Regional teaching

1. Professor M. A. Imam
MD, MSc (Orth)(Hons), D.SportMed, Ph.D., FRCS (Tr. and Orth.)
www.TheArmDoc.co.uk
@MoAImam
Compartment Syndrome
What you need to know?

2. Introduction
Devastating condition where an osseofascial compartment pressure rises to a level
that decreases perfusion
Why this is serious?
may lead to irreversible muscle and nerve damage

3. Where?
May occur anywhere that skeletal muscle is surrounded
by fascia, but most commonly:
Leg - forearm- hand
---foot----thigh--
buttock---shoulder--
Paraspinous muscles

4. 2- Decreased size
Tight casts & dressings
Tight closure of fascial
defects
Fracture reduction
1. Increased contents
- Bleeding / edema
- fracture
- osteotomies
- crush injuries
- post - ischaemic swelling
Prerequisite (volume restricting envelope)
- Fascia & skin
- POP
- Dressings

5. What Happens?
local trauma and soft tissue destruction
bleeding and edema
increased interstitial pressure
vascular occlusion
Myoneural ischemia

6. Presentation
6 Ps

7. Presentation
6 Ps
Pain w/ Passive stretch
is most sensitive finding prior to onset of ischemia
Paresthesia and hypoesthesia
indicative of nerve ischemia in affected compartment
Paralysis: late finding, full recovery is rare in this case
Palpable swelling
Peripheral pulses absent
late finding, amputation usually inevitable in this case

8. Measurements
Indications
1. Unresponsive: - head
injury -Ventilated
2. Uncooperative
- children, drug abusers
3. Underlying peripheral
nerve deficit
- tibial fracture with CPN
nerve deficit
Interpretation
Matsen > 45 mmHg
Mubarek & Rorabeck > 30 mmHg
Whitesides - within 30mmHg of
DBP

9. 1. Needle - Manometer Method (Whitesides)
- 18G needle is connected via a 3 way stop cock to an air filled 20
ml syringe
- air filled tubing which is connected to a Hg Manometer
- a small amount of saline sits in tube connected to needle
- compression of the syringe raises the pressure till saline flows
into the compartment
2. Arterial Pressure Transducer
- Devices used in ICU to measure arterial blood pressure and CVP
- no need to inject fluid
3. Stryker Device
- Variation on 2
Measurement Techniques

10. Management
Prevention
Remove all tight dressings
- splitting POP decreases
pressure by 30%
- bivalving & cutting padding
reduces pressure by another
55%
- elevate limb
Avoid hypotension
Ream without tourniquet

11. Management
Early Fasciotomy
1. Full-length skin incision
2. Complete fasciotomy of all
compartments
3. Assessment of muscle (colour /
consistancy / contraction / bleeding)
4. Debridement dead muscle
5. Delayed DPC / graft