Transcript The crush syndrome

Compartment
Syndrome: Introduction
Acute
Compartment Syndrome:
occures when pressure rises in a
compartment,resulting in a critical
reduction of blood flow to the tissue.
Volkmann`s ischemic
contracture
Is the end stage of neglected acute
compartment syndrom with irreversible
muscle necrosis leading to ischemic
contractures.
The crush syndrome:
The systeic result of muscle necrosis
caused by prolonged external
compression of an Extremity.
Epidemiology
The underlying condition causing it :
MOST COMMONLY: a fracture
2nd most common cause:
Soft tissue injury (crush type injury)
Effects of raised tissue
pressure on:
Muscles
Nerve
Bone
Reperfusion injury:
Is a group of complications following
reestablishment of blood flow to the
ischemic tissue.
Can occur after fasciatomy &
restoration of muscle blood flow.
Clinical DX:
Pain
Paresthesia
Paralysis of limb & hyposthesia
Swelling
Absence of peripheral pulses
Parasis & paralysis
Compartment pressure
monitoring:
Needle manometer method
The wick catheter
The slit catheter
Timing:
Time factors are also important in
making the decision to proceed
to faciotomy.
Treatment:
The single most effective
treatment for acute compartment
syndrome is:
Fasciotomy ( single/ double
incision)
Management of
Fasciotomy wounds:
Incisions must never be closed primarily
because this may result in persistent
elevation of ICP.
48h after, a” 2nd look “ procedure should
be undertaken to ensure the viability of
all muscles.
The wounds may then be closed by
delayed primary closure if possible.
Complications list for
Compartment Syndrome:
Muscle contracture
Muscle weakness
Sensory loss
Infection
fractures
Late diagnosis:
Delay in Dx has been cited as the single
reason for failure in the management of
acute compartment syndrome.
Delay to fasciotomy of more than 6hs is
likely to cause significant complications.