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Michiko C111 08 285 C111 08 221 C111 08 216 C111 08 145 C111 08 175
Advisor : dr. Risqi T. Tuahuns dr. Helmiyadi Kuswardhana dr. Sebastian Mihardja
Orthopaedic and Traumatology Department Medical Faculty of Hasanuddin University Makassar 2013
Definition
Compartment syndrome is a condition that results from
increased tissue-fluid pressure within a defined fascial space. The end result is muscle and nerve ischemia and necrosis.
Robert. R, Scott C., Steven J. Compartment Syndromes. Emergency Orthopedic the Extremities. 5th Ed.
Epidemiology
The most common locations for compartment
syndrome are the forearm and leg. Less common are the foot, upper arm and thigh.
Robert. R, Scott C., Steven J. Compartment Syndromes. Emergency Orthopedic the Extremities. 5th Ed.
Etiology
Fractures (open &
closed)
Arterial injury & vascular
occlusion
Burns Exercise Casting
Thomson J C. Hand. Netters Concise Atlas of Orthopaedic Anatomy.
Patophisiology
Any situation that causes a decrease in compartment size or increase in compartment pressure can initiate compartment syndrome .
ICP capillary blood perfusion cannot maintain
tissue viability.
The local tissue ischemia leads to local edema, which
Jobe M.T. Compartment Syndromes and Volkmann Contrature. Cambells Operative Orthopaedics. 11th Ed.
volar FCU,FDS, PL, FCR, PT Deep volar FDP, FPL, Pronator quadratus. Superficial dorsal AN, EDC, EDM, ECU. Mobile Wad BR, ECRL, ECRB. Deep dorsal Supinator, APL, EPB, EPL, EIP
Opponens pollicis Adductor Adductor pollicis Hypothenar PB, ADM, FDMB, ODM Intrinsics Lumbricals Interosseous - DIO - PIO
deep
peroneal n.
Posterior compartment
- Superficial superficial flexor muscle: soleus, gastrocnemeus, plantaris - Deep deep flexor muscle: FDL, TP, FHL, popliteus, posterior tibial a and v , tibial n peroneal a and v.
Severe extremity pain out of proportion to injury Early sign, worse with passively stretching involved
muscle
Pallor
Heppenstall R .B, McCombs P.R, DeLaurentis D.A. Compartment Syndrome. Rockwood and greens: Fracture in adults. 6th. Volume I.
Paresthesia or
Pulselessness
Robert. R, Scott C., Steven J. Compartment Syndromes. Emergency Orthopedic the Extremities. 5th Ed.
Arterial occlusion
+
Neuro praxia
-
+ +
+
+ +
+
+ -
+
+ +
Decompressing : Remove all bandages, casts, and dress. 2. Elevation max. 30 minutes
1.
Fasciotomy of Hand
Incisions : 3 incisions (2 dorsal and 1 carpal tunnel release) can release all compartments. Dorsal (1) : Over 2nd metacarpla, dissect on both sides; release radial 2 interosseous ( 2 dorsal, 1 palmar) Dorsal (2) : Over 4th metacarpal. Dissect on both sides; release ulnar 4 interosseous ( 2 dorsal, 2 palmar) Medial : Release transverse carpal ligament, then thenar, hypothenar, & adductor compartments.
Fasciotomy of Forearm
Palmar incision Release the entire anterior compartment Dorsal incision Release the entire posterior compartment and mobile wab
Thomson J C. Hand. Netters Concise Atlas of Orthopaedic Anatomy.
Fasciotomy of Leg
Anterolateral Centered over the intermuscular septum between the anterior and lateral compartments Medial Centered over the posterior tibial border/septum between the superficial and deep posterior compartments
Thomson J C. Hand. Netters Concise Atlas of Orthopaedic Anatomy
Complications
Permanent nerve damage
Volkmann's Ischemic Contracture Infection
Amputation
Death
Robert. R, Scott C., Steven J. Compartment Syndromes. Emergency Orthopedic the Extremities. 5th Ed.