acute compartment syndrome
DESCRIPTION
Quite useful for ER physicians and surgeonsTRANSCRIPT
COMPARTMENT COMPARTMENT SYNDROMESYNDROME
BASSEY, A E M.B, B.S
OUTLINEOUTLINE INTRODUCTION
DEFINITION STATEMENT OF IMPORTANCE
EPIDEMIOLOGY CLASSIFICATION AETIOLOGY RELEVANT ANATOMY PATHOPHYSIOLOGY CLINICAL MANIFESTATION
HISTORY EXAMINATION
MANAGEMENT RESUSCITATION INVESTIGATION DEFINITIVE TREATMENT
REHABILITATION COMPLICATIONS PROGNOSIS CURRENT TRENDS CONCLUSION
INTRODUCTION
INTRODUCTIONINTRODUCTIONCOMPARTMENT SYNDROME IS A POTENTIALLY
LIFE-THREATENING CONDITION RESULTING FROM INCREASED PRESSURE WITHIN A CONFINED BODY SPACE, USUALLY A LEG OR FOREARM
THIS CONDITION WITHOUT INTERVENTION LEADS TO LOSS OF LIMB OR EVEN LIFE UNLESS EARLY DIAGNOSIS IS MADE AND TREATMENT INSTITUTED. IT IS IMPERATIVE FOR TODAY’S PHYSICIAN TO HAVE ADEQUATE UNDERSTANDING OF THIS REMEDIABLE MALADY, MORESO WITH INCREASING INCIDENCE OF TRAUMA DUE TO ROAD TRAFFIC INJURY, TERRORIST ATTACKS & COLLAPSING BUILDINGS
EPIDEMIOLOGY
EPIDEMIOLOGYEPIDEMIOLOGYFRACTURES ARE RESPONSIBLE FOR 69% OF
CASES OF COMPARTMENT SYNDROME
M>F
THE LEG IS THE COMMONEST SITE. TIBIAL FRACTURE IS COMMONEST CAUSE AND ANTERIOR COMPARTMENT IS MOST FREQUENTLY INVOLVED
FOREARM IS 2ND COMMONEST SITE, SUPRACONDYLAR FRACTURE IS THE COMMONEST CAUSE WITH FLEXOR COMPARTMENT MOST FREQUENTLY INVOLVED
CLASSIFICATION
CLASSIFICATIONCLASSIFICATIONACUTE
CHRONIC
AETIOLOGY
AETIOLOGYAETIOLOGYFRACTURESGUNSHOT INJURYCRUSH INJURYBURNSIATROGENICDEEP VEIN THROMBOSISENVENOMATIONINTENSE MUSCLE ACTIVITY↓ SERUM OSMOLARITY
RELEVANT ANATOMY
RELEVANT ANATOMYRELEVANT ANATOMY
RELEVANT ANATOMYRELEVANT ANATOMY
PATHOPHYSIOLOGY
PATHOPHYSIOLOGYPATHOPHYSIOLOGYNORMAL LEG COMPARTMENT
PRESSURES NIGERIANS : 3 – 14 mmHg CAUCASIANS : 0 – 15 mmHg
PERIPHERAL INTRAVASCULAR PRESSURES
ARTERIES : 80 – 120 mmHg ARTERIOLES : 35 mmHg CAPILLARIES : 20 mmHg VENULES : 12 mmHg VEINS : 5 mmHg
PATHOPHYSIOLOGYPATHOPHYSIOLOGYTRAUMA
↓RISE IN INTRACOMP. PRESSURE
↓VENOUS OBSTRUCTION + MUSCLE/NERVE
ISCHAEMIA↓
FURTHER RISE IN COMP. PRESSURE↓
CAPILLARY OBSTRUCTION + MYOCYTE NECROSIS↓
ARTERIAL OBSTRUCTION
CLINICAL MANIFESTATION
CLINICAL MANIFESTATIONCLINICAL MANIFESTATION THE 6 Ps HISTORY
DISPROPORTIONATE PAIN FEELING OF TENSION PARAESTHESIA, NUMBNESS – LATE SYMPTOMS HX OF PRECIPITATING EVENT
EXAMINATION INSPECTION : RESTLESSNESS, BULLAE,
FRACTURE BLISTERS PALPATION : PAIN ON PASSIVE MUSCLE
STRETCH – EARLIEST CLINICAL INDICATOR, WOODY FEELING ON DEEP PALPATION
DECREASED 2-POINT DISCRIMINATION – CONSISTENT EARLY FINDING
SENSORY/MOTOR DEFICITS, PULSELESSNESS ARE LATE FEATURES
MANAGEMENT
