COMPARTMENT

SYNDROME
M. NIZAM .E
Definition
Compartment syndrome is elevation of
interstitial pressure in closed fascial
compartmen that result in microvascular
compromise.
As duration & magnitude of interstitial
pressure increase, myoneural function is
impaired & necrosis of soft tissue eventually
develops
Pathophysiology
Occurs when pressure in a muscle compartment is > pressure in
capillaries, which leads to progressive muscle ischemia &
edema, if left untreated can result in infarction of the
compartment contents.
Response of muscle to ischemia, histamine like subtances are
released that dilate the capillary bed & increases endothelial
permeability, leads to intramuscular transudation of plasma with
red plasma cell sludging & decreased microcirculation. The
muscle gain eight ( up to 50 % )
Muscle & nerves can survive for up to 4 hours of ischemia
without irreversible damage.
Nerve kept ischemic for under 4 hours will show neuropraxic
damage, whereas after 4 hours, nerves will show irreversible
damage.
Causes of Compartment
Syndrome
Prolonged compression over a compartment
Fractures ( both open & closed )
Improper casting of fractures
Burn
Intra comparment hemorrhage
Tumors
Snakebites
Intensive use of muscle such as exercise & seizures
Common Sites of Involvement
Upper Extremity :
- Comparmet Syn. of forearm
- Comparment Syn. of hand & wrist
Lower Extremity :
- Compartment Syn. of thigh
- Compartment Syn. of the leg
- Foot Compartment Syn.
Examination
Pain
Pallor
Paralysis
Paresthesia ( early loss vibratory sensation )
Pulselessness
Compartment Pressure
Monitoring
Normal compartment measure is zero
There is in adequate perfusion & relative ischemia
when tissue pressure within a closed compartment
rise within 10 to 30 mm Hg of patients diastolic
blood pressure.
Whitesides et al believe that fasciotomy ussualy is
indicated when tissue pressure rises to 40 to 45 mm
Hg in patients who has a diastolic pressure of 70
mm Hg & any signs or symptoms of a compartment
syndrome.
Compartmen pressure measurements should be
taken as a close to the fracture site as possible.
Compartment Syn. Forearm
Antebrachial Compartment Syn.
- May follow supracondylar fr. Of humerus.
- Compartment syn. In the forearm after wrist fr
ussualy involve the volar compartment.
Tx :
- Forearm fasciotomy , requires decompression
extending from wrist to midarm including : lacertus
fibrosus, deep fascial compartment over flexor carpi
ulnaris, edge of the flexor superficialis muscle.
Compartment Syn. Of Hand
Occur most often iatrogenic injuries.
Symptoms :
- Increase pain.
- Loss of digital motion & continued swelling.
- Digits are found with MCP extension & PIP
flexion.
 Surgical treatment :
- Can be release with carpal tunnel release &
dorsal incision
Compartment syn. Of the Leg
Anterior compartment, contains :
- Tibialis antr, Ext. Dig Longus, Ext. Hallucis
Longus & Peroneous muscle.
- Compartment is primarily responsible for
dorsoflexion of foot & ankle.
Superficial Posterior compartment, contains :
- Gastrocnemius, soleus, popliteus &
plantaris muscle.
 Lateral compartment, contains :
- Peroneus brevis & longus
Deep Posterior compartment, contains :
- Tibialis posterior
 Surgical treatment :
- Anterolateral incision.
- Posteromedial Incision.
- One incision technique over lat. Comprt.
Compartment Syn. Of the Foot
Symptoms :
- Progressive pain, numbness in toes &
decrease motion.
- Tense tissue bulging.
- Increase pain on passive dorsoflexion of
metatarsophalangeal joints.
- Poor capillary refill & absent pulses are late
finding.
 Compartments of the Foot :
- Intrinsic compartment : 4 intrinsic muscle
between the 1st & 5th metatarsal.
- Medial compartment : Abductor hallucis,
Flexor hallucis brevis.
- Central comparment : Flexor digitorum
brevis, Quadratus plantae, Adductor hallucis.
- Lateral compartment : Flexor digiti minimi
brevis, Abductor digiti minimi.
 Surgical treatment :
- Immediate & complete fasciotomy :
abductor hallucis longus, central, lateral &
interosseous compartment must be released.
- Medial approach.
- Dorsal approach.
Cronic Compartment
Syndrome
Is an exercise-related compartment.
Syndrome characterized by local pain,
swelling, paresthesias in the territory of the
nerve crossing the compartment.
Pressure >15 mmHg for >15 min
postexercise.
Pathophysiology
20% increase in muscle volume or weight
during exercise.
Fascial compartment have a limited ability to
expand.
When the pressure in a compartment
increases, the vascular supply to the nerves
can be affected causing paresthesias to
occur.
Examination

No abnormality unless seen immediately after

exercise.
Tenderness & increased tension in the
compartment.
Passive stretching of the involved muscle
after exercise may increase pain.
Treatment
Conservative Tx with antiinflammatory
medication can be successful if the patient is
willing to significantly reduce or stop atheletic
activities.
Fasciotomy- depending on compartment
affected.
Daftar Pustaka
Rockwood & Green, Fractures in Adult, Vol1
pages 487- 492 Lippincot Raven,
Philadelphia, 1996
R.B Salter, Textbook of Disorder & Injuries of
the Musculoskeletal System,3rd edition, pages
468 470 Lippincot, Philadelphia 1999
Brinker Miller, Fundamental of Orthopaedics,
WB Sunders, 1999
Double IncisionTehcnique
(Anterolateral incision & Posteromedial incision)
Single Incision Technique
Two Incision Technique