COMPARTMENT SYNDROME

DIAGNOSIS AND MANAGEMENT

 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

 Demographics
 Incidence:
 Men 7.3/100,000
 Women 0.7/100,000

 69% due to trauma

 36% fx tibia
 9.8% distal radius
 23% soft tissue injury without fx
 10% on anticoagulants
 Incidence
 Lowerleg > Forearm > Hand, Foot,
Thigh, Upper arm

 Lowerleg  anterior compartment

& deep posterior compartment

 Forearm  volar compartment

Etiology
 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 (Whiteside’s)
 Wick catheter technique (Hargens)
 Howmedica slit catheter tehnique
(Rorabeck)
 Stryker’s tonometer
 Stryker Stic System
 Easy to use
 Can check multiple compartments
 Different areas in one compartment
Technique
 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
 Differential Comp syndr Arterial Neuro praxia
diagnosis occlusion
Pressure in
crease in + - -
compartment
Pain on stretch + + -

Paresthesia or + + +
anesthesia
Paresis or + + +
paralysis
Pulses intact + - +
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
Thank you