Acute compartment syndrome

Acute Compartment Syndrome

1. Dr Adeel Riaz
Rotation PGR ORTHO
CPTH, Lahore

2. Compartment Syndrome
A condition in which increased
pressure in one of the compartments
of the body is raised to such a level
resulting in insufficient blood supply
to the tissues within that
compartment of the body.

3. NUMEROUS ETIOLIGIES
Fracture(also open #’s) IM nailing (reaming)
Arterial injury Exertional states
Blunt trauma Closure of fascial defects
Cast/dressing IV & A-lines
Post-ischemic Coag.disorders
Hyperperfusion Intraosseous infusion
Burns/electrical injuries Distorsion(ankle)
Tumour Snake bite

5. Pathophysiology
Increased compartment pressure
Increased venous pressure
Decrease A-V gradient resulting in muscle
and nerve ischemia.

6. Diagnosis
History
Clinical exam:the Ps
Compartment pressures
Laboratory tests
CPK
Urine myoglobin

7. Clinical Diagnosis
The six ‘Ps’:
Pressure
Pain
Paresthesia
Paralysis
Pallor
Pulselessness

8. Pressure
Early finding
Only objective finding
Refers to palpation of compartment and its
tension or firmness

9. Pain
Out of portion to injury
Exaggerated with passive stretch
Earliest symptom but inconsistent
Not available in obtunded patient

10. Paresthesia
 Early sign
Peripheral nerve tissue is more sensitive than
muscle to ischemia
Permanent damage may occur in 75 minutes
Difficult to interpret
Will progress to anesthesia if pressure not
relieved

11. Paralysis
Very late finding
Irreversible nerve and muscle damage present
Paresis may be present early
Difficult to evaluate because of pain

12. Pallor & Pulselessness
Rarely present
Indicates direct damage to vessels rather
than compartment syndrome
Vascular injury more of contributing factor to
syndrome rather than result

13. Compartment Pressure
When
Confirm clinical exam
Obtunded patient with tight compartments
Regional anesthetic
Vascular injury
Technique
Whiteside infusion
Stic technique: side port needle
Wick catheter
Slit catheter

14. Stryker Stic System
Easy to use
Can check multiple compartments
Different areas in one compartment

15. What is Critical Pressure?
>30 mm Hg as absolute number (Roraback)

16. Treatment
Lower leg to level of the heart
Remove cast
Split all dressings down to skin

17. Treatment
If concerned refer these patients early
Fasciotomy if continued clinical findings
and/or elevated compartment pressure

18. Treatment
FASCIOTOMY

19. Wound Care
Soft tissue coverage by 5-7 days
Delayed closure
Split thickness skin graft
Flaps or free tissue transfer

20. NO ONE EVER BLAMES US FOR DOING A
FASCIOTOMY BUT MISSING COMPARTMENT
SYDROME IS A DISASTER