- occurs when pressure in a muscle compartment is > pressure in the capillaries, which leads to progressive muscle ischemia and edema and left untreated can result in infarction of the compartment contents;
- ischemia and necrosis of the muscles occur even though the arterial pressure is still high enough to produce pulses;
- muscle and nerves can survive for upto 4 hours of ischemia w/o irreversible damage;
- nerve kept ischemic for under 4 hours will show neuropraxic damage, whereas after 4 hours, nerves will show irreversible damage;
- Whiteside' Theory:
- the 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
- Causes:
- prolonged compression over a compartment (drug over dose)
- Owen, et al, measured intramuscular pressure by inserting wick catheters into 10 volar forearms and 10 anterior tibial compartments of adult volunteers.
- placed the subjects in positions in which victims of drug overdose are commonly found
- intramuscular pressures in the area of direct compression on hard surfaces ranged from 26 to 240 mm Hg, and averaged 101 mm Hg.
- reference:
- Intramuscular pressures with limb compression clarification of the pathogenesis of the drug-induced muscle-compartment syndrome.
- fractures (both open and closed)
- improper casting of fractures
- burns
- infiltration of IV medications (chemotherapy)
- intra compartment hemorrhage (direct arterial injury, Coumadin, hemophilia)
- tumors
- improper positioning of the well leg on the frx table
Compartment syndrome in the well leg resulting from fracture-table positioning.
- References:
- Skeletal muscle necrosis in pressurized compartments associated with hemorrhagic hypotension.
- Hyperbaric oxygen reduces edema and necrosis of skeletal muscle in compartment syndromes associated with hemorrhagic hypotension.
- Quantitation of skeletal-muscle necrosis in a model compartment syndrome.
- A comparative study of the tolerance of skeletal muscle to ischemia. Tourniquet application compared with acute compartment syndrome.
- Indomethacin reduces cell damage: shedding new light on compartment syndrome.