft tissue fluid infiltration / gun shot injury
/ deep infection / iv drug abuse
 3 compartments
 Volar Henry / volar ulnar / Thompson
 Both superficial and deep compartment should be
released

17. Henry approach

18.  Volar ulnar approach

19.  Dorsal approach

20. LEG
 Fibulectomy – Patman / radical surgery
 Perifibular fasciotomy – Matsen
Single incision technique

21.  Double incision technique -
Mubarak

22. THIGH
 3 compartments

23. FOOT
 Claw toe deformity
 Calcaneal fractures / Lisfranc
injury / blunt trauma
 Difficult to diagnose

24. AFTERCARE
 Collagen / Cuticell
 Splintage
 Antibiotics
 Wound inspection after 48
hrs
 Opsite roller
 Vessel loop bootlace
 Plastic surgery

25. COMPLICATIONS
1. COMPARTMENT SYNDROME
2. FASCIOTOMY

26. MEDICAL MANAGEMENT
 Mannitol
 Hyperbaric oxygen

27. SKELETAL INJURIES
 Fracture must be stabilized
 Location, character of fracture / skill of surgeon
 Plating / nailing / ex fix
 Soft tissue coverage

28. MUST AVOID
 CONTRACTURE
 SENSORY DEFICIT
 PARALYSIS
 INFECTION
 NON UNION
 AMPUTATION