SINDROM KOMPARTEMEN

Pembimbing :
Kapten CKM dr. Mulya Imansyah, Sp. OT

Oleh :
Desti Cahyanti
SYNDROME COMPARTMENT

Sindrom Kompartment adalah suatu

kondisi dimana terjadi penekanan
terhadap syaraf, pembuluh darah dan otot
didalam kompatement osteofasial yang
tertutup.
 ANATOMI

Compartment adalah kelompok dari otot,

saraf dan pembuluh darah di ektremitas .

dibungkus oleh tulang dan fasia

serta otot-otot yang masing-masing
dibungkus
oleh epimisium
 Kompartment Extremitas Bawah -
• Anterior
Calf
• Tibialis anterior, extensor muscles of toes,
anterior tibial artery, and deep peroneal
nerve
• Lateral
• Peroneus longus and peroneus brevis,
superficial peroneal artery
• Deep Posterior
• Tibialis posterior, flexor digitorum longus, and
flexor hallus longus
• Superficial Posterio
• Gastrocnemius and soleus muscle.
Sural nerve
• Lithotomy positions
Figure 1. Cross-section Medial Calf. Adapted from “Grey’s Anatomy,”
2009. Retrieved from : https://radiopaedia.org/images/24012
 Kompartement Ekstremitas Bawah –Thigh
• Anterior
• Vastus lateralis, vastus intermedius,
srtorius, and recutus femoris
• Femoral nerve/artery
• Medial
• Pectineus, external obturator,
gracilis muscles
• Adductors
• Obturator nerve

• Posterior
• Semimembranous, semitendinosis,
and biceps femoris
• Sciatic nerve Figure 2. Cross-section Medial Calf. Adapted from “Grey’
Anatomy,” 2009. Retrieved from :
https://radiopaedia.org/images/24012
 ETIOLOGI
Peningkatan tekanan kompartement
• Balutan yang terlalu ketat
• Berbaring di atas lengan
• Gips

Penurunan volume kompartemen

• Penutupan defek fascia
• Traksi internal berlebihan pada
fraktur ekstremitas
.
ETIOLOGI

Peningkatan Tekanan Pada Struktur

Kompartement :
 FAKTOR RESIKO
Bone Fracture (2/3 of Cast/Splint on
patients) broken bone
Tibia/radius most
commonly seen Trauma OR -same
position for > 8
hrs Lithotomy

Increased Men in their

Muscle Mass 30’s
PATOFISIOLOGI

Perfusi Tekanan Otot =

Tekanan Diastolik – Tekanan Intramuskular

2 Prinsip :
Penurunan Volume Kompartmen
Peningkatan Tekanan Kompartement
PATOFISIOLOGI
PATOFISIOLOGI
 Increasing Inter Compartmental Pressure

Raised Inter Compartmental Pressure

(ICP) > 30mmHg basis for treatment

ICP > 40mmHg = surgical emergency

.

Untreated, within 6-10 hours, the outcome of

persistent high compartmental pressures is muscle
infarction, tissue necrosis, and nerve injury
 MANIFESTASI KLINIS

PAIN PRESSU PARESTH

RE ESIA

PALLOR PULSELE PARALYS

SSNES IS
 PAIN
• Pain that is out of proportion
to the injury

• Pain with passive stretch of

muscle

• Persistent deep ache or

burning

FIRST presenting symptom

 PRESSURE
• Often not utilized –proper equipment required and user errors
are common
• >30-40 mmHg considered diagnostic
PARESTHESIA

• A condition in which you feel

sensation of numbness or prickling

• Pins & Needles

• Early contained to one

compartment
• Late globally within limb
 PALLOR

• Rarely present
• Often times, redness
progresses to pallor
• Sign of vascular injury
and quickly leads to
ischemia
• LATE stage –emergent
intervention require
PULSELESSNESS

• The existence of distal pulses DO

NOT exclude compartment
syndrome
• Check above and below area of
concern
• Late stage –indicates
progression

https://upload.wikimedia.org/wikipedia/commons/thumb/ d/d1/Pulse_sites-
en.svg/220px-Pulse_sites-en.svg.png
 PARALY SIS
• Complete loss of muscle function for one or more muscle groups

• Very late finding indicating nerve damage

http://drawingbooks.org/lutz1/source/images/000088.png
 DIAGNOSIS

Pain, Parasthesia, CPK

Paralysis, Pulseness,,
Pallor, Pressure

Start SINDROM
KOMPARTEMEN

ANAMNESIS Tekanan Urine Myoglobulin

Kompartemen
 Diagnosis

Stryker Manometer
• Normal : 0 -10
mmHg
• Pressures > 30- 40mmHg
menandakan peningkatan
tekanan kompartemen

https://www.slideshare.net/drrohitvikas/compartment-syndrome-14077010
TERAPI

Fasciotomy

8 jam iskemik dapat

menyebabkan kerusakan
otot secara irreversible
 Fasciotomy

Incision prior to
fasciotomy

Fasciotomy in progress –muscle

is still beefy red and viable
 FOLLOW UP

 The postoperative wound check is at 3-

5 days.

 Suture removal occurs at 10-14 days (if

Medical
the wounds are closed).
Presentation
 Patients may need skin grafting or

traction dermoplasty if the skin defect

is large.
 FOLLOW UP
The rehabilitation protocol depends most on the underlying mechanism
of injury. For stable tibial shaft fractures treated with closed reduction
and casting, the following guidelines apply:
0-3 Weeks
Begin quadriceps sets, hamstring sets, gluteal sets, and straight-leg raises before
hospital discharge.
Early weightbearing is performed as tolerated.
Ice, elevation, and anti-inflammatory drugs are recommended.
3-5 Weeks
Increase weightbearing.
Begin range-of-motion (ROM) exercises on knee (0-140°) and start open-chain
exercises with Thera-Band (The Hygienic Corporation, Akron, Ohio) or ankle
weights.
Begin closed-chain exercises if patient is bearing weight.
6-8 Weeks
Ambulate, bearing full weight.
Continue open- and closed-chain exercises.
3-4 Months
Discontinue cast or patellar tendon bearing (PTB).
Begin ankle stretching, ROM exercises, and strengthening.
KOMPLIKASI
 Motor deficits ie foot drop, Volkmann contracture
 Infection, with potential amputation
 Hyperaesthesia & painful dysesthesia: medication
ie phenytoin, carbamazepine, gabapentin
 Recurrent CS, due to scarring - athletes
 Systemic complications: acute renal failure,
sepsis, Adult Respiratory Distress Syndrome
Thank You