2. Definition
• Compartment syndrome is an elevation of the interstitial pressure in a
closed osteofascial compartment that results in microvascular
compromise
3. • Most commonly in anterior and deep posterior compartment of the
leg, volar compartment of forearm
• Can develop anywhere skeletal muscle is surrounded by substantial
fascia
5. Causes
Fractures
Soft tissue trauma
Arterial insufficiency
Limb compression during altered consciousness
Burns
IV fluids extravasation
Anticoagulants
Acute exertional compartment syndromes in the foot in runners and
atheletes
6. • Chronic exertional compartment 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
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 controversy exists 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
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
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.
