WHAT IS COMPARTMENT SYNDROME

COMPARTMENT SYNDROME IS AN URGENT MEDICAL

CONDITION IN WHICH INCREASES PRESSURE WITHIN
A CLOSED FASCIAL SPACE COMPROMISES THE
CIRCULATION AND REDUCES PERFUSION OF THE
TISSUES CONTAINED WITHIN THAT SPACE
PATHOPHYSIOLOGY
• LOCAL TRAUMA AND SOFT TISSUE DESTRUCTION
• BLEEDING AND EDEMA
• INCREASED INTERSTITIAL PRESSURE
• VASCULAR OCCLUSION
• MYONEURAL ISCHEMIA
CAUSES
• TRAUMA (MOST COMMON)
• IPSILATERAL FEMUR/ TIBIA FRACTURES
• INCREASED INCIDENCE WITH CLOSED FRACTURES
CRUSH INJURIES
• CONTUSIONS
• GUNSHOT WOUNDS
• TIGHT CASTS, DRESSINGS, OR EXTERNAL WRAPPINGS
• EXTRAVASATION OF IV INFUSION
• BURNS
• POSTISCHEMIC SWELLING
• BLEEDING DISORDERS
• ARTERIAL INJURY
SIGN
•
AND SYMPTOMS
PAIN: THE MOST COMMON SIGN THAT PEOPLE DESCRIBE AS BEING EXTREME AND
OUT OF PROPORTION TO THE INJURY. IT IS PERSISTENT, PROGRESSIVE, AND DOES NOT
STOP. IT IS MADE WORSE BY TOUCH, PRESSURE, ELEVATION, AND STRETCHING.
• PASSIVE STRETCH: MUSCLES LACKING IN BLOOD ARE VERY SENSITIVE TO
STRETCHING, SO EXTENDING THE AFFECTED LIMB LEADS TO EXTREME PAIN.
• PARESTHESIA: THIS IS A WEIRD SENSATION, SUCH AS TINGLING OR PRICKING,
SOMETIMES DESCRIBED AS PINS AND NEEDLES.
• PALLOR: THE AFFECTED LIMBS MAY BE A PALE OR DUSKY COLOR BECAUSE OF THE
LACK OF BLOOD.
• PULSE: THERE MAY BE WEAK OR NO PULSE FROM THE AFFECTED COMPARTMENT
• DOPPLER
• BP CUFF (DIASTOLIC LESS THAN 30MMHG)
TREATMENT
NON-OPERATIVE TREATMENT
• OBSERVATION
-DIASTOLIC DIFFERENTIAL PRESSURE (DELTA P) IS > 30
• PRESENTATION NOT CONSISTENT WITH COMPARTMENT SYNDROME
• BI-VALVING THE CAST AND LOOSENING CIRCUMFERENTIAL DRESSINGS
-INITIAL TREATMENT FOR SWELLING OR PAIN THAT IS NOT COMPARTMENT SYNDROME
• SPLINTING THE ANKLE BETWEEN NEUTRAL AND RESTING PLANTAR FLEXION (37 DEG) CAN ALSO DECREASE
INTRACOMPARTMENTAL PRESSURES
• HYPERBARIC OXYGEN THERAPY
-WORKS BY INCREASING THE OXYGEN DIFFUSION GRADIENT
OPERATIVE TREATMENT
• EMERGENT FASCIOTOMY OF ALL AFFECTED COMPARTMENTS
• TIBIA/ FIBULA= DUAL MEDIAL-LATERAL INCISION
ANTEROLATERAL INCISION
POSTEROMEDIAL INCISION
• THIGH FASCIOTOMIES = SINGLE INCISION TECHNIQUE FOR ANTERIOR AND POSTERIOR COMPARTMENTS

• FOREARM FASCIOTOMY= VOLAR INCISION AND DORSAL INCISION

ANTEROLATERAL INCISION

POSTEROMEDIAL INCISION
 COMPLICATIONS

• MUSCLE SCARRING, CONTRACTURE AND LOSS OF FUNCTION OF THE LIMB;

• INFECTION
• AMPUTATION
• PERMANENT NERVE DAMAGE
• RHABDOMYOLYSIS (MUSCLE BREAKDOWN) AND KIDNEY DAMAGE
SEKIAN, TERIMA KASIH