COMPARTMENT SYNDROME

DR. Karrar abdul sattar jaber

Orthopedic surgeon
Arabic & Iraqi board
F.A.C.M.S –F.I.C.M.S
COMPARTMENT SYNDROME
*increase the pressure within a close osseofascial Compartments that may lead to irreversible muscle
and nerve damage if no intervention start !!
the microcirculation of the tissues in that compartment is diminished

• So Acute compartment syndrome (ACS) is a surgical emergency

• It can sometimes result in limb loss or even Loss of Life.

*Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and
optimizing tissue perfusion by keeping the limb at heart level
*The compartment syndrome is mostly diagnosed on variation in clinical symptoms and signs in
sequential examinations.
Aetiology B\decrease compartment size c\ both of them
A\increase fluid content of compartment 1. Bandage
1. Fracture 2. Cast
3. burn
2. Trauma
3. Hemorrhage
4. Snake venom
• compartment syndrome may occur anywhere that skeletal muscle is surrounded by fascia, but most
commonly
• leg
• forearm
• hand
• foot
• thigh
• buttock
• shoulder
• paraspinous muscles
Diagnosis
Compartment syndrome is mostly diagnosed clinically
The five “P’s”
pain, “pain out of proportion.”
paralysis,
paresthesiae” first sign of nerve ischemia”
pallor,
pulselessness

In unconscious patients most of the clinical findings cannot be

elicited; hence it is necessary to check compartment pressure
by devices.

ICP is nearly 8 mm Hg in resting adults

*Compartment pressures were found different at various
locations within compartments in relation to injury site; hence
there is a relationship between ICP and distance from the
fracture site
• if the difference between diastolic blood pressure and ICP
was less than 30 mm Hg, it was highly suspicious of ACS
• and if its more than 30 mm Hg needed to be decompressed
Treatment of leg compartment syndrom
single incision fasciotomy with fibulectomy,
single incision fasciotomy without fibulectomy,

and the most common surgical approach

two-incision fasciotomy with anterolateral and posteromedial

incisions.
Volkmann Ischemic Contracture
claw-like deformity of the hands with permanent shortening of
the forearm muscles, resulting from ischemia and necrosis of
the forearm muscles
Symptoms
inability to extend fingers or wrist or open hand

Physical exam
flexion contracture of several or all fingers
wrist may also be involved
may have ↓ sensation
pain with passive extension of fingers or wrist
unable to passively extend fingers or wrist fully
THANKS