EVALUATION AND MANAGEMENT OF

ACUTE COMPARTMENT SYNDROME

Yudha Mathan Sakti

Ahmad Ramdoni
Muhammad Riyad Filza
Where will you breathe
Easier ?
INTRODUCTION

 Our limb divided into compartments

 Each compartments are closed space

 Elevated pressure will compress the structures inside

the compartment  compromises circulation and
function of tissues within that area  DIE
The OBJECTIVE
 The OBJECTIVE
A. Identify compartment syndrome
B. Know the C. Manage based
complications on competence
ETIOLOGY
 Traumatic :
 Fractures
 Thermal/burn injury
 Crush injury
 Penetrating injury
 Snake bites

 Non-traumatic (less common) :

 Overtight cast/bandage
 Thrombosis
 Vascular diseases
 Extravasation of intravenous fluid
 Elevated pressure will compress the structures inside the
osteo fascial compartment  COMPARTMENT SYNDROME
ANATOMY
Upper Arm Compartments :
 Anterior
 Posterior
ANATOMY
Forearm Compartments :
 Dorsal
 Henry’s Mobile Wad
 Superficial Volar
 Deep Volar
ANATOMY
Thigh Compartments :
 Anterior
 Medial
 Posterior
ANATOMY

Lower Leg Compartments :

 Anterior
 Lateral
 Deep Posterior
 Superficial Posterior
 PATHOPHYSIOLOGY

Increase Δ Pressure between

artery and vein  increase
stasis  interstitial tissue 
increased pressure
PATHOPHYSIOLOGY
 DIAGNOSIS

The classic Five P’s

 Pain  EARLIEST sign !!!
 Paresthesia  as early 30 minutes  ischemia in 6 hours
 Pallor
 Pulselessness
 Paralysis
 PAIN

 Pain that is out of proportion to the injury

 Pain with passive stretch of muscle
 Persistent deep ache or burning
 FIRST presenting symptom
 PARESTHESIA
 A condition in which you feel sensation
of numbness or prickling
 Pins & Needles
 Early  contained to one compartment
 Late  globally within limb
 As early in 30 minutes
 PULSELESSNESS
 The existence of distal pulses DO
NOT exclude compartment
syndrome

 Check above and below area of

concern

 Late stage – indicates progression

 PALLOR
 Rarely present

 Often times, redness progresses to pallor

 Sign of vascular injury and quickly leads to

ischemia

 LATE stage – emergent intervention require

 PARALYSIS

 Complete loss of muscle

function for one or more muscle
groups

 Very late finding  indicating

nerve damage
TREATMENTS

 Non-operative

 Operative
 TREATMENTS (Non-Operative)
 Release all bandage  RE evaluate the clinical condition

 Keep the extremity as level as the heart

 Hydration
 Hydration is important in the prevention of complications
 The goal of hydration is to achieve urine production
> 0.5 mL/kg/hour

 Immobilization and/are Analgesics

TREATMENTS (Operative)
 Fasciotomy is the definitive treatment

 Indications :
 Increasing of intra-compartment pressure >30 mmHg, or
 Delta pressure <30 mmHg

Stryker Compartment Pressure Measurement Device

TREATMENTS (Operative) Continued

Principles of fasciotomy :
 Adequate and extensile
incision.
 Complete release of all
involved compartments.
 Preservation of vital structure.
 Thorough debridement.
 Skin coverage at a later date
(7-10 days)
The OBJECTIVE
COMPLICATIONS
 Rhabdomyolisis
 Acute renal failure
 Necrosis of the affected limb
 Ischemic contracture  Volkman
 Infection
 Chronic pain
Posisi !!!!
Volkman contracture
PROGNOSIS

 Overall complication rate is about 50-60% if treatment

is delayed >12 hours

 About 50% lower limbs require amputation when

treatment is delayed, 92% will develop neuropathy

 Mortality is related to renal failure or sepsis

CONCLUSION

 ACS is a surgical emergency.

 A high level of suspicion is needed in all potential cases.
 Compartment pressure monitoring may aid in the
diagnosis.
 The definitive treatment is prompt surgical decompression
of all the involved compartments.
REFERENCES
1. Via AG, Oliva F, Spoliti M, Maffulli N. Acute compartment syndrome. Muscles,
Ligaments and Tendons Journal 2015;5(1):18-22.
2. Garner MR, Taylor SA, Gausden E, Lyden JP. Compartment Syndrome: Diagnosis,
Management, and Unique Concerns in the Twenty-First Century. HSSJ 2014;10:143–
152.
3. Burkhart KJ, Mueller LP, Prommersberger KJ, Rommens PM. Acute Compartment
Syndrome of the Upper Extremity. Eur J Trauma Emerg Surg 2007;33:584-8.
4. Cone J, Inaba K. Lower extremity compartment syndrome. Trauma Surg Acute
Care Open 2017;2:1-6.
5. Gourgiotis S, Villias C, Germanos S, Foukas A, Ridolfini MP. Acute Limb
Compartment Syndrome: A Review. J Surg Edu 2007;64(3):179-186.
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