COMPARTMENT SYNDROME POP-PS-TC

= tissue pressure within closed osteofascial space Non- trauma causes of compartment syndrome: Early signs
Increased Pressure  Reduced blood flow  ischemia impaired function
- tight casts, dressings, or external - Pain out of proportion
wrappings - Pain on passive
Leg Compartment - extravasation of IV infusion stretching (passively
- burns hyperextend the
fingers / toes)
- Palpable : tense
compartment
Forearm compartment - Skin sensation should
be repeatedly checked

Late signs:

- Paresthesia
- Paralysis
- Pulse

Anterior compartment Test :

Tibialis anterior, EHL, EDL, peroneus tertius  Dorsiflexion
Causes of forearm
Nerve : Deep peroneal n.  Extend big toe/ all compartment :
toes
Lateral compartment  Plantar flex/ - Supracondylar fracture
Peroneus longus, peroneus brevis  Foot eversion (in children)
Nerve: Superficial peroneal n.
- Distal radial fracture
-
Superficial posterior  Plantar flex Complication:
Gastrocnemius, soleus, plantaris Why compartment syndrome needs to be identified early?

Nerve : Tibial n. Muscle infarction will occur after 4-6hours of muscle ischemia. Nerve is capable of
Deep posterior  Plantar flex regeneration but muscles once infarcted can never recover & replaced by inelastic fibrous
Popliteus, FHL,FDL, Tibialis posterior  Flex big toe/ all toes tissue  Volkman's ischemic contracture
 Foot inversion Volkman’s ischemic contracture – Muscle contracture that results from arterial injury/
Nerve : Tibial n.
compartment syndrome
Loss of muscle bulk, deformity
High risk injuries: Clawing of the fingers (hyperextension at MCP, flexion at both IP joints)
- Demonstrate that the deformity is d/t contracture of forearm muscle : the fingers
- # of the elbow/ forearm
can extend on passive flexion of the wrist
- Proximal 3rd of the tibia # (damage to the popliteal artery)
 Preserved sensation
- Hand & foot #
- Crush injuries Treatment :
- Circumferential burns
 Tendon release & transfer (detachment of the flexors at their origin & trnafer of
wrist extensor to finger & thumb flexor)
 Pedicle nerve graft to restore protective sensation (in severe case)
PERONEAL NERVER INJURY

Nerve Mechanism of injury Findings Complications Mx

Common peroneal n Knee dislocation Motor: Foot stiff in equinus & Determine mechanism of
External compression  Foot drop varus position injury :
-  Loss of Pt weight bear on lateral
dorsiflexion, foot part of Direct injury
eversion  ulceration - Remove extrinsic
 Loss of big toe compression
extension - Nerve exploration
 High stepping gait
(To overcome the Traction injury
dorsiflexor  Long term
paralysis) management
Sensory loss with tendon
- Anterolateral, transfer (see
dorsum of foot, below)
between big toe &
2nd toe

Deep peroneal nerve Compartment syndrome
(anterior compartment of leg)
Risk factors:
Superficial peroneal n (Lateral) compartment
syndrome
Risk factors :
Loss of dorsiflexion & big toe Similar to above Long term mx:
extension Determine whether the
Loss of sensation between foot drop is mobile/ fixed
big toe & 2nd toe
Mobile foot drop
- Posterior tibialis
tendon transferto
ext. hallucis longus
& ext. digitorum
longus to act as
dorsiflexor,
correct the foot
inversion &
prevent claw
toes)\
Fixed
- Triple arthrodesis
of the hindfoot
(Lambinudi’s operation)
Unable to evert foot
Loss of anterolateral
sensation of leg & over
dorsum of foot