Dr. Tamer Mohammed AlyOrthopedic and spine surgeon

What is a compartment?

Closed area of muscles group, nerves & bl.vs surrounded by fascia

Pressure: 5-15 mmhg

What is a compartment syndrome?

intra comp. pressure

(35-40 mmhg) capillaries collapse

Blood flow to muscles and nerves

Bl.Vs collapse

Why is it dangerous? Nerves:

neuropraxia: will regenerate

Ischemia: cell death

Muscles: contracture (Volkmann's ischemic contracture)

Gangrene

CausesFracture of a long

bone (Supracondylar

humerus, forearm, hand,tibia

and foot)

Drilling & reaming

Dissection

Tourniquet

Tight cast

swelling

Bluish discolorationnumbness

Severe bruised muscle

(even if there is no fracture)

Don’t take contusion lightly

SYMPTOMS

Severe pain inappropriate to the injury(not relieved even with morphia)

Burning of the affected limb

Tight muscle(rigid)

Numbness: bad sign

SIGNS & DIAGNOSIS

Passive stretching of fingers or toes (muscle stretch)will lead to severe pain (diagnostic sign)

Never wait for signs of ischemia (5 Ps):irreversible damage

Whiteside maneuver Wick hand held instrument

syringe

3 way stopcock

mmhg mano.

electrode

Direct reading

Don’t wait so long

Non surgical management:

Remove any tight bandage, tubigrip or soaked dressing

Cast should be removed completely

Elevation

Surgical management:

(FASCIOTOMY) Open skin and

fascia down to a compartment

Close skin by 2ry sutures after oedema subsides

It may need skin graft

Compartment syndrome is a serious syndrome, Which needs to be diagnosed early.Palpable pulse doesn’t exclude compartment syndromeIf diagnosis and fasciotomy were done within 24 hrs, the prognosis is good.If delayed, complications will develop.

The earlier you diagnose, the safer you are

Thank you