Compartment syndrome

Question 1

What is compartment syndrome?

Answer 1

Elevated pressure in closed osteofasical compartment that results in microvascular compromise (restriction of capillary blood flow)
- tissue damage due to hypoxia (lack of oxygen)

compartment- grouping of muscles, nerves, blood vessels in arms & legs- fascia (thin sheet of connective tissue) surrounds muscle compartments

Question 2

Epidemiology of compartment syndrome?

Answer 2

Tibial fractures most common cause of compartment syndrome

Males under 35 yrs- due to large muscle mass & increased likelihood of major trauma

Question 3

Pathophysiology of compartment syndrome?

Answer 3

Fascia doesn’t stretch so any swelling or bleeding in compartment increases pressure on nerves, capillaries & muscles

Pressure stops blood flow in capillaries- prevents oxygen & glucose from reaching nerve & muscle cells

Causes muscle to respire anaerobically= lactic acid builds up= cramp= pain

Question 4

Aetiology of compartment syndrome?

Answer 4

fracture

Soft tissue injury

Burn injuries

Vascular compromise due to trauma

History of bleeding disorder - haemophilia

Question 5

Presentation of compartment syndrome?

Answer 5

Acute onset & rapidly progressive over few hours

Pain- main symptom
- severe, intense pain when muscle is stretched
- pain is disproportionate to severity of injury
- Pain is exacerbated by passive movements

Paraesthesia- numbness, tingling- early sign

Pallor- skin looks pale

• Inability to regulate body temp- limb feels cold

Common fracture- supracondylar (elbow) & tibial shaft

Pulselessness- only in severe compartment syndrome

Question 6

Investigations for compartment syndrome?

Answer 6

Pressure Measurement: Manometer
- or use more accurate slit catheter
- normal pressure between 0mmHg and 8 mmHg

Serum CreatinineKinase – to test for Rhabdomyolysis which can cause and/or be caused bycompartment syndrome.

Urine myoglobin

X-rays, CTs or MRIs can be used to investigate underlying injury causing the compartment syndrome.
- No role in diagnosing compartment syndrome itself

Question 7

Management for compartment syndrome?

Answer 7

Conservative:
- Relieve all external pressure e.g. dressing or casts
- Place limb at heart level

Pharmacological:
- Analgesics
- Supplementary oxygen

Surgical:
- Fasciotomy- w/in 6 hours of injury & not recommended 36 h after injury- involves cutting fascia to relieve tension & pressure above affected muscle compartment

Question 8

Complications of compartment syndrome?

Answer 8

W/out treatment ischameia & necrosis can occur leading to:
- muscle contracrture
- sensory deficits
- paralysis
- infection
- limb amputation