Compartment syndromeBy

KANWAL NOOR

FINAL YEAR MBBS

Definition

Compartment syndrome is a condition that occurs when injury causes generalized painful swelling and increased pressure within a compartment to the point that blood cannot supply the muscles and nerves with oxygen and nutrients leading to muscle and nerve death due to ischemia

Compartment is a closed area of muscle groups nerves and blood vessels surrounded by fascia.

Normal Pressure :5-15 mmhg

Compartment syndrome pressure 35-40 mmhg

pathophysiology

Areas that are subjected to sudden ischemia followed by revascularisation,oedema is likely,muscles swell within the fixed fascial compartments which itself can be the cause of ischemia with both local muscle necrosis and nerve damage due to pressure.Edema of the soft tissue within the compartment further raises the intra-compartment pressure, which compromises venous and lymphatic drainage of the injured area. Pressure, if further increased in a reinforcing vicious circle, can compromise arteriole perfusion, leading to further tissue ischemia

Types of compartment

syndrome

Acute compartment syndrome Chronic compartment syndrome

IT occurs after a traumatic injury such as a car crash. The trauma causes a severe high pressure in the compartment which results in insufficient blood supply to muscles and nerves. Acute compartment syndrome is a medical emergency that requires surgery to correct. If untreated, the lack of blood supply leads to permanent muscle and nerve damage and can result in the loss of function of the limb.

IT is an exercise-induced condition in which the pressure in the muscles increases to extreme levels during exercise. The pressure creates a decrease in blood flow to the affected area which leads to a deprivation of oxygen to the muscles. The symptoms are a sensation of extreme tightness in the affected muscles followed by a burning sensation if exercise is continued

Etiology/origin

Fractures-closed

and

open(M.common)

Blunt trauma

Temp vascular

occlusion

Cast/dressing

Closure of fascial

defects

Burns/electrical

Exertional states

IV lines

Hemophiliac/coag

Intraosseous

IV(infant)

Snake bite

Arterial injury

Tight cast Snake bite

Diagnosis of compartment

syndrome in traumatized patient six ps:

Pain(early finding) with swelling:

pain is most important and when it is out of proportion to injury, when seen on passive stretching and pain on palpation of involved compartment.

Pressure(early finding).

Parenthesis(early finding).pins and needles

Pallor and pulselessness(late usually).shiny skin with bruises

Paralysis.

poikilothermia

Burning of affected limb

Rigid tight muscle

Numbness(bad sign)

Clinical evaluation

“Pain and the aggravation of pain by

passive stretching of the muscles in

the compartment in question are the

most sensitive (and generally the only)

clinical finding before the onset of

ischemic dysfunction in the nerves

and muscles.”

Diagnosis confirmed with

Whiteside

maneuver

Wick hand held

instrument

Management(Don’t wait for

long!)Non surgical treatment:

Remove any tight bandage, soaked

dressing

Cast should be removed completely

Elevation

Surgical treatment:

Fasciotomy - prophylactic release of

pressure before permanent damage

occurs. Will not reverse injury from

trauma.

Indications for fasciotomy

Rising tissue pressure,constantly

greater than 30mmhg or above

Significant tissue injury or high risk pt

> 6 hours of total limb ischemia

CONTRAINDICATION - Missed

compartment syndrome (>24-48

hrs)

Fasciotomy principles

Make early diagnosis

Long extensile incisions on lateral side

to get access to all compartments

Release all fascial compartments

Preserve neurovascular structures

Debride necrotic tissues.

Fasciotomy complications

Dry, scaly skin Pruritus Discolored wounds Swollen limbs scars ulceration Muscle herniation Pain related to the wound Tethered tendons

Complications of compartment

syndrome Late Sequelae

Volkmann’s contracture

necrosis

Claw toes

Sensory loss

Chronic pain

Amputation

Rhabdomyolysis

Renal failure

VOLKMANN’S CONTRACTURE

Volkmann's contracture,

also known as Volkmann's

ischemic contracture, is a

permanent flexion contractu

re of the hand at the wrist,

resulting in a claw-like

deformity of the hand and

fingers. It is more common

in children. Passive

extension of fingers is

restricted and painful. On

examination the fingers are

white or blue and cold and

the radial pulse is absent.

Any fracture in elbow region or

upper arm may lead to

Volkmann's ischemic

contracture but commonly

caused due to supracondylar

fracture of the humerus

Rhabdomyolysis

Rhabdomyolysis is a condition in which damaged skeletal muscle tissue breaks down rapidly. Breakdown products of damaged muscle cells are released into the bloodstream; some of these, such as the protein myoglobinare harmful to the kidneys and may lead to kidney failure