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Compartment Syndrome.pptx
- 1.
- 2. Definition • Compartment syndromeis an elevation of the interstitial pressure in a closed osteofascial compartment that results in microvascular compromise
- 3. • Most commonlyin anterior and deep posterior compartment of the leg, volar compartment of forearm • Can develop anywhere skeletal muscle is surrounded by substantial fascia
- 4. Classification • Acute • Chronic Dependingon the cause of increased pressure and duration of the symptom
- 5. Causes Fractures Soft tissue trauma Arterialinsufficiency Limb compression during altered consciousness Burns IV fluids extravasation Anticoagulants Acute exertional compartment syndromes in the foot in runners and atheletes
- 6. • Chronic exertionalcompartment syndrome is recurrence of increased pressure most commonly in the anterior or deep posterior compartment of the leg
- 7. Anatomy and pathophysiology •Insult to normal local tissue homeostasis that results in increased tissue pressure , decreased capillary blood flow, and local tissue necrosis caused by oxygen deprivation • Experimental evidence suggests that significant muscle necrosis can occur in patients with normal blood flow if intracompartmental pressure is increased to more than 30mm Hg for longer than 8 hours
- 8. Clinical features • Pain •Paraesthesia • Pallor • Paralysis • Pulselessness
- 9. Measurement pressure level •Invasive Commercially available compartment pressure monitor Arterial line manometer Whitesides three-way stopcock apparatus Wick monitor Demerit: Studies shown that pressure measurements are errorneous in as many as 30% to 35% patients Therefore, shouldnot be used as the primary determinant for or against fasciotomy • Non invasive USG Infrared imaging Demerit : Lack of availability and accuracy
- 10. Treatment • Significant controversyexists regarding appropriate compartmental pressure for performing fasciotomies • If compartmental pressure greater than 30 mm Hg in the presence of clinical findings, immediate fasciotomy is indicated • Equivoal readings require continuous monitoring and serial clinical examinations • In patient with major disruption of arterial circulation or circumferential full-thickness burns, fasciotomy should be performed at the time of initial surgery
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Editor's Notes
- #9 Pain on passive motion. Pain is out of proportion to that expected injury Parasthesia is evaluated by testing with pinprick, light touch and 2 point discrimination Diagnosis of acute compartment syndrome may be delayed in patient with multiple injuries or altered consciousness and in children, in whom physical findings cannot be documented accurately. Because of the variability of clinical signs and symptoms of compartment syndrome, the sensitivity and PPV of clinical findings are low , however the specificity and PPV are high The absence of clinical findings assosciated with compartment syndrome is more useful for excluding the dx than the presence of findings is for confirming diagnosis. If CS is suspected and an adequate examination cannot be performed, pressure level should be measured
- #12 If the surgeon believes there is a compartment syndrome , fasciotomy is justified even if a predetermined pressure threshold has not been reached or the facility to measure pressure is not available.