Compartment Syndrome

Question 1

What is compartment syndrome?

Answer 1

Critical pressure increase within a confined compartmental space

Question 2

What does compartment syndrome cause?

Answer 2

Decline in perfusion presssure to the compartment tissue lesding to ischaemia, necrosis, permanent disability of the affected region.
Left untreated, this can lead to limb loss, multi-organ failure and death.

Question 3

How can compartment syndrome occur?

Answer 3

Following traumatic injury or fractures that cause vascular injury
Other causes include iatrogenic vascular injury (post-operatively), tight casts or splints, DVT, post-reperfusion syndrome swelling (following ischaemia reperfusion syndrome)

Question 4

What is the underlying pathophysiology of compartment syndrome?

Answer 4

• In a closed fascial compartment, any fluid deposited will cause an increase in the intra-compartmental pressure.
• As this pressure increases, the lower pressure venous system will be compromised, leading to venous congestion and a further increase in compartmental pressure.
• Capillaries will subsequently by compromised and the arterial supply to the muscles will cease, leading to ischaemia and infarction.

Question 5

What are the most common sites for compartment syndrome?

Answer 5

Lower limb - anterior tibial, peroneal compartment, superficial and deep posterior compartments
Can occur in the forearm

Question 6

What are the two main fractures that lead to compartment syndrome?

Answer 6

Supracondylar fractures

Tibial shaft injuries

Question 7

What are the clinical features of compartment syndrome?

Answer 7

Pain (disproportionate to injury - worsened through passive movement)
Pallor (mottled, which becomes non-blanching)
Perishingly cold
Paralysis
Pulselessness

Paraesthesia in cutaneous distribution of any affected nerves

Question 8

How is compartment syndrome diagnosed?

Answer 8

Intracompartmental pressure measurements (>40mmHg) or MRI

Question 9

How is compartment syndrome managed conservatively?

Answer 9

Keep limb at a neutral level
Improve oxygen delivery with high flow oxygen and augment BP with IV crystalloid fluids
Remove any constrictive dressings or any circuferential casts
Treat symptomatically with opioid analgesia alongside anti-emetics

Question 10

What is the definitive treatment for compartment syndrome?

Answer 10

Emergency open fasciotomy to relieve pressure inside the compartment
Skin incisions are left open for re-look in 24-48 hours
Monitor electrolyte and renal fusion due to potential effects of rhabdomyolysisis (creatine kinase) - myoglobinuria may occur and result in renal failure or ischaemic repercfusion injury

When muscles are necrotic, debridement and consider amputation

4-6 hours for death of muscle groups

Question 11

What is the circle of Volkmann’s ischaemia?

Answer 11

Direct injury
oedema - swelling pain
Increased intracompartmental pressure
reduced blood flow
ischaemia
oedema...