compartment syndrome

1. COMPARTMENT
SYNDROME

2. PATHOLOGY
• Increased intracompartmental
pressure sufficient to occlude
microvascular circulation causing
ischemia and tissue necrosis
subsequently
• Intracompartmental
• Muscle and tissue bounded by
fascia and bone with little
room for expansion

3. PATHOPHYSIOLOGY
• Decreased blood inflow + outflow
• Tissue injury results in bleeding and edema
• Increased intracompartmental pressure
disrupts Starling forces
• Compromised perfusion results in further
tissue damage
• Further edema and perfusion compromise
• Order of collapse
• Capillaries -> venules -> arterioles (last to
collapse because have muscles)

4. SIGNIFICANCE
Muscle will die within 4-
6hours of ischemia
01
May lead to
rhabdomyolysis and
kidney failure if
untreated
02
Nerve then undergoes
necrosis later
03

5. COMPLICATIONS
Death
Renal failure
from release of
myoglobin from
muscle necrosis
Permanent
functional
impairment
Volkmann
ischemic
contracture

6. COMMON SITES
Leg
Proximal
third of tibia
Forearm flexor
compartment
Hand Foot Elbow

7. ETIOLOGY
• External restriction of compartment or internal increase in compartment volume
• Trauma – crush injury,fracture,dislocation,soft tissue damage and muscle
swelling -> edema and haemorrhage
• Vascular,arterial compromise (post-ischemic swelling),muscle anoxia,venous
obstruction,increased venous pressure
• Iatrogenic – tight cast,constrictive dressing,splint

8. DIAGNOSIS
• Clinical (5Ps)
• Lack of oxygenated blood and lack of waste product
removal results in pain and decreased peripheral sensation
secondary to nerve irritation
• Pain of out proportion (not relieved by analgesic) –
paraesthesia – pallor – palpable tense swollen
compartment – pulselessness - paralysis

9. INVESTIGATION
• Split Catheter (compartment pressure monitor) :
• Perfusion pressure (difference between diastolic pressure
and intracompartmental pressure) <30mmHg or absolute
pressure of >30mmHg
• Role : unresponsive patients
• Normal tissue pressure is about 0 mmHg

10. MANAGEMENT
• Remove : cast,constrictive dressings
• Place limb at level of heart
• Bivalve casts down to skin and spread open
• Fasciotomy – open all 4 compartments with medial and
lateral incisions in leg
• Usually indicated when perfusion pressure falls to
<30mmHg (inadequate perfusion and/or ischemia
begins) in a patient who has any signs or symptoms of
a compartment syndrome – even if distal pulses still
present
• Or indicated if unable to monitor and there is no
improvement in clinical signs after 2hours of splitting
the dressings (examine at 15mins interval)