compartment syndrome.pptx د0عبدالكريم.pptx

Compartment

1. COMPARTMENT SYNDROME PREPAREAD BY: DR. ABDULKAREEM BAGWAN SUPERVISOR : PROF.KHALED ALNUZILI PROF. ESAM ALNJASHI

2. OBJECTIVES DEFINITION SITE AND ANATOMY TYPES PATHOPHYSIOLOGY ETILOGY CLINICAL AND EVALUTION DIAGNOSIS MANAGEMENT

3. DEFINITION Compartment syndrome is the development of muscle swelling within an indistensible fascial compartment, resulting in increased intracompartmental pressure and tissue hypoperfusion. Left untreated, the tissues within the compartment become ischaemic, dysfunctional and then necrotic . Compartment syndrome is therefore a surgical emergency.

4. SITE AND ANATOMY SITE : compartment syndrome may occur anywhere that skeletal muscle is surrounded by fascia, but most commonly Leg Forearm Hand Foot Thigh Buttock S houlder Paraspinous muscles

5. SITE AND ANATOMY ANATOMY What is the fascial compartment ? It is a section within the body that contains muscles and nerves and is surrounded by deep fascia A compartment is an anatomical space, bounded on all sides by bone or deep fascia, which contains one or more muscle belly.

6. SITE AND ANATOMY Leg Compartment Syndrome 4 compartments of the leg 1-anterior compartment muscles : tibialis anterior extensor hallucis longus extensor digitorum longus peroneus tertius Function : D orsiflexion of foot and ankle Nerve : Deep peronial nerve

7. SITE AND ANATOMY Leg Compartment Syndrome 2-lateral compartment muscles: peroneus longus peroneus brevis Function : Plantarflexion and eversion of foot Nerve : superficial peronial n .(MC.N) 3-deep posterior compartment muscles : tibialis posterior flexor digitorum longus flexor hallucis longus Function : Plantarflexion and inversion of foot Nerve : posterior tabial n

8. SITE AND ANATOMY Leg Compartment Syndrome 4-superficial posterior compartment muscles gastrocnemius soleus plantaris Function : mainly plantarflexion of foot and ankle Nerve : tibial (medial popliteal) N

9. Nerve supply Deep peronial nerve superficial peronial n.(MC.N) posterior tabial n tibial (medial popliteal) N

10. Action : Extensor of the kne joint Flexors of the hip joint action : Adductors of hip joint action : Fexors of the hip joint

11. SITE AND ANATOMY Forearm Compartment Sy ndrome 4 compartment : 1-Deep volar : most commonly affected Innervated by anterior interosseous nerve Muscles: Flexor digitorum profundus Flexor pollicis longus pronator quadratus 2-superficial volar : Innervated by median and ulnar nerves Muscles: Flexor carpi ulnaris Palmaris longus Flexor digitorum superficialis Flexor carpi radialis Pronator tere s

12. SITE AND ANATOMY Forearm Compartment Sy ndrome 3 _ mobile wad (lateral ): rarely involved Innervated by superficial radial nerve muscles brachioradialis extensor carpi radialis longus Extensor carpi radialis brevis 4-Dorsal compartment: Innervated by posterior interosseous nerves muscles Extensor digitorum Extensor Digiti minimi Extensor Carpi ulnaris Abductor poillicis longus Extensor poillicis longus & bravs Extensor indicis

13. SITE AND ANATOMY Hand Compartment Syndrome 10 in total: hypothenar abductor digiti minimi flexor digiti minimi, and opponens digiti minimi ) thenar adductor pollicis abductor pollicis brevis flexor pollicis brevis and opponens pollicis adductor pollicis dorsal interosseous (x4) volar (palmar) interosseous (x3 )

14. SITE AND ANATOMY Foot Compartment Syndrome 9 main compartments 1- medial : abductor hallucis flexor hallucis brevis 2- lateral : abductor digiti minimi flexor digiti minimi brevis 3- interosseous (x4)

15. SITE AND ANATOMY Foot Compartment Syndrome 4- central (x3 ) superficial flexor digitorum brevis 5- middle quadratus plantae 6- deep adductor hallucis posterior tibial neurovascular bundle

16. TYPE OF CS ACUTE follows traumatic event, commonly fractures, with worsening symptoms & irreversible tissue damage within hours CHRONIC a recurrent syndrome occurring with exercise or work (micro trauma or repetitive overexertion). Symptoms often resolve with rest.

