COMPARTEMENT

SYNDROME IN FOREARM
Pembimbing : dr. Irsan Abubakar, Sp.OT

Oleh :
Naufal Rabbany
Fannia Yasmine
Raihanah Fadhilah Y
Muthia Ara Agusti Ayu

BAGIAN/SMF BEDAH
FAKULTAS KEDOKTERAN UNIVERSITAS SYIAH KUALA
RSUD dr. ZAINOEL ABIDIN BANDA ACEH
2023
ANATOMI

John. C. Thompson. 2002. Netter’s Atlas Orthopaedic Anamtomy. First Edition

ANATOMI

John. C. Thompson. 2002. Netter’s Atlas Orthopaedic Anamtomy. First Edition

ANATOMI

John. C. Thompson. 2002. Netter’s Atlas Orthopaedic Anamtomy. First Edition

DEFINITION

• Compartment syndrome is a condition in which

increased tissue pressure within a limited space
compromises the circulation and function of the
contents of that space.

• It is a true orthopedic emergency

• Compartements are groups of muscles surrounded by

in elastic area

Jimenez A, Marappa-Ganeshan R. Forearm Compartment Syndrome. [Updated 2022 Aug 22]. In: StatPearls [Internet].
Salter.Textbookof Disorders and injuries of the Musculoskeletal SystemThird Edition
Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
ETIOLOGY

• Trauma is, by far, the most common cause.

• Tight casts, dressings, or external wrappings
• Extravasation of intravenous fluids/infusions
• Burns
• Bleeding disorders
• Post-ischemic swelling
• Arterial injuries
• Intensive use of muscles during exercise, seizures, eclampsia, tetany
• Intravenous drug administration
• Anticoagulation therapy increases the risk of compartment syndrome
in patients who sustain an injury to their forearm.
• Rare causes such as snake bites or carbon monoxide intoxication

Jimenez A, Marappa-Ganeshan R. Forearm Compartment Syndrome. [Updated 2022 Aug 22]. In: StatPearls [Internet].
Salter.Textbookof Disorders and injuries of the Musculoskeletal SystemThird Edition
Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
EPIDEMIOLOGY

• Compartment syndrome in the forearm is most commonly seen after

trauma associated with fractures, crush injuries, head injuries, and burns.
• The National Trauma Data Bank (U.S.A.) reveals 1.22% of forearm
fractures and 3.79% of tibial fracture patients underwent fasciotomy for
compartment syndrome.
• Young patients with a mean age of 32 years in males and a mean of 44
years in females are likely to be affected, while the overall incidence of
acute compartment syndromes is 3.1 per 100000 population per year in
the western world.
• Incidence is increased in men compared to women with a ratio of 10 to 1.

Jimenez A, Marappa-Ganeshan R. Forearm Compartment Syndrome. [Updated 2022 Aug 22]. In: StatPearls [Internet].
Salter.Textbookof Disorders and injuries of the Musculoskeletal SystemThird Edition
Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
PATOPHYSIOLOGY

Pathophysiology of compartment syndrome. © 2011 American Academy of Orthopaedic Surgeons, Volume 19 [1], pp. 49-50.
TYPES OF COMPARTEMENT SYNDROME

• Acute Compartement Syndrome :

1. Caused by severe injury/trauma
2. Acute exertional compartement syndrome have been
reported in foot in runners, basketball players and
other athelets

• Chronic Extertional Compartement syndrome :

1. It is recurrence of increased pressure seen most
often in anterior and deep posterior compartement
of leg
2. Also been reported in forearm in weight lifters,
rowers, welders.

Sanjit, et al. (2017). Acute Compartment Syndrome of the Leg. Journal of Orthopaedic Trauma, 31(8), pp. S17-8.
SYMPTOMS

• Pain
• Parestesia
• Pallor
• Paralysis
• Pulselessness
• Poikilothermia

Hanandeh
Swain R. Ross A, Maniextremity
D, Lower VR, Bauer P, Ramcharan
compartment A, toDonaldson
syndrome. When suspect acute B. Identification
or chronic andPostgrad
pressure buildup. Surgical
MedManagement of 165,
1999; 105: 159- 162, Upper
168 Arm and
Forearm Compartment Syndrome. Cureus. 2019 Oct 08;11(10):e5862.
DIAGNOSIS

Anamnesis
Clinical Findings
Pain in forearm (pain in
proportion to the •They present with a swollen, tense,
tender forearm with overlying skin
severity of the trauma) that is often pink.

•Pain that is out of proportion to the

injury is the pathognomonic sign,
especially on passive stretching of the
fingers.

•Sensory Deficit (Paresthesia) and

Paralysis (Late Sign)

Hanandeh A, Mani VR, Bauer P, Ramcharan A, Donaldson B. Identification and Surgical Management of Upper Arm and
Forearm Compartment Syndrome. Cureus. 2019 Oct 08;11(10):e5862.
 Supporting Examination

● Measurement of intracompartmental pressure.