MANAGEMENTMANAGEMENTRESUSCITATION
INVESTIGATION: INTRACOMPARTMENTAL PRESSURE
MEASUREMENT – STANDARD OF DIAGNOSIS GLOBALLY
PCV URINALYSIS E,U & Cr ULTRASONOGRAPHY ANCILLARY INVESTIGATIONS
STRYKER PRESSURE STRYKER PRESSURE TONOMETERTONOMETER
MANAGEMENTMANAGEMENTDEFINITIVE TREATMENT –
PRINCIPLES REMOVE ALL CAST, DRESSINGS &
BANDAGES BIVALVE ALONE WILL NOT SUFFICE
RENAL PROTECTION IV CRYSTALLOID 500ml/hr IV MANNITOL 1g/Kg ALKALINIZE URINE
EARLY DECOMPRESSION VIA EMERGENCY FASCIOTOMY
MANAGEMENT - FASCIOTOMYMANAGEMENT - FASCIOTOMYINDICATIONS
NORMOTENSIVE PATIENT WITH CLINICAL FEATURES OF COMPARTMENT SYND. AND COMPARTMENT PRESSURE >30mmHg
HYPOTENSIVE PATIENT WITH COMPARTMENT PRESSURE >20mmHg
UNCONSCIOUS PATIENT WITH COMPARTMENT PRESSURE >30mmHg
OBTAIN INFORMED CONSENTDONE UNDER GADECOMPRESSION OF
COMPARTMENTS + EXCISION OF NECROTIC MUSCLE
DOUBLE-INCISION LEG DOUBLE-INCISION LEG FASCIOTOMYFASCIOTOMY
FOREARM FASCIOTOMYFOREARM FASCIOTOMY
FASCIOTOMY – POST OPFASCIOTOMY – POST OPELEVATE LIMB FOR 24 – 48HRSANALGESIAANTIBIOTICSDELAYED PRIMARY CLOSURESPLIT-THICKNESS SKIN GRAFT IF
CLOSURE NOT POSSIBLE AFTER 5 DAYS
REHABILITATION
REHABILITATIONREHABILITATIONPHYSICAL THERAPY
OCCUPATIONAL THERAPY
COMPLICATIONS
COMPLICATIONSCOMPLICATIONSEARLY
ACUTE RENAL FAILURE MUSCLE INFARCTION SEPSIS
LATE VOLKMANN ISCHAEMIC CONTRACTURE CHRONIC LIMB PAIN PARESIS/PARALYSIS
PROGNOSIS
PROGNOSISPROGNOSISTIME LAPSE BETWEEN INJURY &
INTERVENTION – MOST IMPORTANT
FASCIOTOMY WITHIN 6HRS : ≈100% FULL RECOVERY
WITHIN 12HRS : 68% BEYOND 12HRS : 8%
SITE OF AFFECTATION
CURRENT TRENDS
CURRENT TRENDSCURRENT TRENDSHYPERBARIC OXYGEN
CONCLUSION
CONCLUSIONCONCLUSIONCOMPARTMENT SYNDROME HAS DISASTROUS CONSEQUENCES IF PERMITTED TO RUN ITS COURSE.
TIMELY INTERVENTION IS INDISPENSABLE IF A SATISFACTORY OUTCOME IS TO BE ACHIEVED.
THANKYOU
REFERENCESREFERENCES The clinical diagnosis of compartment syndrome of the lower
leg: are clinical findings predictive of the disorder? J Orthop Trauma 2002 Sep;16(8):572-7
Acute compartment syndromes: diagnosis and treatment with the aid of the wick catheter. J Bone Joint Surg Am. 1978 Dec;60(8):1091-5.
Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br. 1996 Jan;78(1):99-104.
Fasciotomy in the treatment of the acute compartment syndrome.
J Bone Joint Surg Am. 1976 Jan;58(1):112-5 emedicine.medscape.com/article/307668-overview emedicine.medscape.com/article/2058838-overview Bailey & Love’s Short Practice of Surgery, 24th Ed, pp. Principles & Practice of Surgery including Pathology in the
tropics, 4th Ed, pg. 90 Schwartz’s Principles of Surgery, 8th Ed, pg. 349