COMPARTMENT SYNDROME

DIAGNOSIS AND MANAGEMENT

 Backgrounds
 1872, Richard von Volkmann  nerve injury &
subsequent contracture following compartment syndr.

 1932, Jepson  experimentsl study in dog

 1941, Bywater and Beall  revealed mechanism &

consequences of compartment syndr.

 1970  1st measuring intracompartment pressure

 Definition

 Compression of nerve & bloodvessels

 Within enclosed anatomic space (osteofacial)

 Leading to impaired bloodflow

 Demographics
 Incidence:
 Men 7.3/100,000
 Women 0.7/100,000

 69% due to trauma

 36% fx tibia
 9.8% distal radius
 23% soft tissue injury without fx
 10% on anticoagulants
 Incidence
 Lowerleg > Forearm > Hand, Foot, Thigh,
Upper arm

 Lowerleg  anterior compartment & deep

posterior compartment

 Forearm  volar compartment

Etiology
 Causes of Compartment Syndrome

 Fractures (open & closed)

 Arterial injury & vascular occlusion
 Snake bite
 Burns
 Intraosseus fluid replacement (Infant)
 Pathophysiology

2 main pathways
 Increasing fluid content within the
compartment (ex : haemorrhage, oedema)
 Decreasing the compartment size
(ex : external compression)
 How to Diagnosed ?

 Mainly by clinical examination

 Objective Measurements of Intracompartmental
Pressure
 Sign & Symptoms
Classic signs 5 P
 Pain
Severe extremity pain  out of proportion to
injury
Early sign, worse with passively stretching involved
muscle

 Pallor
 Paresthesia or anesthesia to light touch

 Paralysis

 Pulselessness
Not present in early cases
 Pitfall
Does the presence of normal distal pulses rule out a
compartment syndr. ?

Absolutely NOT

Compartment syndr. occurs when venous outflow

is impeded  arterial pulsation still present in
many compartment syndr. cases
 Objective Measurements of
Intracompartmental Pressure
 Infusion technique (Whiteside’s)
 Wick catheter technique (Hargens)
 Howmedica slit catheter tehnique (Rorabeck)
 Stryker’s tonometer
 Stryker Stic System
 Easy to use
 Can check multiple compartments
 Different areas in one compartment
Technique
 When do Fasciotomy ?
 Normal pressure : 0 – 8 mmHg
 P intra comp> 30 mmHg  risk of tissue
necrosis
 Muscle :
 Tolerate 4 hrs ischemia (reversible)
 > 8 hrs  complete irreversible
 Nerve :
 < 4 hrs : neuropraxic
 > 8 hrs : axonotmesis & irreversible changes
 Differential Comp syndr Arterial occlusion Neuro praxia
diagnosis
Pressure in crease
in compartment + - -

Pain on stretch + + -

Paresthesia or + + +
anesthesia
Paresis or paralysis + + +

Pulses intact + - +
 When not to do Fasciotomy ?
 > 8 hrs (critical point)
 Increase infection rate
 Controversion : to save retain muscle
 Prognosis

 Depends upon the timeless of diagnosis

 MATSEN - < 6hours of surg interv 
complete recovery of limb function
 Delay result in muscle ischemia and necrosis
 Complications
 Permanent nerve and muscle damaged 
myonecrosis  contracture (Volkmann
ischemic contracture)
 Dry ganggrene
 Infection
 Loss of Limb
 Cosmetic deformity from fasciotomy
 Death