This document discusses compartment syndrome, including diagnosis, investigation, and management. Diagnosis is based primarily on pain out of proportion to injury that worsens with passive stretching of the compartment. Compartment pressure should be measured using Whitesides technique, with fasciotomy recommended if pressure is within 30 mmHg of diastolic blood pressure. Management includes splitting casts to reduce pressure, elevating the limb, monitoring circulation, and fasciotomy if pressure remains high after cast removal. Fasciotomy decompresses all compartments and wounds should be inspected after 2 days, with delayed fasciotomy after 12 hours not recommended due to risk of infection and nerve/muscle damage.

1. COMPARTMENT SYNDROME
•DIAGNOSIS
•INVESTIGATION
•MANAGEMENT

2. DIAGNOSIS
• Clinical features Pain – most important.
Especially pain out of proportion to the injury
(child becoming more and more restless
/needing more analgesia)
• Other features like pallor, pulselessness,
paralysis, paraesthesia etc appear very late
and we should not wait for these things.

3. • Most reliable signs are pain on passive
stretching of the involved compartment, pain
on palpation of the involved compartment
and sensory deficit in the distribution of any
sensory nerve traversing the involved
compartment.

4. • Pressure measurement
– Normal compartment pressure is zero.
– There is inadequate perfusion and relative
ischemia when this rises to within 10 – 30 mm Hg
of diastolic pressure. There is no effective
perfusion when it is equal to the diastolic
pressure.

5. Whitesides Technique

6. slit catheter (Stryker)

7. • A difference of less than 30 mmHg between
tissue pressure and the diastolic pressure
indicates need for fasciotomy

8. MANAGEMENT
What should we do if pressure is raised
1.Split the plaster
– Compartmental pressure falls by 30% when cast
is split on one side,
– by 65% when the cast is spread after splitting.
– Splitting the padding reduces it by a further 10%
– complete removal of cast by another 15%.
– (Total of 85-90% reduction by just taking off the
plaster)

9. 2. Elevate the limb
-Improve venous return (good) but
-decrease end capillary pressure
3. Circulation chart
- for monitoring (interval 15 minutes)
4. Measure compartment pressure
-A difference of less than 30 mmHg between
tissue pressure and the diastolic pressure
indicates need for fasciotomy.

10. When should fasciotomy be done?
• difference of less than 30 mmHg between
tissue pressure and the diastolic pressure
indicates need for fasciotomy.
• time interval between trauma and the
operation was the main factor in the poor
results; avg delay of 23 H due to secondary
referral.
• Morbidity from fasciotomy is minimal and
should be done as soon as possible.

11. • If facilities for measuring comparment
pressure are not available, clinical assesment
is very important
• The limb should be examine at 15 minutes
interval.
• If there is no improvement after removal of
splint and dressings, fasciotomy should be
done (muscle will loss after 4-6 of total
ischemia)

12. How to do fasciotomy
• Forearm
– Three compartments need to be
decompressed in the forearm –volar
(superficial and deep), dorsal and the mobile
wad of common extensor origin.
– Henry’s approach for volar aspect of forearm
– Thompson’s approach for the dorsal
compartment
.

13. • In the leg there are 4 compartments –the
anterior, the lateral (peroneal) superficial and
deep posterior.
• 3 techniques are recommended
– Fibulectomy,
– perifibular fasciotomy
– double incision fasciotomy.

14. • The wound should left open and inspected
after 2 days
• KIV for another debridement
• If healthy wound can be sutured or SSG or
simply allowed to heal by secondary intention.

15. Delayed Fasciotomy – is it safe ?
• If delayed more than 12 hours – Not safe
according to most papers.
• Why not ?
– Converts it into an open injury but with dead
tissue inside.
– Does not correct associated nerve or muscle
damage.
– Intact skin will act as a protection against infection
and should not be removed.