COMPARTMENT

SYNDROME
AINUL BASYIRAH BT
JUSTI@SAINI
012012100154

Outline
Definition
Pathophysiology

WHAT IS COMPARTMENT
SYNDROME?
Compartment
syndrome (CS) is:
caused by increased
pressure within a
closed anatomical
space
which compromises
the circulation and
function of the tissues
within that space
may result in
temporary or
permanent damage to
muscles and nerves
(tissue ischemia).

 Compartment syndrome can occur wherever

a compartment is present:
Upper limbs (most common)
Lower limbs (most common)
Gluteal
Abdominal

 Compartments
Group of muscles,
nerves, & blood vessels
in arms and legs.
Fascia a tough
membrane covering the
tissues. Does not
stretch or expand
easily.
F(x) of Fascia To
keep tissue in place.

Pathophysiology
of
Compartment Syndrome

Insult/Injury
Vascular Compromised (Microvascular & Venous
Congestion)
Hypoxia
Cell Death & Protein
Release
Edema
Increase Intra-compartmental
Pressure
Further Cell
Damage
Muscle
Necrosis
Permanent Disability, Amputation,
Death

Reference
http://patient.info/doctor/compartme
nt-syndrome-pro

COMPARTMENT
SYNDROME

AC U T E C O M PA RT M E N T S Y N D R O M E

Most common type

It is a medical emergency
It is usually caused by a severe
injury
Develop rapidly over hours or
days
High pressure in the
compartment can lead to
permanent muscle and nerve
damage if left untreated.

 Fractures especially at
the elbow, forearm
bones, proximal 1/3rd
tibia, hand and foot.
Crush injury (soft
tissue injury)
Circumferential burns
Tight plaster cast
Anabolic steroid use
Surgery to blood
vessels

E TIOLOGY

CLINICAL PRESENTATION
5Ps:
Pain* - disproportionate to
that expected injury, bursting
sensation, progressive,
worsens by passive
stretching.
Paraesthesia* - due to nerve
ischaemia
Paralysis* - lost of function of
ischaemic muscle (weakness)
Pulselessness
Pallor

CHRONIC COMPARTMENT SYNDROME

Known as exertional
compartment syndrome
Usually not a medical
emergency
Rise in compartmental pressure
due to regular vigorous exercise
(eg : running, football, cycling,
tennis and gymnastics)
Occurs over days or weeks

ETIOLOGY
Reversible painful condition in which
increased intramuscular pressure
during exercise impedes local muscle
blood fl ow and impairs the
neuromuscular function of the tissue
within the compartment.
High occurrence in the lower legs, but
occasionally occurs in the thighs,
upper arms, forearms and hands.

CLINICAL PRESENTATION
Pain is triggered by exercise and becomes
worse as exercise continues.
The pain resolves with rest.
Paralysis, muscle weakness
Paraesthesia Numbness, tingling
Abnormal gait

INVESTIGATION

COMPARTMENT PRESSURE

Normal 0 to 10 mmHg
Compartment syndrome
= <30mmHg (delta
pressure = DBP intra
compartment pressure)

NEEDLE INFUSION TECHNIQUE

Needle inserted into muscle, tube

with air/saline interval kept at this
height, manometer indicates
pressure
Air injected by syringe via 3-way
stopcock
When the pressure of the injected
air exceeds the compartment
pressure , the saline interval
moves in the tube
Read the pressure from

PRESSURE
MEASUREMENT
Must be made in all
compartments
Anterior and deep
posterior are highest
Performed within 5 cm of
the injury

Stryker hand-held system

Stryker slit catheter

TREATMENT &
COMPLICATION OF
COMPARTMENT
SYNDROME

NON-SURGICAL TREATMENT

All bandages, cast and dressings must be removed

completely.

Place the affected limb or limbs at the level of the heart.

(Elevation is contraindicated as it causes decrease in
arterial flow
and narrows the arterial-venous pressure gradient)

Hyperbaric oxygen therapy

Promotes hyperoxic vasoconstriction which
reduces swelling and improves local blood
flow and oxygenation.
Increases tissue oxygen tension and improves
survival of marginally viable tissue.

Take pain medication

SURGICAL TREATMENT
Fasciotomy
Incision to the fascia that surrounds the muscle which
immediately relieve the pressure inside the muscle
compartment and prevents permanent tissue damage.
Indicated when the differential pressure is less than
30mmHg.
Following fasciotomy, fracture reduction, stabilization
and vascular repair can be performed if needed.
The wound should be left open and inspected 48-72 hours
later.
muscle necrosis - debridement
healthy muscles wound can be sutured or skin
grafted

CHRONIC COMPARTMENT
SYNDROME (CCS)
It is not a medical emergency.

Reduction of activity with cross-training

exercises and muscle stretching before initiating
exercises.
rest, shoe modification
It is recommended to avoid casting, splinting or
compression that affects the limbs.
Elective fasciotomy is done.

COMPLICATIONS
With late diagnosis, irreversible tissue
ischaemia can develop in acute setting.
Permanent nerve damage
Permanent muscle damage and
reduced function of the affected limb
Muscle contracture or Volkmann
contracture
Infection
Amputation
Kidney damage

REFERENCES

Apley and Solomans Concise System of

Orthopaedics and Trauma

http://emedicine.medscape.com/article/30
7668-treatment#d13

http://www.nlm.nih.gov/medlineplus/ency/ar
ticle/001221.htm
http://www.podiatryinstitute.com/pdfs/Updat
e_1994/1994_03.pdf