Compartment Syndrome

Question 1

Definition

Answer 1

Rise in pressure within the closed osseofacial compartment may jeopardise the blood supply to muscles and nerves leading to compartment syndrome.

Question 2

Sites

Answer 2

Compartment of forearm
Ant and posterior compartment of leg
Shoulder hand buttock foot (rare sites )

Question 3

Cause

Answer 3

Snake bite
Forearm bone #
Supracondylar #
Proximal tibia fibula #
Crush injuries to leg and forearm
Traumatic swelling of leg

Question 4

Pathogenesis

Answer 4

Muscle ischaemia > histamine release > increase capillary permeability > muscular edema > increase intramuscular pressure > venous lymphatic obstruction> arterial occlusion cycle repeats

Question 5

Clinical features

Answer 5

6 P
Pallor
Pain
Pulselessness
Paresthesia
Paralysis
Positive passive stretch test

Question 6

Diagnosis

Answer 6

Pain not relieved by analgesics
Passive stretch test +ve
Tense compartment
Hypoesthesia in the area supplied by nerve
Muscle weakness
Pulselessness
Intra compartment pressure > 40 mm h2o
If ICP cant be measured , 3 or more signs of ischaemia must be present

Question 7

Tt

Answer 7

Tight casts bandage must be removed
Limb placed flat
Fasciotomy ( forearm single incision along ulnar border , leg all 4 compartments released by medial and lateral incision )
Fibulectomy ( mid 3rd of fibula excised )