COMPARTMENT SYNDROME

DIAGNOSIS AND MANAGEMENT

Definition
Insiden Orthopaedic Injury Causing
Compartment Syndrome

Rockwood & Green's Fractures in Adults, 6th Edition

Patofisiologi

LBF = (Pa − Pv)/R.

Green's Operative Hand Surgery, 6th ed)

 Reduction in the arterial pressure ( Pa )
(e.g., hypotension, bleeding, arterial occlusion, limb elevation above the heart)
Increase in local vascular resistance (R)
(e.g., tight bandage, cast, crush injury)

Decrease in the local blood flow (LBF)

local ischemia

Tissue necrosis occurs.

For muscle, this means the replacement of muscle fibers with dense
fibrous tissue

Green's Operative Hand Surgery, 6th ed)

(Green's Operative Hand Surgery, 6th ed)
ETIOLOGI

Rockwood & Green's Fractures in Adults, 6th Edition

 ETIOLOGI
Mechanism of
Causes
Injury

Decreased Tight casts, dressings, air splints, tourniquet, lying on limb, entrapment under heavy weights,
compartment tight closure of fascial defects, excessive traction on fractured limbs, limb lengthening,
thermal injuries, burn eschar
volume
Coagulopathy (due to drugs, systemic diseases, hemorrhagic shock, etc.), major vascular
injury, increased capillary permeability, reperfusion after replantation, arterial bypass
Increased grafting, embolectomy, ergotamine injection, extensive subcutaneous drug infiltration, high-
pressure injection injury, pressure transfusion, cardiac catheterization, fracture, fracture
compartment reduction and internal fixation, contusion, strenuous exercise, seizure, eclampsia, tetany,
content electrical burn, intra-arterial injection, frostbite, snakebite, venous ligation, nephritic
syndrome, necrotizing infection, metastasis to skeletal muscle, leaky dialysis cannula, acute
rhabdomyolysis, muscular dystrophy, muscular hypertrophy, tendon avulsion

(Green's Operative Hand Surgery, 6th ed)

Sign & Symptoms

Pain

Pulseless-
ness Paresthesia

5P
Pallor
Paralysis
PAIN : (

(Green's & Rockwood )

PARASTHESIA

PARALYSIS

• A late sign of Compartment Syndrome

• full recovery is rare
• Bradley (93) reported full recovery in only 13% of patients
with paralysis
Rockwood & Green's Fractures in Adults, 6th Edition
Palpable Swelling
PULSNESS

Rockwood & Green's Fractures in Adults, 6th Edition

Pitfall

ABSOLUTELY NOT
Objective Measurements of
Intracompartmental Pressure
Rockwood & Green's Fractures in Adults, 6th Edition
 Whiteside’s
method)

Rockwood & Green's Fractures in Adults, 6th Edition

 Matsen's
method

Green's Operative Hand Surgery, 6th ed)

Wick catheter
technique

slit catheter
tehnique
(Rorabeck)
Stryker’s tonometer ( commercial device).
• Muscle :
• Tolerate 4 hours ischemia (reversible)
• > 6 hrs  complete irreversible
• Nerve :
• < 4 hrs : neuropraxic
• > 8 hrs : axonotmesis & irreversible changes
Appley System of Orthopaedic 10th edition
Rockwood & Green's Fractures in Adults, 6th Edition
Appley System of Orthopaedic 10th edition
Appley System of Orthopaedic 10th edition
Generally, fasciotomy is recommended in cases in which the
compartment pressure rises above 30 to 45 mm Hg
and does not decrease. (Green )

Compartment release by fasciotomy is indicated if the

patient has one or more of the signs and symptoms listed
above and the absolute pressure is greater than 40 mm Hg
or there is less than 30 mm Hg difference between the
compartmental pressure and the diastolic pressure.
(AAOS)
Rockwood & Green's Fractures in Adults, 6th Edition
Rockwood & Green's Fractures in Adults, 6th Edition
Rockwood & Green's Fractures in Adults, 6th Edition
Thigh

Rockwood & Green's Fractures in Adults, 6th Edition

Arm & Forearm

Rockwood & Green's Fractures in Adults, 6th Edition

Hand

Rockwood & Green's Fractures in Adults, 6th Edition

Foot

Rockwood & Green's Fractures in Adults, 6th Edition

Rockwood & Green's Fractures in Adults, 6th Edition
Rockwood & Green's Fractures in Adults, 6th Edition
Rockwood & Green's Fractures in Adults, 6th Edition
CONTRAINDICATION
TERIMA KASIH