Compartment syndrome

Question 1

Pathophysiology

Answer 1

Increased pressure > dimension of muscle perfusion > Ischemia > extravasation of fluids > increased pressure with decreased arteriovenous gradient

Question 2

6 P:s rule

Answer 2

Pain
Pulselessness 
Pallor
Paresthesia
Paralysis
(Poikilothermia - affected limb feels cooler)

Question 3

Pressure measurement

Answer 3

Not reliable

• correct technique only 31%
• only 60% accuracy with correct technique

Question 4

Compartments of forearm

Answer 4

1. Dorsal
2. Lateral a.k.aMobile wad (BR, ECRL, ECRB)
3. Volar divided into subcompartment
   - superficial
   - deep (FDP + FPL most susceptible)

Question 5

When too late to release the compartment?

Answer 5

After 48h the pathological pressure decrease spontaneously due to muscle necrosis
>24 may not be treated with risk of septicemia, kidney failure, arrhythmia, death.

Question 6

Compartments of the hand

Answer 6

10

Thenar, hypothenar, adductor policies, dorsal interosseous (n=4), volar interosseous (n=3)

Question 7

Is dorsal incision necessary?

Answer 7

All pressure can be released with one volubly incision (1 study). If, the incision can be over the muscle belly dorsal 10cm long.

Question 8

When to do skin closure?

Answer 8

When swelling subsides. If skin closure not possible within 5 days > split thickness skin graft. VAC no benefit.

Question 9

Hand fasciotomies

Answer 9

4 incisions + carpal tunnel incision
Thenar + hypothenar
Over MC 2 and 4 opening all compartments

Do not hesitate to excise all interosseous muscle if necrotic - risk of contracture