Transcript Compartment Syndrome

Compartment Syndrome
By
Waleed M. Awwad, MD, FRCSC
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.
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.
Compartment Syndrome


Suspect with long bone fx,
crush injuries.
Presents as pain out of
proportion to physical
findings, +/- hypoesthesia,
pulselessness (late).
Compartment Syndrome

Remember the 6 P’s

Pain, paresthesias, paralysis,
pallor, pulselessness,
poikilothermia (cool limb).
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.
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.
Compartment Syndrome

Measure intra-compartmental
pressure when considering
compartment syndrome.
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.
Compartment Syndrome

Sequelae.

Irreversible damage within hours





To which structures in the
compartment?
Contractures (Volkmann’s).
Paralysis.
Myoglobinuria and renal failure.
Limb loss.
Compartment Syndrome

Simple Fracture Vs Comminuted
Fractures.

Open Fractures.

Pain with Passive stretching.
Thank You