Compartment Syndrome

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Compartment Syndrome

• By
• Waleed M. Awwad, MD, FRCSC

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Compartment Syndrome

• Occurs when pressure in a fixed body compartment
  increases to level that exceeds venous pressure,
  compromising venous blood flow, and limiting
  capillary perfusion.
• Leads to muscle ischemia and necrosis.

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Compartment Syndrome

• Contributing Factors
• External
• Conditions that reduced size of muscle
  compartment (casts/splints) occlusive dressing
  eschar of burns.
• Internal
• Conditions that increase compartment volume
  bleeding, swelling, fluid extravasation into
  tissue.

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Compartment Syndrome

• Suspect with long bone fx, crush injuries.
• Presents as pain out of proportion to physical
  findings, /- hypoesthesia, pulselessness (late).

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Compartment Syndrome

• Remember the 6 Ps
• Pain, paresthesias, paralysis, pallor,
  pulselessness, poikilothermia (cool limb).

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Compartment Syndrome

• History of injury.
• Pain Out of proportion to injury
• Tough, because you need to know how much pain is
  appropriate.
• Paresthesias Later on.
• Ddx Neuropraxia from direct trauma.

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Compartment Syndrome

• Physical examination.
• Pain with passive stretch.
• Pressure or tense swelling.
• Paresis? Very late!.
• Pulses? Almost always INTACT!
• If absent, consider other disease process.
• Emboli, direct arterial interruption.

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Compartment Syndrome

• Measure intra-compartmental pressure when
  considering compartment syndrome.

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Compartment Syndrome

• Management.
• Decreases pressure by opening closed space.
• Limb should be flat.
• Emergency fasciotomy.
• Often, will leave skin open because of severe
  swelling of muscles.
• Delayed primary closure or skin graft.

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Compartment Syndrome

• Sequelae.
• Irreversible damage within hours
• To which structures in the compartment?
• Contractures (Volkmanns).
• Paralysis.
• Myoglobinuria and renal failure.
• Limb loss.

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Compartment Syndrome

• Simple Fracture Vs Comminuted Fractures.
• Open Fractures.
• Pain with Passive stretching.

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Thank You