- Discussion:
- pathophysiology:
- compartment syndrome is elevation of interstitial pressure in closed fascial compartment that results in microvascular compromise;
- as duration & magnitude of interstitial pressure increase, myoneural function is impaired & necrosis of soft tissues eventually develops;
- intracompartmental pressure:
- necrosis of tissue may begin at interstitial pressure as low as 30 mm
- while others have suggested that it begins at higher level;
- w/ periods of hypotension and trauma to limb, interstitial tissue pressure of 30 mm of mercury has been suggested
as threshold at which diagnosis of compartment syndrome should be considered;
- diastolic pressure: (Whiteside' Theory):
- development of a compartment syndrome depends not only on intra-compartment pressure but also depends on systemic
blood pressure;
- DBP - CP should be greater than 30
- references:
- Diastolic blood pressure in patients with tibia fractures under anaesthesia: implications for the diagnosis of compartment syndrome.
- Diagnostic techniques in acute compartment syndrome of the leg.
- Common Sites of Involvement:
- compartment syndrome of the upper extremity:
- compartment syndrome of forearm
- compartment syndrome of hand and wrist (after crush, hemmorhage, edema)
- compartment syndrome of the lower extremity:
- compartment syndrome of thigh
- compartment syndrome of the leg:
- compartment syndrome from tibial frx
- chronic compartment syndromes
- fasciotomy of leg
- anatomy: (4 compartments)
- lateral compartment
- superfical posterior compartment
- deep posterior compartment
- anterior compartment
- foot compartment syndromes
- Exam:
- blood pressure (compartment syndrome is potentiated by hypotension);
- extreme pain out of proportion to the injury,
- pain on passive ROM of the fingers or toes (stretch pain of the involved compartment):
- patient will usually hold injured part in a position of flexion to maximally relax the fascia and reduce pain;
- pallor of the extremity,
- paralysis - loss of motor function
- note that in teenagers, the muscle is stronger and more durable than adults, and so there may be a delayed appearance of loss
of active motors;
- paresthesias (early loss of vibratory sensation);
- pulses:
- when checking an extremity pulse (such as dorsalis pedis) be sure to occlude the other major artery (posterior tibial artery) so
that retrograde flow does not confuse the diagnosis;
- or apply a pulse oximetry monitor to the great toe, and sequentially occlude the posterior tibial and dorsalis pedis pulses;
- compare pulses to the opposite non injured side (to rule out vascular injury);
- ref: Physicians’ Ability to Manually Detect Isolated Elevations in Leg Intracompartmental Pressure
- Compartment Pressure Monitoring:
- Ankle and knee position as a factor modifying intracompartmental pressure in the human leg.
Complications:
- reperfusion injury
- need to address:
- fluid loss
- shock
- acidosis
- hyperkalemia
- myoglobinuria
- renal failure
- consider:
- perioperative hydration
- mannitol
- bicarbonate
Scientific Papers: Fasciotomy after trauma to the extremities.
Recurrent Compartment Syndrome Leading to the Diagnosis of McArdle Disease: Case Report
Compartmental syndrome complicating Salter-Harris type II distal radius fracture.
Simulation of compartment syndrome by rupture of the deep femoral artery from blunt trauma.
Quantification of intracompartmental pressure and volume under plaster casts.
A practical approach to compartmental syndromes. Part II. Diagnosis.
Well-limb compartment syndrome after prolonged lateral decubitus positioning. A report of two cases.
Compartment Syndrome in Upper Limb