Compartemen Syndrome

ORTHOPAEDIC LESSON

BACKGROUND

Compartment -> osteofascial component > room that consist of muscles, nerves, and blood vessels that surround by bone and fascia and individual muscle that surround epimysium. In anatomical compartment are in the extremity region

From the Region

Upper extremity Lower Extremity a. Lengan atas : a. Upper Leg: - kompartemen anterior - anterior - kompartemen - medial posterior - posterior b. Lengan Bawah : - flexor superficial - flexor profundus - ekstensor c. Hand - Thenar - Adductor b. Lower Leg: - anterior - lateral - posterior superficial - posterior profundus / Deep

Definition

condition of increased pressure within a nonexpansile space that results in compromised tissue perfusion and ultimate dysfunction of neural and muscular structures contained within that space.

CAUSE
Increase fluid content in compartment Fracture intracompartment hemorrahage Direct arterial trauma Burns edema , venous or lymphatic obstruction Muscle swelling: due to overexertion Metabolic : nephrotic syndrome External compression Prolonged compression of limb : trauma Tight cast of dressing

PATHOPHYSIOLOGY
Increased pressures Decreased perfusion myonecrosis

Fracture of the arm or leg (arterial damage), Bleeding, oedema or inflammation (infection) increase pressure of compartmentreduce capillary flowhipoksiasevere ischemia Hipoksia increase of permeability increase of pressure Muscle dead after 4-6 hours of total ischaemia . Nerve is capable of regeneration but muscle never recover and replaced by inellastic fibrous tissue ( Volkmanns ischaemic contracture)

Clinical manifestation

Earliest symptoms are pain ( describe as a bursting sensation) and altered sensibility Pain (a.c ischaemic): Painful to palpation or with passive stretch Pallor : lack of perfusion Paresthesia ;because of nerve or muscle ischemia. Paralysis : late symptoms Pulselessness Compartment pressure above 30-40 mmHg

COMPARTEMENT SYNDROME (LOWER LEG)

Measuring pressure
P = Diastolic pressure compartment pressure If P less than 30 mmHg, immediate fasciotomy

TREATMENT

COMPLICATION
Muscle necrosis : mioglobin Acute renal failure. hiperkalemia infeksi