COMPARTMENT SYNDROME TRYandhelpyouwith.pptx

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1. COMPARTMENT SYNDROME. MORARA MORAA- MBChB VI SUPERVISOR- DR. MUSA

2. INTRODUCTION It is raised pressure in an musculofacial compartment to a level that compromises tissue perfusion. Common areas ; forearm, hand, gluteal region, thigh, leg and foot Causes of increased pressure; - Increase in compartment content –bleeding, oedema , inflammation. - Decrease in compartment size –tight dressing.

3. LEG

4. FOREARM

5. HAND

6. FOOT

7. THIGH

8. AETIOLOGY Fractures in sited common areas. Soft tissue contusion Post ischaemic swelling Burns – circumferential third degree burns. Tight casts/dressings Extravasation of intravenous infusions Bleeding disorders including anticoagulants. Internal fixation and infection may precipitate.

9. PATHOPHYSIOLOGY. Increased pressure within the compartment. Reduced capillary flow. Sequale is muscle ischaemia . Further oedema , greater pressure, more profound ischaemia . Viscious cycle end in 6 hours or less. Necrosis of nerve and muscle within compartment. Nerve can regenerate but muscle if infarcted replaced by inelastic fibrous tissue.

10. CLINICAL FEATURES Pain – out of proportion, on passive stretch. Swollen or tense limb. Paraesthesia Pallor Paralysis pulselessness

11. The unconscious patient; Intracompartment pressures - more than 30mmHg Differential pressure (diastolic BP- Intracompartmental pressures) – less than 30 mmHg NOTE- compartment syndrome is a clinical diagnosis

12. TREATMENT GOAL – Decompression of the compartment. Casts, bandages and dressings completely removed. Limb be nursed flat. Fasciotomy- Then wound left open and inspected 2 days later. IF muscle necrosis, debride, if not- tension free suturing or grafting. If clinical signs ‘soft’ – examine limb at 30 minute interval if no improvement within 2 hours split the dressing, fasciotomy. Compartment syndrome is pressure- and time- dependent.

13. DELAYED RECOGNITION. Neurologic deficit. Muscle necrosis Ischemic contracture Infection Delayed healing of fractures Possible amputation Myoglobinuria

14. REFERENCES Advanced Trauma and Life Support, 10 th edition. Apley and Solomon’s System of Orthopaedics and Trauma, 10 th edition. Bailey and Love_s Short Practice of Surgery, 27 th edition . Orthobullets .