Compartment syndrome (any site)

Question 1

Define compartment syndrome.

Answer 1

• injury and soft tissue destruction
• causes bleeding and oedema
• which causes increasing pressures within a closed osteofascial compartment
• causing restriction of venous return
• eventually ischaemia
• leading to muscle death

Question 2

How is compartment syndrome diagnosed?

Answer 2

Clinical diagnosis - high index of suspicion and early recognition and crucial. Based on 6Ps:

• Pain
• Pressure
• Pulselessness
• Paralysis
• Paaresthesia
• Pallor

Intracompartmental pressure measured - excess of 20mmHg are abnormal and >40mmHg is diagnostic.*

*The delta pressure is found by subtracting the compartment pressure from the diastolic pressure. Many clinicians use the delta pressure of 30 mmHg to determine the need for fasciotomy, while others use a difference of 20 mmHg.

Question 3

Which two fractures commonly carry a complication of compartment syndrome?

Answer 3

The two main fractures carrying this complication include supracondylar fractures and tibial shaft injuries.

Question 4

What are the main signs/symptoms of compartment syndrome?

Answer 4

• Pain even on passive movement +/- excess use of breakthrough analgesia
• Paraesthesia
• Pallor may be present
• Arterial pulsation may be elt despite necrosis occurring
• Paralysis of muscle group
• NB: presence of pulse does not rule out compartment syndrome

Question 5

What is the management of compartment syndrome?

Answer 5

• IV fluids
• Prompt and extensive fasciotomy - done for all compartments (not just those affected)
• Debridement and amputation - if muscle groups are frankly necrotic at fasciotomy

Question 6

How quickly does death of muscle groups occur in compartment syndrome?

Answer 6

4-6 hours

Question 7

How many compartments are there in the leg?

Answer 7

4 - anterior, lateral superficial posterior, deep posterior

Question 8

How many compartments are there in the arm?

Answer 8

Arm - 2- anterior (flexor) and posterior (extensor)

Forearm - 3 - volar, dorsal, mobile wad (lateral - brachioradialis, ECRL, ECRB)

Hand - 10 - hypothenar, thenar, adductor pollicis, dorsal interosseus (x4), volar (palmar) interosseous (x3)

Question 9

What is a complication of myoglobinuria in compartment syndrome?

Answer 9

Renal failure - so aggressive IV fluids should be given

Question 10

What are the different aetiologies of compartment syndrome?

Answer 10

• trauma
  
  • fractures (69% of cases)
  • crush injuries
  • contusions
  • gunshot wounds
• tight casts, dressings, or external wrappings
• extravasation of IV infusion
• burns
• postischemic swelling
• bleeding disorders
• arterial injury