Compartment Compartment Syndrome: Syndrome: IntroductionIntroduction

Acute Acute Compartment Syndrome: Compartment Syndrome:

occures when pressure rises in a occures when pressure rises in a

compartment,resulting in a critical compartment,resulting in a critical

reduction of blood flow to the tissue.reduction of blood flow to the tissue.

Volkmann`s ischemic Volkmann`s ischemic contracturecontracture

Is the end stage of neglected acute Is the end stage of neglected acute

compartment syndrom with irreversible compartment syndrom with irreversible

muscle necrosis leading to ischemic muscle necrosis leading to ischemic

contractures.contractures.

The crush syndrome:The crush syndrome:

The systeicThe systeic result ofresult of muscle necrosis muscle necrosis

caused by prolonged externalcaused by prolonged external

compression of an Extremity.compression of an Extremity.

Epidemiology Epidemiology

The underlying condition causing it : The underlying condition causing it :

MOST COMMONLY: a fractureMOST COMMONLY: a fracture

22ndnd most common cause: most common cause:

Soft tissue injury (crush type injury)Soft tissue injury (crush type injury)

Effects of raised tissue Effects of raised tissue pressure on:pressure on:

Muscles Muscles

Nerve Nerve

Bone Bone

Reperfusion injury:Reperfusion injury:

Is a group of complications following Is a group of complications following reestablishment of blood flow to the reestablishment of blood flow to the ischemic tissue.ischemic tissue.

Can occur after fasciatomy & restoration Can occur after fasciatomy & restoration of muscle blood flow.of muscle blood flow.

Clinical DX: Clinical DX:

Pain Pain

ParesthesiaParesthesia

Paralysis of limb & hyposthesiaParalysis of limb & hyposthesia

SwellingSwelling

Absence of peripheral pulsesAbsence of peripheral pulses

Parasis & paralysisParasis & paralysis

Compartment pressure Compartment pressure monitoring:monitoring:

Needle manometer methodNeedle manometer method

The wick catheter The wick catheter

The slit catheter The slit catheter

Timing: Timing:

Time factors are also important inTime factors are also important in

making the decision to proceedmaking the decision to proceed

to faciotomyto faciotomy..

Treatment:Treatment:

The single most effective The single most effective treatment for acute compartment treatment for acute compartment syndrome is:syndrome is:

Fasciotomy ( single/ double Fasciotomy ( single/ double

incision) incision)

Management of Management of Fasciotomy wounds:Fasciotomy wounds:

Incisions must never be closed primarily Incisions must never be closed primarily because this may result in persistent because this may result in persistent elevation of ICP.elevation of ICP.

48h after, a” 248h after, a” 2ndnd look “ procedure should look “ procedure should be undertaken to ensure the viability of be undertaken to ensure the viability of all muscles.all muscles.

The wounds may then be closed by The wounds may then be closed by delayed primary closure if possible.delayed primary closure if possible.

Complications list for Complications list for Compartment Syndrome:Compartment Syndrome:

Muscle contractureMuscle contracture

Muscle weaknessMuscle weakness

Sensory lossSensory loss

InfectionInfection

fracturesfractures

Late diagnosis: Late diagnosis:

Delay in Dx has been cited as the single Delay in Dx has been cited as the single reason for failure in the management of reason for failure in the management of acute compartment syndrome.acute compartment syndrome.

Delay to fasciotomy of more than 6hs is Delay to fasciotomy of more than 6hs is likely to cause significant complications.likely to cause significant complications.