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Compartment Syndrome Overview and Management

Compartment syndrome is characterized by increased pressure within a confined space, leading to reduced blood flow and potential tissue ischemia and necrosis. It can manifest as exertional compartment syndrome, Volkmann ischaemic contracture, or crush syndrome, with various causes including fractures and soft tissue injuries. Diagnosis involves assessing pain, paresthesia, and muscle paralysis, and treatment often requires fasciotomy to relieve pressure, with careful postoperative management.

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30 views20 pages

Compartment Syndrome Overview and Management

Compartment syndrome is characterized by increased pressure within a confined space, leading to reduced blood flow and potential tissue ischemia and necrosis. It can manifest as exertional compartment syndrome, Volkmann ischaemic contracture, or crush syndrome, with various causes including fractures and soft tissue injuries. Diagnosis involves assessing pain, paresthesia, and muscle paralysis, and treatment often requires fasciotomy to relieve pressure, with careful postoperative management.

Uploaded by

raj.kumar311559
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Compartment

Syndrome
Definition
◦ Rise of pressure within a confined space resulting in critical
reduction of blood flow to tissues.

‘OR’

◦ Elevation of intracompartmental pressure to a level and duration


that without decompression will cause ischemia and necrosis.
Exertional Compartment Syndrome: During exercise causing
ischaemia, pain. Resolves on rest but compartment syndrome if continues.

Volkmann Ischaemic Contracture: End stage of neglected acute


compartment syndrome with irreversible muscle necrosis leading to
ischemic contractures.

Crush Syndrome: Prolonged external compression leading to muscle


necrosis
Causes:
Increasing volume of compartment:
◦ Fracture
◦ Soft Tissue Injury
◦ Crush Syndrome
◦ Revascularisation

Decreasing volume of compartment:


◦ Burns

Medical Comorbidity:
◦ Diabetes/ Hypothyroid
Diaphyseal Forearm 7.9%

Distal Radius 9.8%

Diaphyseal Femur 7.9%

Tibial Diaphyseal 36 %
Diagnosis
◦ Pain-
◦ First symptom
◦ May be Absent due to nerve injury
◦ Sensetivity 19% Specificity 97%
◦ Pain on passive stretch
◦ Paresthesia/ Hyposthesia-
◦ First symptom of nerve ischaemia
◦ Sensetivity 13% Specificity 98%
◦ Paralysis of muscle-
◦ Late sign
◦ Peripheral pulses and capillary refill are always intact in acute compartment syndrome
Pathogenesis
◦ Critical Closing Pressure Theory
◦ Decreased arterio-venous gradient
◦ Microvascular Occlusion of Capillary
Reperfusion injury
Following re-establishment of blood flow (For eg Fasciotomy)

Procoagulants + Antioxidant
Muscle Antithromboxane
Ischaemia Inflammatory
breakdown Antileukotrienes
mediators Antiplatelets

Systemic
MODS Increased ICP coagulopathy +
Capillary leakage
Compartment Pressure
Monitoring
Needle Manometer
Others
◦ Slit Catheter
◦ Solid State Transducer Intra-compartmental Catheter
◦ Infrared Spectroscopy
Critical Pressure
◦ > 30mm Hg (Roraback)
◦ > 45mm Hg (Matsen)
◦ ΔP <30mm Hg ( Mc Queen)
◦ Mars and Hardley used Mean arterial pressure
◦ Increasing ICP with ΔP <30mm Hg consistently for 2 hrs  FASCIOTOMY

◦ Normal ICP= 0-7 mm of Hg


Ischaemia Duration
Nerves Muscles

30 mins
2-4hrs
(paraesthesia)
(impairment)

12-24 hrs
(irreversible loss) 4-12hrs
(irreversible loss)
Fasciotomy
◦ Entirety of the length of the affected compartment
◦ All muscles visualized
◦ Subcutaneous fasciotomy is contra indicated

◦ Single Incision Four Compartment Fasciotomy


◦ Lateral incision for anterior/ lateral compartment
◦ Retract peroneal muscles for superficial posterior compartment
◦ Incision posterior to P-L border of fibula for Deep posterior
◦ DOUBLE INCISION FOUR COMPARTMENT FASCIOTOMY
◦ Better as dissection superficial and faster
◦ Lateral incision- over lateral im septa to visulaize ant/ lat compartment
◦ Superficial peroneal nerve at risk
◦ Medial incision-2 cm from medial edge of tibia
◦ Saphenous nerve/ vessels and Posterior tibial nerve and vessels at risk
Forearm
Post-operative care
◦ Left open and dressed
◦ Second look procedure at 48 hrs depending on viability
◦ Closure not done till muscle necrosis present
◦ Delayed primary closure with dermotraction/ SSG/ VAC

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