17. PATHOPHYSIOLOGY The normal pressure within the compartment is between 0 mmHg to 8 mmHg. When intra-compartmental pressure increases to within 10 mmHg to 30 mmHg of the patient's diastolic blood pressure, this indicates inadequate perfusion and relative ischemia of the involved extremity

18. ETIOLOGY Increased Volume internal Hemorrhage in to a compartment Fractures (most common cause ) 69% Tibia shaft Supracondylar Bleeding disorders Swelling from traumatized tissue Crush syndrome Soft tissue injury Increased fluid Burns\injections Post-ischemic swellin Decreased volume externa l Tight casts / dressing burns

19. Etiology Traumatic : Fractures (69%) crush injuries Contusions Gunshot wounds Non-traumatic Tight casts, dressings, or external wrappings. Extravasation of IV infusion Burns Postischemic swelling Bleeding disorders Arterial injury

20. CLINICAL AND EVALUTION SYMPTOM & SIGN The six ‘Ps ’: Pressure Pain Paresthesia Paralysis Pallor Pulselessness

21. CLINICAL AND EVALUTION Pressure Early finding Only objective finding Refers to palpation of compartment and its tension or firmness

22. CLINICAL AND EVALUTION Pain Deep , poorly localized and Out of portion to injury Not reliving by analgesia Exaggerated with passive stretch Earliest symptom but inconsistent Not available in obtunded patient Paresthesia Early sign Peripheral nerve tissue is more sensitive than muscle to ischemia Permanent damage may occur in 75 minutes Will progress to anesthesia if pressure not relieved

23. CLINICAL AND EVALUTION Paralysis Very late finding Irreversible nerve and muscle damage present Paresis may be present early Difficult to evaluate because of pain Pallor & Pulselessness Rarely present Indicates direct damage to Vessels rather than compartment syndrome Vascular injury more of contributing factor to syndrome rather than result

24. History Physical exam in patient with intact mental Status (6P) Compartment pressures Laboratory test DIAGNOSIS

25. DIAGNOSIS Compartment pressures Measurement When Confirm clinical exam Obtunded patient with compartment Regional anesthetic Vascular injury

26. DIAGNOSIS Compartment pressures Measurement Technique Whiteside infusion Stic technique Wick catheter Stryker Slit caheter IF Compartment Perfusion more 30mmHg confirm ACS

27. DIAGNOSIS Measurement pressures Compartment Leg should be performed within 5cm of fracture site anterior compartment 1cm lateral to anterior border of tibia deep posterior compartment posterior to the medial border of tibia lateral compartment anterior to the posterior border of fibula superficial posterior middle of calf

28. MANAGEMENT Check neurovascular status Remove any tight cast or dressing Don't elevation the affected limb more than 35 cm above heart level Any fracture should be realigned, immobilized and splinted Fasciotomy (definitive therapy)

29. MANAGEMENT The principles of fasciotomy include Adequate and extensile incision Complete release of all involved compartment Preservation of vital structure Thorough debridement Skin coverage at a later date (7-10 days )

30. MANAGEMENT FASCIOTOMY OF THE LEG Daul medial-lateral incision Approach Two 15-18cm vertical incisions separated by 8cm skin bridge anterolateral incision protect the superficial peroneal nerve Decompress of anterior compartment and decompress of lateral compartment posteromedial incision protect saphenous vein and nerve decompress superficial posterior compartment decompress deep posterior compartment

31. MANAGEMENT FASCIOTOMY OF THE THIGH single incision technique for anterior and posterior compartments incise fascia lata may add medial incision for decompression of adductor compartment

32. MANAGEMENT FASCIOTOMY OF T HE FOREARM volar incision Incision starts just radial to FCU at wrist and extends proximally to medial epicondyle decompresses volar compartment, dorsal compartment, carpal tunnel dorsal incision Dorsal longitudinal incision 2cm distal to lateral epicondyle toward midline of wrist decompresses mobile wad

33. MANAGEMENT FASCIOTOMY OF THE HAND two longitudinal incisions over 2nd and 4th metacarpals decompresses volar/dorsal interossei and adductor compartment longitudinal incision radial side of 1st metacarpal decompresses thenar compartment l ongitudinal incision over ulnar side of 5th metacarpal decompresses hypothenar compartment

34. MANAGEMENT FASCIOTOMY OF THE FOOT dorsal medial incision medial to 2nd metatarsal releases 1st and 2nd interosseous, medial, and deep central compartment dorsal lateral incision lateral to 4th metatarsal releases 3rd and 4th interosseous, lateral, superficial and middle central compartments may add medial incision for decompression of calcaneal compartment

35. Fasciotomy

36. THANK YOU