Compartment Syndrome Approach

  • Definition:
    • ↑ of pressure w\in a confined anatomical compartment -> compromised perfusion
  • Most common:
    • Leg (esp anterior compartment), forearm
  • Causes: 
    • Fractures, hematoma, constrictive cast, burns, thermal injuries, frost bites, IV fluid extravasation
  • Ddx:
    • DVT
    • Ischemia
    • Muscle rupture
    • Cellulitis
    • Peripheral nerve injury
  • Clinical presentation:
    • Pain out of proportion
    • 3 sings: pain w\ passive stretch, decreased two-point discrimination, decreased vibration
    • Swollen, tense compartment
    • Hypo\paresthesia in the compartment’s nerve distribution
    • Paralysis, pallor, pulseless (late findings)
  • Diagnosis:
    • If the pt is awake: diagnosis is made clinically
    • If the pt is not awake:
      • Pressure measurement (w\ either Stryker needle or pump method)
      • Absolute pressure > 30 mmHg
      • Diastolic pressure – compartment pressure < 30 mmHg
    • If chronic\exertional compartment syndrome:
      • Measure pre- and post-exercise compartment pressure; difference of > 20 mmHg
  • Treatment:
    • If acute:
      • Urgent fasciotomy to all 4 leg compartments (w\in 6 hrs)
        • Anterolateral incision -> anterior + lateral compartment
        • Risk: injury to superficial peroneal N
        • Medial incision -> deep + superficial posterior compartments
    • If chronic:
      • Stop exercise, if persistent + objective measurement -> elective fasciotomy
  • Care for fasciotomy incisions:
    • Closure is by either VAC or shoelace technique
    • Take to OR every 48 hrs to debride and change
  • Complications:
    • Volkmaan’s contractures
    • Rhabdomyolysis
    • Renal failure

 


compartment 1compartment 2

 


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