compartment syndrome

Question 1

what are the most common sites for compartment syndrome?

Answer 1

The most common sites affected are in the leg, thigh, forearm, foot, hand and buttock.

Question 2

what can cause compartment syndrome?

Answer 2

high-energy trauma, crush injuries, or fractures that cause vascular injury.

Other causes include iatrogenic vascular injury, tight casts or splints, deep vein thrombosis, and post-reperfusion swelling.

Question 3

what is the pathophysiology of compartment syndrome (include how the veins and arteries can be involved)?

Answer 3

fluid enters a fascial compartment that cannot distend, causing intra-compartmental pressure to increase.

As it increases, the veins will be compressed. This increases the hydrostatic pressure within them, causing fluid to move down its gradient and out of the veins into the compartment, increasing pressure further.

Lastly, as the intra-compartmental pressure reaches diastolic blood pressure, arterial inflow will be compromised, leading to ischaemia (a cool, pale, pulseless and paralysed distal limb). This is a late sign of missed compartment syndrome.

Question 4

why do people with comparment syndrome present with parasthesia?

Answer 4

the traversing nerves are compressed. This causes a sensory +/- motor deficit in the distal distribution. Paraesthesia is therefore a common symptom.

Question 5

what are the clinical features of compartment syndrome?

Answer 5

• acute onset
• severe pain disproportionate to the injury, made worse by stretching muscles around compartment
• compartment may feel tense

if missed, get the 5 P’s of acute arterial insufficiency

• Pain
• Pallor (or mottled which becomes non blanching)
• Paraesthsia
• Perishingly cold
• Pulselessness

Question 6

what investigations can be done for compartment syndrome?

Answer 6

essentially clinical

can do intra compartmental pressure monitor if there is clinical uncertaincy/ patient is unconscious.

can also check creatine kinase levels and diagnose if risen or is rising.

Question 7

how is compartment syndrome treated?

Answer 7

initially

• keep limb level with patient - high flow oxygen
• fluids (crystalloids) for blood pressure
• remove any dressings/splint/casts
• treat symptomatically with IV analgesia

then

• fasciotomies prefomed to drain compartment
• skin incision is left open and re look done 24-48hrs after to asses for any dad tissue.
• monitor kidneys for rhabdomylosis or reperfusion injury