Compartment Syndrome Flashcards
What is compartment syndrome
An increase in pressure within a compartment which leads to damage to the structures within the compartment and insufficient blood flow to the tissues
Pressure of the compartment exceeds 30mmHg
What is the first sign of compartment syndrome
Pain out of proportion to the injury
Which fractures often precede compartment syndrome
fractures of the tibial diaphysis
How many compartments are in the lower leg
four
- anterior
- lateral
- superficial posterior
- deep posterior
What are the causes of compartment syndrome
Extraneous forces
- tight plaster casts
- closure of fascial defects
- compression bandages
- pneumatic anti shock garments
Intrinsic changes
- Haemorrhage
- post op swelling and oedema
- post ischaemic swelling e.g. after tourniquet use
How would you examine for compartment syndrome
Feel of the compartment involved - will be swollen and and tender
Passive stretch of the muscles in the compartment will cause severe pain
Compartment syndrome is a clinical diagnosis however in a patient with reduced consciousness how could compartment syndrome be investigated
Measure intracompartmental pressure - if pressure exceeds 30 mmHg then compartment syndrome likely
If it exceeds 40mmHg or is within 20mmHg of the patients diastolic BP then urgent fasciotomy is needed
What is the initial management of compartment syndrome
Remove any bandages or casts which could be causing external compression
Elevate limb to the level of the heart
Ring ortho reg
What is the definitive management of compartment syndrome
urgent fasciotomy
What are the complications of compartment syndrome
Necrosis of the muscles –> ischaemic contracture
In the forearm this is called volkmanns contracture –> fixed flexion of the wrist and claw like deformity of the hand
Rhabdomyolysis
Renal failure
Which fracture is Volkmanns contracture associated with
Supracondylar fracture of the humerus
results in necrosis and ischaemia of the flexor muscles of the forearm –> muscles become fibrotic and shortened
Caused by obstruction of the brachial artery near the elbow
What is the pathophysiology behind compartment syndrome
There is an increase in intra-compartmental pressure due to haemorrhage, fracture, swelling of soft tissues
This compromises venous return and lymphatic drainage so the pressure increases because the compartment cannot be drained
Further increase in pressure reduced arterial perfusion and obstructs arterioles
leading to tissue ischaemia
