compartment syndrome
DESCRIPTION
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COMPARTMENT SYNDROME
DEFINITION
• A condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space.
SITES
FORE- ARM & CALFHAND,ARM, BUTTOCK, ABDOMEN
ANATOMY
Fracture
Blick et al JBJS 1986Blick et al JBJS 1986
Blunt Trauma
• 2nd most common cause
McQueen et al; JBJS Br 2000
OTHER CAUSES….
• Temp vascular occlusion
• Cast/dressing• Closure of fascial
defects• Burns/electrical
• Exertional states• GSW• IV/A-lines• Hemophiliac/coag• Intraosseous IV(infant)
• Snake bite• Arterial injury
EFFECTS
MUSCLE NECROSIS AND NERVE DAMAGE
• INFECTION, SEPTICEMIS,ABSCESS FORMATION• GANGRENE OF LIMB• CHRONIC ISCHEMIC CONTRACTURE• DISABLED LIMB• RENAL FAILURE
Compartment SyndromeDiagnosis
• Pain out of proportion• Palpably tense compartment• Pain with passive stretch• Paresthesia/hypoesthesia• Paralysis• Pulselessness/pallor
Compartment Pressure • Infusion– manometer– saline– 3-way stopcock (Whitesides, CORR 1975)
• Catheter– wick– slit wick
• Arterial line– 16 - 18 ga. Needle (5-19 mm Hg higher)– transducer– monitor
• Stryker device– Side port needle
Compartment SyndromePressure Measurements
• Arterial line– Zero at the
level of the affected limb
Compartment SyndromePressure Measurements
• Simple Needle– 18 gauge– Least accurate– Usually gives falsely higher
reading
• Slit Catheter and Side ported needle– No significant difference– More accurate
Side port
Moed et al JBJS 1993Moed et al JBJS 1993
Surgical Treatment
• Fasciotomy, Fasciotomy, Fasciotomy,
– All compartments !!!