COMPARTMENT SYNDROMES

dr. Jufri Latief, Sp.B., Sp.OT

Bagian Ortopedi & Traumatologi Fakultas Kedokteran Universitas Hasanuddin Makassar, 2006

DEFINITION
Increase pressure within a comfined space (osteofascial space) that leads to microvasculary compromise and ultimately to cell death or tissue death

ETIOLOGY
1. Trauma
Fracture Hematoma Gunshot (stab wounds) Animal/Insect bites/Snack bites Post ischemic swelling Crush injuries Vascular damage Electric injuries

3. Coagulopathies
Genetic / hemophilia Iathrogenic Acquired coagulopathies

4. Others
External compression / most trousers, cast, thight dressings) Thight closure of fascial defects Burn-hypo / hiperthermia / combustio Lost of conciousness (drug overdose resulting in lying on limb four hours) Infected : clostridiu perfringeus / walchii (gas ganggren)

2. Edema related
Nephrotic syndrome Frosbite (trauma dingin) Burns Over use injuries (over training) Prolonged tourniquet Mast trousers (celana ketat)

ANATOMICAL LOCATION
Forearm The most common site Anterior compartment of the leg Abdominal compartment syndrome Hand and wrist compartment syndrome Thigh compartment syndrome Foot compartment syndrome

PATOPHYSIOLOGY
Vascular congestion capillary beds occludedmuscle & nerve ischemiatransudation of colloid plasma into the surrounding tissues increase of tissue pressurearterial impaired (ellipsoid theory)

CLINICAL PRESENTATION
Pain (pain out of proportion) Paresthesias / anesthesia (dont pin prick test, because fibers smallerst, use two point discrimination test) Passive strestch severe pain Pressure tenderness PulsessnesThis is least releable of the examination are frequently not affective (a disorders microvasculature, major vessel)

DIAGNOSIS
Clinical presentation Measurement
Whick catheter technique Slit catheter technique Stic catheter technique Continous infusion technique Needle manometer technique

Normal pressure = 20-30 mmHg >30 mmHg need fasciotomy Necrosis of the muscle happened 8 hours in 30 mmHg intra compartement pressure
Lab
CPK, B.U.N., creatinin, aldolase, SGOT, LDH Myoglobinuria, oliguria

Urine EMG SSEP

PROPER INITIAL MANAGEMENT

Constrictive dressing should be removed or splint Circumferential cast should be valued Limb should be placed at the level of the heart

DEFINITIVE TREATMENT
Fasciotomy = skin & fascia are left open on > 30 mmHg pressure Prophylactic fasciotomy should be performed on
Tibial osteotomy Leg lenghtening Arterial repair Open tibial fracture

Genereous fluids (IVFD) Alkalization urine by : bicarbonates or acetazolamide Antibiotic

COMPLICATION
Local
ischemic contracture

General
Renal failure Cardiac arrest Septicemia / septic shock Death

Patophysiology and cause death of compartment syndromes

Trauma / injury Swelling / increases pressure in osteofascial space Microcirculation cuts off
Hypoxia Sistemic complication

Fasciotomy

Cell / tissue death K+ Release from cell Hyper kalemia

Infection Septicemia

Pressure released

Referfussion

Septic shock

Myoglobulin in the muscle released

Cardiac arrest

Precitates in the renal tubule

Renal Failure