Compartment Syndrome

Question 1

What is the pathophysiology of compartment syndrome

Answer 1

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

Fascial compartments are closed and cannot be distended; consequently, any fluid that is deposited therein will cause an increase in the intra-compartmental pressure.

As pressure increases, it causes compression of the veins => increases hydrostatic pressure. This increases pressure even more

Nerves are compressed => causes paraesthesia

If the intra-compartmentalise pressure equalises to diastolic pressure => arterial flow compromise => ischaemia => 6p signs of limb ischaemia.

Question 2

What are the clinical features

Answer 2

Pain disproportionate to the injury

Not readily improved by analgesia or splitting of cast

Paraesthesia

Late signs - 6 Ps of limb ischaemia

Question 3

How do you investigate compartment syndrome

Answer 3

Diagnosis is clinical but can use CK to aid

Question 4

What is the initial management of compartment syndrome

Answer 4

Keep the limb at a neutral level with the patient (do not elevate or lower)

Improve oxygen delivery with high flow oxygen

Augment blood pressure with bolus of intravenous crystalloid fluids
This transiently improves perfusion of the affected limb)

Remove all dressings / splints / casts, down to the skin. No layers of any dressing must be left circumferentially.

Treat symptomatically with opioid analgesia (usually intravenous)

Question 5

What is the definitive treatment for compartment syndrome

Answer 5

Urgent fasciotomies

Monitor renal function as can get rhabdo or repercussion injury