Acute Compartment Syndrome

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