Compartment Syndrome Flashcards
What is compartment syndrome?
The result of elevated interstitial pressure within a closed fascial compartment resulting in microvascular compromise
What are the common sites at which compartment syndrome occurs?
Leg
Forearm
Thigh
Compartment syndrome is an orthopaedic emergency. T/F?
True
Compartment syndrome is caused by either an increased internal pressure and/or increased external compression. What could cause an increase in internal pressure?
Bleeding
Swelling
Iatrogenic infiltration
Compartment syndrome is caused by either an increased internal pressure and/or increased external compression. What could cause an increase in external compression?
Casts
Bandages
Full thickness burns
Describe the pathogenesis of how compartment syndrome can cause loss of function, limb or life.
The pressure within the compartment exceeds the pressure within the capillaries which reduces blood flow.
Muscle become ischaemic and develop oedema through increased endothelial permeability and autoregualtory mechanisms are overwhelmed.
Necrosis begins in the ischaemic muscles after four hours. Irreversible damage leads to loss of function, limb or life.
Describe the changes which occur in muscles and nerve at one, four and eight hours of ischaemia?
One hour - nerve conduction and the muscle is still viable
Four hours - reversible neuropraxia in the nerves, reversible muscle ischaemia
Eight hours - nerve axonotmesis and irreversible change causes irreversible muscle ischaemia and necrosis
The diagnosis of compartment syndrome is clinical. T/F?
True
What can cause internal pressure leading to compartment syndrome?
Trauma - fractures, entrapment causing bleeding
Muscle oedema and myositis
Intracompartmental administration of fluid or drugs
Re-perfusion via vascular surgery
What can cause external compression leading to compartment syndrome?
Impaired consciousness or protective reflexes due to drug/alcohol misuse and iatrogenic
Positioning in theatre
Bandaging/casts
Full thickness burns
What are the clinical features of compartment syndrome?
Pain which is out of proportion to that expected from the injury
Pain on passive stretching of the compartment
Pallor
Parasthesia
Paralysis
Pulselessness
What signs will be seen on examination in compartment syndrome?
Swelling
Shiny skin
Autonomic responses such as sweating and tachycardia
Pulses present until late stages
Paraesthesia and paralysis in later stages
What is the first stage of management of compartment syndrome?
Open any dressings / bandages
What is involved in surgical release of compartment syndrome?
Full length decompression of all compartments and excision of any dead muscle
Wound left open
Debridement should be repeated until pressure is down and all dead muscle is excised
Then wound closure and skin grafting
When should non-operative treatment be considered in compartment syndrome?
If there is late presentation or diagnosis and irreversible damage is present
