COMPARTMENT

SYNDROME
Definition
 Compartment syndrome is elevation of
interstitial pressure in closed fascial
compartmen that result in microvascular
compromise.
 As duration & magnitude of interstitial
pressure increase, myoneural function is
impaired & necrosis of soft tissue eventually
develops
Pathophysiology
 Occurs when pressure in a muscle compartment is > pressure in
capillaries, which leads to progressive muscle ischemia &
edema, if left untreated can result in infarction of the
compartment contents.
 Response of muscle to ischemia, histamine like subtances are
released that dilate the capillary bed & increases endothelial
permeability, leads to intramuscular transudation of plasma with
red plasma cell sludging & decreased microcirculation. The
muscle gain eight ( up to 50 % )
 Muscle & nerves can survive for up to 4 hours of ischemia
without irreversible damage.
 Nerve kept ischemic for under 4 hours will show neuropraxic
damage, whereas after 4 hours, nerves will show irreversible
damage.
Causes of Compartment
Syndrome
 Prolonged compression over a compartment
 Fractures ( both open & closed )
 Improper casting of fractures
 Burn
 Intra comparment hemorrhage
 Tumors
 Snakebites
 Intensive use of muscle such as exercise & seizures
Common Sites of Involvement
 Upper Extremity :
- Comparmet Syn. of forearm
- Comparment Syn. of hand & wrist
 Lower Extremity :
- Compartment Syn. of thigh
- Compartment Syn. of the leg
- Foot Compartment Syn.
Examination
 Pain
 Pallor
 Paralysis
 Paresthesia ( early loss vibratory sensation )
 Pulselessness
Compartment Pressure
Monitoring
 Normal compartment measure is zero
 There is in adequate perfusion & relative ischemia
when tissue pressure within a closed compartment
rise within 10 to 30 mm Hg of patient’s diastolic
blood pressure.
 Whitesides et al believe that fasciotomy ussualy is
indicated when tissue pressure rises to 40 to 45 mm
Hg in patient’s who has a diastolic pressure of 70
mm Hg & any signs or symptoms of a compartment
syndrome.
 Compartmen pressure measurements should be
taken as a close to the fracture site as possible.
Compartment Syn. Forearm
 Antebrachial Compartment Syn.
- May follow supracondylar fr. Of humerus.
- Compartment syn. In the forearm after wrist fr
ussualy involve the volar compartment.
 Tx :
- Forearm fasciotomy , requires decompression
extending from wrist to midarm including : lacertus
fibrosus, deep fascial compartment over flexor carpi
ulnaris, edge of the flexor superficialis muscle.
Compartment Syn. Of Hand
 Occur most often iatrogenic injuries.
 Symptoms :
- Increase pain.
- Loss of digital motion & continued swelling.
- Digits are found with MCP extension & PIP
flexion.
 Surgical treatment :
- Can be release with carpal tunnel release &
dorsal incision
Compartment syn. Of the Leg
 Anterior compartment, contains :
- Tibialis antr, Ext. Dig Longus, Ext. Hallucis
Longus & Peroneous muscle.
- Compartment is primarily responsible for
dorsoflexion of foot & ankle.
 Superficial Posterior compartment, contains :
- Gastrocnemius, soleus, popliteus &
plantaris muscle.
 Lateral compartment, contains :
- Peroneus brevis & longus
 Deep Posterior compartment, contains :
- Tibialis posterior
 Surgical treatment :
- Anterolateral incision.
- Posteromedial Incision.
- One incision technique over lat. Comprt.
Compartment Syn. Of the Foot
 Symptoms :
- Progressive pain, numbness in toes &
decrease motion.
- Tense tissue bulging.
- Increase pain on passive dorsoflexion of
metatarsophalangeal joints.
- Poor capillary refill & absent pulses are late
finding.
 Compartments of the Foot :
- Intrinsic compartment : 4 intrinsic muscle
between the 1st & 5th metatarsal.
- Medial compartment : Abductor hallucis,
Flexor hallucis brevis.
- Central comparment : Flexor digitorum
brevis, Quadratus plantae, Adductor hallucis.
- Lateral compartment : Flexor digiti minimi
brevis, Abductor digiti minimi.
 Surgical treatment :
 - Immediate & complete fasciotomy :
abductor hallucis longus, central, lateral &
interosseous compartment must be released.
 - Medial approach.
 - Dorsal approach.
Cronic Compartment
Syndrome
 Is an exercise-related compartment.
 Syndrome characterized by local pain,
swelling, paresthesias in the territory of the
nerve crossing the compartment.
 Pressure >15 mmHg for >15 min
postexercise.
Pathophysiology
 20% increase in muscle volume or weight
during exercise.
 Fascial compartment have a limited ability to
expand.
 When the pressure in a compartment
increases, the vascular supply to the nerves
can be affected causing paresthesias to
occur.
Examination

 No abnormality unless seen immediately

after exercise.
 Tenderness & increased tension in the
compartment.
 Passive stretching of the involved muscle
after exercise may increase pain.
Treatment
 Conservative Tx with antiinflammatory
medication can be successful if the patient is
willing to significantly reduce or stop atheletic
activities.
 Fasciotomy- depending on compartment
affected.
Daftar Pustaka
 Rockwood & Green, Fractures in Adult, Vol1
pages 487- 492 Lippincot – Raven,
Philadelphia, 1996
 R.B Salter, Textbook of Disorder & Injuries of
the Musculoskeletal System,3rd edition,
pages 468 – 470 Lippincot, Philadelphia
1999
 Brinker Miller, Fundamental of Orthopaedics,
WB Sunders, 1999
Double IncisionTehcnique
(Anterolateral incision & Posteromedial incision)
Single Incision Technique
Two Incision Technique