COMPARTEMEN SYNDROM

REFERAT
OLEH
FITRI
080610006






PROGRAM STUDI PENDIDIKAN DOKTER
UNIVERSITAS MALIKUSSALEH
2013


Fitri,S.Ked
Pembimbing:
Dr.M.TambahThaibsyah,
Sp.B
Dr.Syafruddin, Sp.B
Dr.Mufrizal, Sp.B


Apa itu kompartemen?

kondisi dimana terjadi
peningkatan tekanan
intertisial di dalam
ruangan yang terbatas,
yaitu di dalam
kompartemen osteofasial
yang tertutup yang berisi
otot, saraf dan pembuluh
darah.
anatomi
Antebrachium :
Komprtemen volar
(otot flexor pergelangan,
dan jari tangan)
Kompartemen dorsal
(otot extensor pergelangan
tangan dan jari tangan, N
interosseus post).
Mobil wad

Leg Anatomy
Compartment Syndrome
Lower Leg
4 compartments

Lateral: Peroneus longus and
brevis
Anterior: Tibialis anterior,
ekstensor ibu jari kaki
Supeficial posterior-
Gastrocnemius, Soleus
Posterior profunda-Tibialis
posterior, flesor digiti pedis




.




Tahun 2011, pasien HIV
berjumlah 7 orang yang
terdiri dari 4 perempuan
dan 3 laki-laki.
di
Menurut data dari
Dinas Kesehatan
Aceh Utara

What is a compartment
syndrome?
intra comp. pressure
(35-40 mmhg)
capillaries collapse

Blood flow to muscles
and nerves

Bl.Vs collapse



Why is it dangerous?
Nerves:
neuropraxia: will
regenerate
Ischemia: cell death

Muscles: contracture
(Volkmann's ischemic
contracture)

Gangrene

Causes

Fracture of a long bone
(Supracondylar humerus,
forearm, hand,tibia and
foot)



Bleeding within the
compartment:

Post operative

Closed reduction
Drilling &
reaming
Dissection
Tourniquet




Tight cast
swelling
Bluish
discoloration numbness



Severe bruised muscle
(even if there is no fracture)

Dont take contusion lightly
SYMPTOMS


Severe pain
inappropriate to the
injury(not relieved even
with morphia)
Pain that out of proportion
Burning of the affected limb

Tight muscle(rigid)

Numbness: bad sign
SIGNS & DIAGNOSIS

Passive stretching of fingers or toes (muscle
stretch)will lead to severe pain (diagnostic sign)

Never wait for signs of ischemia (5 Ps):irreversible
damage


5 Ps
1.Pain
2. Paraesthesia
3. Pallor
4. Paralysis
5. Pulselessness

Signs :
1. tight swelling
2. Loss of strength
3. Loss of sensation
4. Blister

(presence of a pulse does not exclude the diagnosis)

The earliest sign : PAIN
Pain that out of proportion to the injury
Pain that is not responsive to the normal dosage of
pain medication
Severe pain with passive stretch
During passive stretch of a muscle, there is increased
intramuscular pressure.

Pressure in a volume-loaded compartment increases more during
passive stretching than in a normally hydrated compartment.
Passive stretching is a
form of static stretching
in which an external force
exerts upon the limb to
move it into the new
position
Describe as bursting sensation
High risk
Tibia fractures
Tibia plateau fractures
Patients casted after injury
Polytrauma patients
Drug overdose/unconscious patients
For obtunded, intubated, or unreliable patients who have a
swollen extremity but who otherwise cannot be evaluated
Confirmed by measuring
intracompartmental
pressures
Whiteside maneuver Wick hand held instrument
syringe
3 way stopcock
mmhg
mano.
electrode
Direct
reading
A split catheter is introduced
into the compartment & the
pressure is measured closed to
the level of the fracture.
Differential pressure (P)
=diastolic pressure compartment
pressure
= < 30mmHg
Immediate
compartment
decompression
Complications
Leads to muscle death
Leads to nerve death
Contracture
Paralysis
Chronic pain
Numbness

Sequele
Acute renal failure secondary to rhabdomyolysis
Disseminated intravascular coagulation
Volkmanns contracture (where infarcted muscle is
replaced by inelastic fibrous tissue)
Amputation

Dont wait so long
COMPLETELY remove the casts, bandages and
dressings.

Cast should be removed completely

The limb should be nursed FLAT.
( elevating the limb further in end capillary
pressure aggravates the muscle ischaemia)





Non surgical management
Surgical management:


(FASCIOTOMY)
Open skin and fascia
down to a compartment
Surgical incision to the fascia to relieve tension or
pressure.
Complete opening of all fascial envelopes.
The wound should be left open and inspected 2 days
later.
If there is muscle necrosis debridement.
If the tissues are healthy, the wound can be
- sutured (without tension) OR
- skin-grafted OR
- allowed to heal by secondary intention


If P < 30mmHg
If no facilities for
compartmental
pressure
measurement, the
decision to operate
will make on clinical
grounds
Examine the limb at 15
minutes intervals. If no
improvement within 2
hours of removing the
dressings
FASCIOTOMY
Muscle will
be dead after
4-6 hours of
total
ischemia
Leg Single Incision Technique
Leg Two Incision Technique



Close skin by 2ry sutures
after oedema subsides
It may need skin graft
Compartment syndrome is a serious syndrome, Which needs
to be diagnosed early.
Palpable pulse doesnt exclude compartment syndrome
If diagnosis and fasciotomy were done within 24 hrs, the
prognosis is good.
If delayed, complications will develop.

The earlier you diagnose, the safer you are

Thank you