Systemic effect of

Compartment Syndrome
Compartment syndrome is defined as dysfunctional and
defective perfusion of organs and tissues within the
confined anatomical space due to limited blood supply.

Two factors are responsible for this condition, either a

decrease in a compartment volume, or an increase in the
contents of a compartment, or both of these factors.

Compartment syndromes can be classified as primary

(pathology/injury is within the compartment) or
secondary (no primary pathology or injury within the
compartment)
 The five “P's” :
1. Pain
Compartment syndrome is 2. Paralysis
mostly diagnosed clinically. 3. Paresthesia
4. Pallor
5. Pulselessness

The first sign of nerve ischemia

Pulselessness is a late finding.
is paraesthesia which is
Pressure in the compartments
followed by hypoaesthesia,
is not usually high enough to
anaesthesia, paresis, and
compress arteries.
paralysis.
Muscle Viability
 The extent of muscle debridement performed in the
setting of open fractures, crush injury, and compartment
syndrome is determined by the treating surgeon’s gross
assessment of the tissue and a prediction of muscle
viability
 The impetus driving this debridement is the fear that
potentially necrotic tissue will create a nidus for infection
and that a build up of muscle necrosis byproducts, such as
myoglobin, can have potentially disastrous end-organ
consequences.
Muscle Viability

Muscle color Consistency

Prediction of
viability include 4 C

Contractility Capacity to bleed

Muscle Viability

Color was graded Consistency was capacity to bleed

Contractility
as : graded as : were graded as :
• pink/red • Firm • Contractile • Bleeding
• purple • Friable • Non contractile • Non Bleeding
• tan/brown

Surgeons were then asked to provide their impression of

the overall viability of the biopsied muscle, rating it as
healthy, borderline, or dead.
Systemic effect of Compartment Syndrome

 Rhabdomyolysis
 Renal failure
 Acidosis
Rhabdomyolysis

 A complex medical condition involving the rapid

dissolution of damaged or injured skeletal muscle through
either physical forces or nonphysical
 This disruption of skeletal muscle integrity leads to the
direct release of intracellular muscle components,
including myoglobin, creatine kinase (CK), aldolase, and
lactate dehydrogenase, as well as electrolytes, into the
bloodstream and extracellular space
Rhabdomyolysis

 Rhabdomyolysis ranges from an asymptomatic illness with

elevation in the CK level to a life-threatening condition
associated with extreme elevations in Creatin Kinase,
electrolyte imbalances, acute renal failure (ARF), and
disseminated intravascular coagulation
 Triad of symptoms: myalgia, weakness, and myoglobinuria
 Manifested as tea-colored urine.
Rhabdomyolysis – Renal Failure

uncontrolled
Myoglobin has
oxidation of
The release of nephrotoxic effect
biomolecules, lipid
myoglobin from due to its activity
peroxidation and
damaged muscle as peroxidase-like
generation of
enzyme
isoprostanes

renal
dysfunction

obstructing the
Myoglobin
tubuli, along with
interacting with
creates casts sloughed destroyed
Tamm-Horsfall
cells from tubular
protein
necrosis
Rhabdomyolysis - Acidosis

Damaged muscle

depletion of oxygen from involved tissues

lactic acidosis
 Bhalla MC and Perez RD. 2014. Case Report: Exercise Induced Rhabdomyolysis
with Compartment Syndrome and Renal Failure. Hindawi Publishing
Emergency Medicine; 735820, 3
 Keltz E, Khan FY, and Mann G. 2013. Rhabdomyolysis. The role of diagnostic
and prognostic factors. Muscle Ligaments Tendons Journal; 3(4):303-312
 Sassoon A, Riehl J, Rich A, Langford J, Haidukewych G, Pearl G, and Koval KJ.
2016. Muscle Viability Revisited: Are We Removing Normal Muscle? A Critical
Evaluation of Dogmatic Debridement. J Orthop Trauma; 30(1)
 Torres PA, Helmstetter JA, Kaye AM, Pharm D, and Kaye AD. 2015.
Rhabdomyolysis: Pathogenesis, Diagnosis, and Treatment. The Ochsner
Journal; 15(1): 58-69