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Pathophysiology of Compartment Syndrome

- Discussion:
    - 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.