Compartment syndrome is a condition caused by increased pressure within a compartment of the body, limiting blood flow to tissues within that compartment. It has numerous potential etiologies including fractures, trauma, casts/dressings, and reperfusion injuries. The pathophysiology involves increased compartment pressure raising venous pressure and decreasing the arterial-venous gradient, causing ischemia of muscles and nerves. Diagnosis is based on history, clinical exam assessing the six Ps (pressure, pain, paresthesia, paralysis, pallor, pulselessness), compartment pressure measurements, and laboratory tests. Treatment involves lowering the affected limb, removing casts/dressings, and potentially performing an emergency fasciotomy to release pressure if clinical signs and pressures indicate ongoing ischemia

1. Dr Adeel Riaz
Rotation PGR ORTHO
CPTH, Lahore

2. Compartment Syndrome
 A condition in which increased
pressure in one of the compartments
of the body is raised to such a level
resulting in insufficient blood supply
to the tissues within that
compartment of the body.

3. NUMEROUS ETIOLIGIES
Fracture(also open #’s) IM nailing (reaming)
Arterial injury Exertional states
Blunt trauma Closure of fascial defects
Cast/dressing IV & A-lines
Post-ischemic Coag.disorders
Hyperperfusion Intraosseous infusion
Burns/electrical injuries Distorsion(ankle)
Tumour Snake bite

5. Pathophysiology
Increased compartment pressure
Increased venous pressure
Decrease A-V gradient resulting in muscle
and nerve ischemia.

6. Diagnosis
 History
 Clinical exam: the Ps
 Compartment pressures
 Laboratory tests
 CPK
 Urine myoglobin

7. Clinical Diagnosis
 The six ‘Ps’:
 Pressure
 Pain
 Paresthesia
 Paralysis
 Pallor
 Pulselessness

8. Pressure
 Early finding
 Only objective finding
 Refers to palpation of compartment and its
tension or firmness

9. Pain
 Out of portion to injury
 Exaggerated with passive stretch
 Earliest symptom but inconsistent
 Not available in obtunded patient

10. Paresthesia
 Early sign
 Peripheral nerve tissue is more sensitive than
muscle to ischemia
 Permanent damage may occur in 75 minutes
 Difficult to interpret
 Will progress to anesthesia if pressure not
relieved

11. Paralysis
 Very late finding
 Irreversible nerve and muscle damage present
 Paresis may be present early
 Difficult to evaluate because of pain

12. Pallor & Pulselessness
 Rarely present
 Indicates direct damage to vessels rather
than compartment syndrome
 Vascular injury more of contributing factor to
syndrome rather than result

13. Compartment Pressure
 When
 Confirm clinical exam
 Obtunded patient with tight compartments
 Regional anesthetic
 Vascular injury
 Technique
 Whiteside infusion
 Stic technique: side port needle
 Wick catheter
 Slit catheter

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

15. What is Critical Pressure?
 >30 mm Hg as absolute number (Roraback)

16. Treatment
 Lower leg to level of the heart
 Remove cast
 Split all dressings down to skin

17. Treatment
If concerned refer these patients early
 Fasciotomy if continued clinical findings
and/or elevated compartment pressure

18. Treatment
FASCIOTOMY

19. Wound Care
 Soft tissue coverage by 5-7 days
 Delayed closure
 Split thickness skin graft
 Flaps or free tissue transfer

20. NO ONE EVER BLAMES US FOR DOING A
FASCIOTOMY BUT MISSING COMPARTMENT
SYDROME IS A DISASTER