T&O: Compartment Syndrome

Question 1

Outline the pathophysiology of compartment syndrome

Answer 1

As pressure increases, lower pressure venous system will first be compromised = venous congestion, further increase in the intra-compartmental pressure

Capillaries will subsequently be compressed and arterial supply to the muscles will cease = ischaemia and subsequent infarction, nerve and muscle necrosis

Most commonly affects lower leg = 1 of 4 compartments (anterior tibial - dorsiflexion, peroneal compartment plantarflexion, superficial posterior - plantarflexion, deep posterior - plantarflexion)

Question 2

Outline the aetiology of compartment syndrome.

Answer 2

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

Question 3

What are the symptoms of compartment syndrome?

Answer 3

Pain (disproportionate to injury) = on active contraction and passive stretching of the muscle compartment

Paraesthesia

Pulselessness

Paralysis

Pallor

Perishingly cold

Question 4

How would you investigate compartment syndrome?

Answer 4

Hx = severe pain disproportionate to injury

MRI of affected compartment

Measure compartment pressure = diff between diastolic BP and compartment, normal is 0-10, >30 = CS

Question 5

How would you manage compartment syndrome?

Answer 5

NBM

Circumferential dressings released to skin

Limb elevated to heart level

Oxygen, analgesia (be careful not to mask symptoms

Fasciotomy = skin incisions are left open, and a re-look is planned for 24-48 hours (two-incision four-compartment decompression)

Close wound or skin graft

Debridement of muscle necrosis

Question 6

What are the complications of compartment syndrome?

Answer 6

Necrosis

Rhabdomyolysis (23%) = 1) myoglobin = kidney disease, 2) hyperkalaemia = cardiac arrest

Volksman contracture = permanent contraction of the muscle