Acute Compartment Syndrome Flashcards
What is the possible outcome for compartment syndrome in forearm?
Volkmann’ ischaemic contracture - flexor muscles become ischaemic and contracted
Is permanent
What is the definition of compartment syndrome?
Condition in which circulation to, and function of tissues in, a closed space are compromised by increased pressure within that space
What are the risk sites for compartment syndrome?
Mainly lower leg and forearm
Hand, foot and thigh
How does compartment syndrome happen?
Increased volume (internal) -haemorrhage, swelling and increased fluid to burns
Decreased swelling - tight casts and dressings
Haemorrhage is most common cause
What is the cycle involved in compartment syndrome?
Soft tissue injury and bleeding causing swelling - raised compartment pressure - decreased tissue perfusion - ischaemia - cell death and release of myoglobin causing more swelling - repeat
What does the extent of damage becoming irreversible depend on?
Depends on pressure and time
Before 4 hrs is till reversible for muscles then at 6 hrs is variable and after 8 is irreversible
At 2hrs conduction lost in nerves and 8hr is axonotmesis
What is the aetiology of compartment syndrome?
After trauma - usually a fracture, soft tissue trauma alone, vascular reperfusion, burns, crush injuries, haemorrhage, drug injection, post lithotomy positioning and acute on chronic exertional
What is the clinical diagnosis of compartment syndrome?
Pain - out of proportion of injury, pain on passive stretch, altered sensation, weakness and swelling
Elevated compartment pressure - within 30mmHg of diastolic
What are the 5Ps of compartment syndrome?
Pain - early symptom
Later -
Paraesthesia
Pale and cold
Pulselessness
Paralysis
Why monitor compartment pressure?
Can avoid irreversible deficits
For compromised/ obtunded patients - comatose, alcohol and distracting injuries
Where is compartment pressure measured?
Highest pressure at fracture site and in anterior compartment
May be 20mmHg lower than 5cm away from fracture
Tip of cannula at fracture site
What is the critical pressure?
Anything above capillary closing pressure
Varies between individuals
Difference between compartment and diastolic pressure is less than 30mmHg
More susceptible is low BP such as multiple injuries
What are key facts for compartment syndrome?
Can occur with comminuted fractures, open fractures, without fractures, intact pulses, unconscious patients and in thigh, foot and hand
What is the treatment for compartment syndrome?
Open constrictive dressings to skin
Emergency fasciotomy of all altered compartments
For tibia use 2 incisions 1-2cm posterior to subcutaneous border of tibia