● Forearm Radiograph
● MRI Forearm

Hanandeh A, Mani VR, Bauer P, Ramcharan A, Donaldson B. Identification and Surgical Management of Upper Arm and
Sanjit, et al. (2017). Acute Compartment Syndrome of the Leg. Journal of Orthopaedic Trauma, 31(8), pp. S17-8.
Forearm Compartment Syndrome. Cureus. 2019 Oct 08;11(10):e5862.
Jimenez A, Marappa-Ganeshan R. Forearm Compartment Syndrome. [Updated 2022 Aug 22]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
Treatment

● First steps can be taken on initial assessment such as oxygen

administration, elevating the arm in a sling, splitting or removing a tight
cast or dressing, ensuring the patient is normotensive as hypotension
reduces perfusion pressure and causes further tissue injury.

● The definitive treatment of acute compartment syndrome is a surgical

intervention in the form of urgent forearm compartment fasciotomies

Hanandeh A, Mani VR, Bauer P, Ramcharan A, Donaldson B. Identification and Surgical Management of Upper Arm and
Forearm Compartment Syndrome. Cureus. 2019 Oct 08;11(10):e5862.
Treatment
• Fasciotomy
Once compartment syndrome has been diagnosed,
fasciotomy can be performed, when the
intracompartmental pressure is more than 30 mmHg

Hanandeh A, Mani VR, Bauer P, Ramcharan A, Donaldson B. Identification and Surgical Management of Upper Arm and
Forearm Compartment Syndrome. Cureus. 2019 Oct 08;11(10):e5862.
Treatment
• Fasciotomy
Once compartment syndrome has been diagnosed,
fasciotomy can be performed, when the
intracompartmental pressure is more than 30 mmHg

Hanandeh A, Mani VR, Bauer P, Ramcharan A, Donaldson B. Identification and Surgical Management of Upper Arm and
Forearm Compartment Syndrome. Cureus. 2019 Oct 08;11(10):e5862.
Complications

● Volkmann ischemic contracture (Most Common Complication)

● Other complications include nerve damage, gangrene, chronic
regional pain syndrome, and rhabdomyolysis, potentially leading to
kidney failure.

Jones CD, Addison PR, Lam WL, Davidson DM. Compartment Syndrome of the Forearm Following Dermofasciectomy-A
Rare and Devastating Complication. J Hand Surg Asian Pac Vol. 2019 Dec;24(4):491-493.

Wrafter PF, Kelly O, O'Shaughnessy M. Acute Bilateral Compartment Syndrome of the Forearms. J Hand Surg Am. 2020
Mar;45(3):259.e1-259.e4.
Prognosis

• Prognosis varies from full recovery to amputation depending on the

time of presentation, symptoms at presentation (absent pulses, as
well as paralysis of the affected limb, are signs associated with late
presentations), time to diagnosis, and surgical intervention.

• The most important prognostic value in patients with acute

compartment syndrome of the forearm is the time to diagnosis and
fasciotomy.

• The timing of the diagnosis and immediate surgical intervention is

critical and limb saving. Delayed diagnosis can have devastating
consequences on the patient.

Hanandeh A, Mani VR, Bauer P, Ramcharan A, Donaldson B. Identification and Surgical Management of Upper Arm and
Forearm Compartment Syndrome. Cureus. 2019 Oct 08;11(10):e5862.
• John. C. Thompson. 2002. Netter’s Atlas Orthopaedic Anamtomy. First
Edition
• Jimenez A, Marappa-Ganeshan R. Forearm Compartment Syndrome.
[Updated 2022 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2022 Jan-.
• Pathophysiology of compartment syndrome. © 2011 American Academy
of Orthopaedic Surgeons, Volume 19 [1], pp. 49-50.
• Sanjit, et al. (2017). Acute Compartment Syndrome of the Leg. Journal of
Orthopaedic Trauma, 31(8), pp. S17-8.
• Hanandeh A, Mani VR, Bauer P, Ramcharan A, Donaldson B.
Identification and Surgical Management of Upper Arm and Forearm
Compartment Syndrome. Cureus. 2019 Oct 08;11(10):e5862.
• Jones CD, Addison PR, Lam WL, Davidson DM. Compartment Syndrome
of the Forearm Following Dermofasciectomy-A Rare and Devastating
Complication. J Hand Surg Asian Pac Vol. 2019 Dec;24(4):491-493.
• Wrafter PF, Kelly O, O'Shaughnessy M. Acute Bilateral Compartment
Syndrome of the Forearms. J Hand Surg Am. 2020
Mar;45(3):259.e1-259.e4.