T&O: Compartment Syndrome

Question 1

A Pt presents with compartment syndrome. What are the signs and symptoms of this?

Answer 1

1. Pain - out of proportion to primary injury and exacerbated on passive stretch of affected muscle group
2. Pink - due to peripheral vasodilation
3. Paresis - muscle weakness, with tenderness and swelling
4. Paraesthesia - sensory deficit in distribution of nerves passing through compartment

Pulses are generally present as central arterial flow is rarely occluded.

Late features are of tissue ischaemia: pallor, pulselessness, paralysis, coolness, loss of capillary return.

Question 2

What is the differential diagnosis for compartment syndrome?

Answer 2

• peripheral oedema
• infection, e.g. cellulitis
• DVT
• acute limb ischaemia

Question 3

What is compartment syndrome?

Answer 3

Increased pressure within a closed osteofacial compartment, which compromises the circulation and function of the tissues within that space.

May be acute or chronic and can result in temporary or permanent damage to muscles and nerves.

Question 4

In which individuals is chronic compartment syndrome usually seen?

Answer 4

In athletes <40yo who exercise with repetitive motions or activity, e.g. running, football, cycling, tennis. Excessive training increases the risk

Question 5

Suggest common causes of acute compartment syndrome.

Answer 5

1. decreased compartment size
   - constrictive casts
   - burns or frostbite
2. increased compartment contents (oedema or haemorrhage)
   - fractures and crush injuries
   - haemorrhage
   - ischaemia-reperfusion injury
   - venous disease
   - infection

Question 6

Describe the pathophysiology of compartment syndrome.

Answer 6

Cycle of:

i. local trauma and tissue destruction (necrosis)…
ii. bleeding and oedema…
iii. increased interstitial pressure so that compartment pressure exceeds systolic blood pressure…
iv. reduced arterial blood inflow…
v. myoneuronal ischaemia…
vi. more oedema, etc.

Question 7

How long does it take or tissues to be damaged in compartment syndrome?

Answer 7

• nerve ischaemia - 6hrs

- muscle ischaemia - 12hrs

Question 8

How would you manage ambiguous cases?

Answer 8

Continuous compartment pressure monitoring (several methods) with ICP >30mmHg of diastolic BP significant of compartment syndrome.

MRI scans can also help diagnose.

Question 9

How would you manage a Pt with compartment syndrome?

Answer 9

Urgent decompression via open fasciotomy - skin and deep fascia must be divided along whole length of compartment, and wound should be left open.

Question 10

Which structures are at risk in compartment syndrome of the forearm (ventral and dorsal compartments)?

Answer 10

Ventral:

• median and ulnar nn.
• radial and ulnar aa.

Dorsal:
- posterior interosseus n.

Question 11

Which structures are at risk in compartment syndrome of the leg (anterior tibial, supericial posterior an peroneal compartments)?

Answer 11

Anterior tibial:

• deep peroneal n.
• anterior tibial a.

Superficial posterior:

• posterior tibial n. and a.
• peroneal a.

Peroneal:
- deep and superficial peroneal nn.