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Compartment Syndrome- an

overview
By Suvarna Maharaj

Intro
Compartment syndrome is a limb and life
threatening condition that occurs when perfusion
pressure falls below tissue pressure in a closed
anatomical compartment .
If left untreated -tissue necrosis and sequele
Ultimately death
It is found wherever a compartment is present.

Causes
Simple cause: THE PRESSURE IS TOO HIGH.
Either decreased compartment size or increased
fluid content.
Increased fluid contentintensive muscle use
burns
intra-arterial injection
infiltrated infusion
haemorrhage
envenomation

Causes
Decreased compartment pressure
Burns
Casts
Military aftershock trousers

Pathophysiology
This follows the path of ischemic injury. When
fluid is introduced into a fixed volume or when
volume decreases, pressure rises.
In the case of CS, compartments have a
relatively fixed volume. An introduction of excess
fluid or extraneous constriction increases
pressure and decreases tissue perfusion until no
O2 is available for cellular metabolism.

Pathophysiology cont.
Elevated perfusion pressure is the physiological
response to rising intracompartmental pressure (IP).
When IP rises, autoregulatory mechanisms are
overwhelmed and a cascade of injury develops.
Tissue perfusion pressure is measured by
subtracting the interstitial fluid pressure from the
capillary perfusion pressure. When this pressure
falls below a critical level, injury results.

Pathophysiology cont.
When intracompartmentalpresssure rises,
venous pressure rises. When venous pressure
exceeds CPP, capillaries collapse. Generally, an
intracompartmental pressure greater than
30mmHg requires intervention.
At this point, blood flow stops, resulting in
decreased O2 delivery. Hypoxic injury causes
cells to release vasoactive substances which
increases endothelial permeability.

Pathophysiology cont.
Capillaries allow continued fluid loss which
increases tissue pressures and advances injury.
Nerve conduction slows,tissue ph falls due to
anaerobic metabolism,surrounding tissue suffers
further damage, and muscle tissue suffers
necrosis releasing myoglobin.
The end is loss of the extremity and possibly, the
loss of life.

Clinical- History
Suspect CS whenever significant pain
occurs in an extremity
Mechanism of injury- long bone fracture,
high energy trauma, penetrating injuries,
crush injuries
Remember to ask about anticoagulationincreases risk of CS

Signs
5 Ps parasthesia, pallor,pulselessness,
pain, poikilothermia are not diagnostic of
CS. Except for pain and parasthesia , the
other traditional signs are not reliable.
Severe pain at rest or with any movement
especially passive stretching of the
muscles should raise suspicion

Less common sites of CS


FOOT
-Classic signs What are they?
expected with foot fractures and injury so
tense tissue bulging maybe the most
reliable sign.
-associated with CS of deep posterior
compartment of leg.

CS of the hand
Symptoms from compression causes pain,
loss of sensation and decreased hand
function due to pressure on blood vessels
and the median nerve within the wrist
compartment .

CS of the gluteal region


The large gluteal muscle mass is confined in
fascia hence area prone to CS. How?
Signs include pain especially on passive
flexion at the hip and tense swelling of the
buttock. Late signs include foot drop with a
loss of sensation along distribution of
sciatic nerve and no active movements of
the ankle.

Workup
LAB STUDIES
- Often normal and not helpful in diagnosing
or excluding CS
- Definitive diagnosis is compartment
pressure measurement using a tonometer
if available.
- Remember PITFALLS

Measurement Methods

Simple needle
Wick Catheter
Slit catheter
Side Port catheter
Transducer Tipped Catheter

Technique
STRYKER TECHNIQUE
MERCURY MANOMETER

Technique

Demonstration
Go to
www.emprocedures.com/compartment

ED care
Stabilize the patient
Ischemic injury is basis for CS. Additional
O2 should be given.
IV hydration is essential. Hypovolemia
worsens ischemia.
Do not elevate the affected limb-decreases
arterial pressure
Fasciotomy is definitive treatment so early
referral is warranted.

Fasciotomies
Two Incision Technique
Used to adequately decompress all four
compartments
Medial Incision made longitudinally just posterior
to tibia
Lateral incision made posterior to fibula from
level of head to lat malleolus
Closure
Post-op

Complications

Permanent nerve damage


Infection
Loss of limb
Death
Cosmetic deformity from fasciotomy

References
Emedicine Compartment Syndrome by Richard
Paula MD Director of Research, Assistant
Professor of Emergency Medicine,University of
South Florida
Mutimedia Procedure Manual- Compartment
pressure Measurement
Gluteal Compartment Syndrome following Joint
Arthroplasty Under Epidural Anaesthesia,Journal
of Orthopaedics Surgery

References
April 2007 By Kumar V Saeed, A
Panagopoulos, PJ Parker
Wheeless Textbook of OrthopaedicsCompartment syndrome of the Foot.
Acute Compartment Syndrome Update on
Diagnosis and treatment by TE Whitesides
and MM Heckman Academy of
Orthopaedic Surgery July 1996

The end
Thank you