COMPARTMENT

SYNDROME
DIAGNOSIS AND
MANAGEMENT
Dwikora Novembri Utomo
Dept of Orthopaedic and Traumatology
Dr. Soetomo General Hospital/Airlangga
University

Backgrounds

1872, Richard von Volkmann nerve injury &

subsequent contracture following compartment
syndr.

1932, Jepson experimentsl study in dog

1941, Bywater and Beall revealed mechanism

& consequences of compartment syndr.

1970 1st measuring intracompartment

pressure

Definition

Compression of nerve &

bloodvessels

Within enclosed anatomic space

(osteofacial)

Leading to impaired bloodflow

Incidence

Lowerleg > Forearm > Hand, Foot,

Thigh, Upper arm

Mc Queen : 69% (164) w/ comp syndr

ec fract, ( 50% were Tibia fract)

Lowerleg anterior compartment &

deep posterior compartment

Forearm volar compartment

Causes of Compartment
Syndrome

Fractures (open & closed)

Arterial injury & vascular occlusion

Snake bite

Burns

Intraosseus fluid replacement (Infant)

Pathophysiology
2 main pathways
Increasing

fluid content within the

compartment (ex : haemorrhage,
oedema)

Decreasing

the compartment size

(ex : external compression)

How to Diagnosed ?

Mainly by clinical examination

Objective Measurements of
Intracompartmental Pressure

Sign & Symptoms

Classic signs 5 P

Pain
Severe extremity pain out of
proportion to injury
Early sign, worse with passively
stretching involved muscle

Pallor

Paresthesia or anesthesia to light touch

Paralysis

Pulselessness
Not present in early cases

Pitfall
Does the presence of normal distal pulses
rule out a compartment syndr. ?
Absolutely NOT
Compartment syndr. occurs when venous
outflow is impeded arterial pulsation
still present in many compartment
syndr. cases

Objective Measurements of
Intracompartmental Pressure

Infusion technique (Whitesides)

Wick catheter technique (Hargens)

Howmedica slit catheter tehnique

(Rorabeck)

Strykers tonometer

Differential
diagnosis

Comp syndr

Arterial
occlusion

Neuro praxia

Pain on
stretch

Paresthesia or
anesthesia

Paresis or
paralysis

Pulses intact

Pressure in
crease in
compartment

When do Fasciotomy ?

Normal pressure : 0 8 mmHg

P intra comp> 30 mmHg risk of
tissue necrosis
Muscle :
Tolerate 4 hrs ischemia (reversible)
> 8 hrs complete irreversible

Nerve :
< 4 hrs : neuropraxic
> 8 hrs : axonotmesis & irreversible
changes

When not to do
Fasciotomy ?

> 8 hrs (critical point)

Increase infection rate

Controversion : to save retain

muscle

Prognosis

Depends upon the timeless of diagnosis

MATSEN - < 6hours of surg interv

complete recovery of limb function

Delay result in muscle ischemia and

necrosis

Complications

Permanent nerve and muscle damaged

myonecrosis contracture
(Volkmann ischemic contracture)

Dry ganggrene

Infection

Loss of Limb

Cosmetic deformity from fasciotomy

Death