all about compartment syndrome

1. Compartment Syndrome

2. Definition
• Condition where the osseofascial compartment pressure rises to level
that decreases perfusion and may lead to irreversible muscle and
neurovascular damage

3. Epidemiology
• May occur anywhere that skeletal muscle is surrounded by fascia but
most commonly affected at the leg, forearm, hand, foot, thigh,
buttock, shoulder, paraspinous muscle
• Risk Factor
• Diaphyseal fracture
• Young age (highest prevelance in 12-19 years olds)

4. Etiology
• Trauma : fracture, crush injuries, contusions, gunshot wound
• Tight casts, dressings, or external wrapping
• Extravasasion of IV infusion
• Burn, Post ischemic swelling
• Bleeding disorders
• Arterial injury

5. Pathoanatomy
Local trauma
and soft tissue
destruction
bleeding and
edema
increased
interstitial
pressure
vascular
occlusion
(decreased
venous
outflow
relative to
arterial
inflow)
myoneural
ischemia

6. Presentation
• Pain out of proportion to the clinical situation is usually first symptom
• May be absent in cases of nerve damage
• Pain is difficult to assess in polytrauma patient, sedated patient, in
children (unable to verbalize)

7. Physical exam
• Pain with passive stretch (most sensitive finding prior to onset of
ischemia)
• Paresthesia and hypoesthesia
• Paralysis (late finding, full recovery is rare in this case)
• Palpable swelling
• Peripheral pulses absent (late finding, amputation usually inevitable
in this cases)

8. Imaging
• To rule out the fracture

9. Studies
• Compartment pressure measurement the indication are polytrauma
patients, patient not alert/unreliable, inconclusive physical exam
findings
• Relative contraindication are unequivocally positive clinical findings
should prompt emergent operative intervention without need for
compartment measurements

10. Diagnosis
• Clinical diagnosis on physical exam in patients with intact mental
status

11. Treatment
• Nonoperative :
• Observation (Delta P > 30, presentation not consistent with compartment
syndrome),
• Bi valving the cast and loosening circumferential dressings (initial treatment
for swelling or pain not compartment syndrome) ,
• Hyperbaric oxygen therapy (increasing the oxygen diffusion gradient)
• Operative : Emergent fasciotomy
• Clinical consistent with compartment syndrome (within 30 mmHg of diastolic
blood pressure delta p)

12. Special considerations
• Children unable to verbalize; if suspicion the perform compartment
measurement under sedation
• Hemophiliacs patient give factor VIII replacement before measuring
compartment tissue