COMPARTMENT SYNDROME

PRESENTED BY :
ARI ANDINI
ANA ZAHARINA HASYIM
NUR NAJWA SARONI
DEWI YUNITA DONER
MUHAMMAD IDHAM

ADVISOR :
DR SALMAN AL WAHABY
DR FENDY
DR IRA NONG
DR RIZAN


Definition
Compartment syndrome is a condition characterized
by raised pressure within a closed space with a
potential to cause irreversible damage to the contents
of the closed space
Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma,
Basic Science, Management and Reconstruction 4
th
edition. p: 341-363

A Transverse Section Through The forearm
Anatomy
Greys anatomy
Etiology
Type of syndrome Causes
Decreased compartment
size
Constriction by cast, dressing, garments
Compression by rubble
Excessive traction to fractures
Surgical closure of fascial defects
Thermal injuries such as third-degree burns
Increased compartment
contents
Iatrogenic injection or infusion of hemorrhage
Hereditary bleeding disorder ex: hemophilia
Anticoagulant therapy
Trauma from fractures, osteotomies, vessel laceration
Edema
Post ischemic
Arterial injury
Thrombosis
Embolization
Limb reimplantation
Arterial spasms
Torniquet
Increased capillary permeability pressure
Reperfusion after trauma
Burns and frostbite

Heinrich MJ, Janzing. Epidemiology, Etiology, Pathophysiology and Diagnosis of the Acute Compartment Syndrome of the
Extermity. European Journal of Trauma and Emergency. 2007

Pathophysiology
Increased
compartment content
Decreased
compartment size
Shock
Elevation of extreamity
Increased intra
compartmental pressure
vasopsams
Increased
venous
pressure
Increased
capillary
pressure
Increased
exudation
Decreased
perfussion
pressure
Decreased tissue
perfussion
Muscle and
nerve necrosis
Increased capillary
permeability
Decreased arteriolar pressure
Closure of arterioles
Decreased arteriolar transmural
pressure difference
Prasarn, M. Ouellette,E. Acute Compartment Syndrome of The Upper Extremity. J Am Acad Orthop Surg . 2011. p: 49-53

Nerve Ischemia

1 hour - normal conduction
1- 4 hours - neuropraxic damage reversible
8 hours - axonotmesis and irreversible change
Hargens et al. JBJS 1979
Pain
- Passive muscle stretching
- Out of proportion
- Progressive
- Not relieved by immobilization
Pallor / paleness
Pulselessness
Parasthesia
- Secondary to nerve ischemia
Paralysis (Weakness)
- Ischemic muscles lose function





Sign and Symptoms
Look : swollen compartment, bullae (+), the overlying skin can be shiny
Palpation : tenderness (+), pain referred to a compartment on passive
stretching
Physical examination
Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma,
Basic Science, Management and Reconstruction 4
th
edition. p: 341-363

pain referred to a compartment on
passive stretching of the digits
Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma,
Basic Science, Management and Reconstruction 4
th
edition. p: 341-363

NVD : hypesthesia in the territory of the rst webspace,
presence of normal capillary refill and palpable
Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma,
Basic Science, Management and Reconstruction 4
th
edition. p: 341-363

Compartment Pressure Measurement
Normal ICP of healthy muscle is 10-12 mmHg.
Compartment pressures can be measured to aid in the
diagnosis
Values of absolute pressure greater than 30 mm Hg or
those within 20 mm Hg of the diastolic pressure should
raise suspicion of a compartment syndrome



Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma,
Basic Science, Management and Reconstruction 4
th
edition. p: 341-363
Miller MD, Thompson SR, Hart JA. Compartment syndrome . In Miller MD, Thompson SR, Hart JA edittors, Review of
Orthopaedics Sixth Edition. Elsevier. p; 578
Prasarn, M. Ouellette,E. Acute Compartment Syndrome of The Upper Extremity. J Am Acad Orthop Surg . 2011. p: 49-53



Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma,
Basic Science, Management and Reconstruction 4
th
edition. p: 341-363

Treatment
Elevation
Fasciotomy
Treatment

Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma,
Basic Science, Management and Reconstruction 4
th
edition. p: 341-363

Fasciotomy
Compartment syndrome occur in almost any muscular area
Principles
- Release all compartment in a limb
- Leave all layers open
- Stabilize rigidly fractures underneath
- Debride necrotic tissue
- Second look in 48 hr for more necrotic tissue

Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma,
Basic Science, Management and Reconstruction 4
th
edition. p: 341-363

Complications
1. Volkmans Ischemic Contracture
2. Infection
3. Amputation


Prasarn, M. Ouellette,E. Acute Compartment Syndrome of The Upper Extremity. J Am Acad Orthop Surg . 2011. p: 49-53

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