UNDERGRADUATES

1. Dr Kishore Vemula
Senior Resident
Department Of Orthopaedics
Apollo Medical College,chittoor
COMPARTMENT SYNDROME
& VIC

2. • Case 1
• Case 2
Case 3
Case 4

3. DEFINITION
Elevation of interstitial pressure in
a closed osteofascial compartment that
results in microvascular compromise and
neuro vascular damage.
… acute/chronic

4. DECREASE IN SIZE OF
COMPARTMENT
• Tight plaster/ bandages
• Prolonged external pressure in
unconscious patient
• Cloure of facial defects
INCREASE IN CONTENT OF
COMPARTMENT
INCREASED CAPILLARY PERMEABILITY
• Fractures
• Severe soft tissue injury(blunt trauma)
• Arterial damage/ blocks
• Burns
• Electrical shock
• Snake bite
FLUID EXTRAVASATION/ BLEEDING
• Failed IV cannulas
• Drug abusers
• Bleeding disorders/ coagulopathy
ETIOLOGY OF ACUTE COMPARTMENT SYNDROME

5. • Increased Intracompartmental
Pressures
↓
• Local Muscle Ischemia
↓
• Nerve Damage
↓
• Complete Arterial Occlusion
• Severe pain ( out of proportion)
• Tense compartment
• Stretch sign positive
• Parasthesia/ hyperesthesia
• Allodyna
• Pallor
• pulseless
PATHOLOGY CLINICAL FEATURES

6. Critical pressure
• Normal intracompartmental pressure
is 5-10mm hg
1 . >30 mm intracompartmental pressure
2 . < 30mm of pulse pressure
PP= DBP– compartment pressure
3. < 40 mm of ∆P
∆P= MAP – compartment pressure
TIME
A PRESSURE OF > 30 MM OF
INTRACOMPARTMENTAL PRESSURE
FOR > 8HRS CAN CAUSE
IRREVERSIBLE NEUROVASCULAR
DAMAGE.
How Much Is This Pressure And How Much Time
You Have To Save The Limb???

7. INCIDENCE
Age < 35 years
MOST COMMON SITES
1. LEG = TIBIAL SHAFT FRACTURES
2. FOREARM = DISTAL RADIUS FRACTURES
# SHAFT OF RADIUS AND ULNA

8. QUESTIONS???
• Can It Occur In ?????
• Thigh
• Shoulder
• Buttock
• Hand
• Foot
• Paraspinal Area
• Open Fractures???
Most Common Cause For Acute Compartment Syndrome??
Most Common Site??
Most Common Compartment In Leg??
Most Common Compartment Involved In Forearm?

9. QUESTIONS???
• Can it occur in ????? YESSSSSSS
• Thigh
• Shoulder
• Buttock
• Hand
• Foot
• Paraspinal area
• Open fractures?? yessssssssssss
. most common cause for acute compartment syndrome?? FRACTURES >BLUNT TRAUMA
• most common site?? LEG
• most common compartment in leg?? ANTEROLATERAL , DEEP POSTERIOR
COMPARTMENT
• Most common compartment involved in forearm? FLEXOR

10. MANAGEMENT
SEVERE PAIN OUT OF
PROPORTION TO INJURY IN A TENSE
COMPARTMENT AND STRETCH SIGN
POSITIVE IN A CONSCIOUS PATIENT
SHOULD ARIE THE SUSPICIAN OF
COMPARTMENT AND EMERGENCY
FASCIOTOMY IS INDICATED.
• Pulselessness, Pallor, Neural Deficits Are
Late Signs And Should Not For Them To
Appear.

11. PRINCIPLES OF FASCIOTOMY
• MAKE EARLY DIAGNOSIS AND DECISION
• RELEASE ALL COMPARTMENTS
• GIVE LONG EXTENSILE INCISIONS
• STABILISE THE FRACTURE WITH EXTERNAL FIXATOR
• PROPER WOUND CARE
• PRESERVE THE NEUROVASCULAR STRUCTURES
• COVER THE WOUND AFTER WEEK/10 DAYS

12. Hand fasciotomy
Foot fasciotomy

13. PRECAUTIONS
• ELEVATION OF LIMB
• COLD COMPRESSION
not indicated in recent studies
• Remove Cast And Bandages( 85-90% Reduction)
• Remove Tractions
• Maintain B.P
• Maintain Oxygen Support
• Rest To Limb
• Use An Unreemed Nail If Needed

14. HOW TO SUSPECT IN UNCONSCIOUS PATIENT??
OBJECTIVE MEASUREMENT OF COMPARTMENTAL
PRESSURES.
• PRESSURE MONITORS
• ARTERIAL LINE MONITOR
• WHITESIDES MONITOR
• WICK MONITOR
• STIC MONITOR
• USG
• NIRS ( NEAR INFRARED SPECTROSCOPY)

15. • Permanent sensory /motor loss
• Contractures ( VIC)
• Infections
• amputations
• <6hrs--- almost complete recovery
• < 12 hrs--- 60-70% limb function
• > 12 hrs-- <10% limb function
PROGNOSIS COMPLICATIONS

16. VOLKMANNS ISCHEMIC CONTRACTURE(VIC)
• Usually the end result of compartment syndrome
Prolonged ischemia of muscles and nerves in extremity
leading to necrosis , fibrosis, contracture, muscle dysfunction, sensory
deficit, chronic pain.
Most common site of VIC = FOREARM (supracondylar # humerus in
children)
Most common muscles involved is FDP > FPL

17. CLASSIC DEFORMITY OF VIC
• ELBOW FLEXION
• FOREARM PRONATION
• WRIST FLEXION
• MCP EXTENSION
• IP FLEXION
• THUMB ADDUCTION, FLEXION
• MEDIAN , ULNAR NEUROPATHY

18. VOLKMANNS SIGN
• EXTENSION OF INTER PHALYNGEAL JOINTS( FINGERS) IS POSSIBLE
ONLY ON FLEXION OF WRIST IS CHARECTERISTIC OF VIC

19. • MCP EXTENSION
• IP FLEXION
CLAW HAND
VIC
• MCP FLEXION
• IP FLEXION
OBSERVE THE DIFFERENCE
INTRINSIC PLUS DFORMITY INTRINSIC MINUS DEFORMITY

20. MANAGEMENT
• SPLINTS (EARLY CASES)
• MAXPAGE MUSCLE SLIDING OPERATION = RELEASING COMMON FLEXOR ORIGIN
FROM MEDIAL EPICONDYLE AND PASSIVE STRETCHING OF FINGERS
• TENDON TRANFERS
• NEUROLYSIS
• CARPECTOMY/ARTHRODESIS IN SEVERE CASES
• AMPUTATION (IF GANGRENE )

21. Thank you …..