Compartment syndrome Department of Orthopaedics Phramongkutkhlao College of Medicine

1. (Lower Extremities)
Anuchit Nawatthakul
Fifth year medical student
Department of Orthopaedics
Phramongkutkhlao College of Medicine

2.  What is a compartment?
 Closed area of muscles
group, nerves & bl.vs
surrounded by fascia
 Pressure: 5-15 mmhg

3. Leg Anatomy

4. Compartment Syndrome
Lower Leg
4 compartments
Lateral: Peroneus longus and
brevis
Anterior: EHL, EDC, Tibialis
anterior, Peroneus tertius
Supeficial posterior-
Gastrocnemius, Soleus
Deep posterior-Tibialis
posterior, FHL, FDL

6.  What is a compartment
syndrome?
 intra comp. pressure
(35-40 mmhg)
 capillaries collapse
 Blood flow to muscles
and nerves
 Bl.Vs collapse

8. Why is it dangerous?
 Nerves:
neuropraxia: will
regenerate
Ischemia: cell death
 Muscles: contracture
(Volkmann's ischemic
contracture)
 Gangrene

9. Causes
 Fracture of a long bone
(Supracondylar humerus,
forearm, hand,tibia and
foot)

10. Dissection
Drilling &
reaming
Tourniquet

11. swelling
Tight cast
Bluish
numbness discoloration

12.  Severe bruised muscle
(even if there is no fracture)
 Don’t take contusion lightly

14. SYMPTOMS
 Severe pain
inappropriate to the
injury(not relieved even
with morphia)
Pain that out of proportion

15.  Burning of the affected limb
 Tight muscle(rigid)
 Numbness: bad sign

16. SIGNS & DIAGNOSIS
 Passive stretching of fingers or toes (muscle
stretch)will lead to severe pain (diagnostic sign)
 Never wait for signs of ischemia (5 Ps):irreversible
damage

17. 5 P’s
1.Pain
2. Paraesthesia
3. Pallor
4. Paralysis
5. Pulselessness
Signs :
1. tight swelling
2. Loss of strength
3. Loss of sensation
4. Blister
(presence of a pulse does not exclude the diagnosis)

18. The earliest sign : PAIN
Pain that out of proportion to the injury
Describe as ‘bursting’ sensation
Pain that is not responsive to the normal dosage of
pain medication
Severe pain with passive stretch
Passive stretching is a
form of static stretching
in which an external
force exerts upon the
During passive stretch of a muscle, there is increased limb to move it into the
intramuscular pressure. new position
Pressure in a volume-loaded compartment increases more
during passive stretching than in a normally hydrated
compartment.

19. HigH risk
Tibia fractures
Tibia plateau fractures
Patients casted after injury
Polytrauma patients
Drug overdose/unconscious patients

20. For obtunded, intubated, or unreliable patients who have a
swollen extremity but who otherwise cannot be evaluated
Confirmed by
measuring
intracompartmental
pressures

21. Whiteside maneuver Wick hand held instrument
Direct
syringe reading
mmhg
mano.
3 way stopcock
electrode

22. A split catheter is introduced
into the compartment & the
pressure is measured closed
to the level of the fracture.
Differential pressure (∆P)
=diastolic pressure – compartment
pressure
= < 30mmHg
Immediate
compartment
decompression

23. Complications
 Leads to muscle death
 Leads to nerve death
 Contracture
 Paralysis
 Chronic pain
 Numbness
sequele
Acute renal failure secondary to rhabdomyolysis
Disseminated intravascular coagulation
Volkmann’s contracture (where infarcted muscle is
replaced by inelastic fibrous tissue)
Amputation

25. Don’t wait so long

26. Non surgical management
COMPLETELY remove the casts, bandages and
dressings.
Cast should be removed completely
The limb should be nursed FLAT.
( elevating the limb  further in end capillary
pressure  aggravates the muscle ischaemia)

27.  Surgical management:
 (FASCIOTOMY)
Open skin and fascia
down to a compartment

28. Surgical incision to the fascia to relieve tension or
pressure.
Complete opening of all fascial envelopes.
The wound should be left open and inspected 2 days
later.
If there is muscle necrosis  debridement.
If the tissues are healthy, the wound can be
- sutured (without tension) OR
- skin-grafted OR
- allowed to heal by secondary intention

29. If no facilities for
compartmental
pressure
measurement, the
If ∆P < 30mmHg decision to operate
will make on clinical
grounds
Examine the limb at 15
minutes intervals. If no
improvement within 2
hours of removing the
dressings
Muscle will
be dead after
FASCIOTOM
4-6 hours of
total
ischemia
Y

31. Leg Single Incision Technique

32. Leg Two Incision Technique

34. Close skin by 2ry sutures
after oedema subsides

35. It may need skin graft

36.  Compartment syndrome is a serious syndrome, Which
needs
to be diagnosed early.
 Palpable pulse doesn’t exclude compartment syndrome
 If diagnosis and fasciotomy were done within 24 hrs, the
prognosis is good.
 If delayed, complications will develop.
The earlier you diagnose, the safer you are

37. Thank you