Compartment Syndrome: Rahma Aulia Khairunnisa

Compartment
Syndrome
Rahma Aulia Khairunnisa
• Devastating condition
where an osseofacial
compartment pressure
rises to a level that
decreases perfusion
• May lead to irreversible

muscle and nerve damage
What is compartment
syndrome? https://www.orthobullets.com/trauma/1001
/leg-compartment-syndrome
• Compartment
syndrome may occur
anywhere that skeletal
muscle is surrounded
by fascia
https://www.orthobullets.com/trauma/1001
ACUTE Vs
CHRONIC • Medical Emergency
• Caused by severe Injury
ACUTE
• Lead to permanent muscle
damage
• not a medical emergency

• exertional compartment syndrome
CHRONIC • caused by exercise / athletic exertion.
• usually relieved by discontinuing the
exercise, and is usually not dangerous
American Academy of Orthopaedic Surgeons

https://orthoinfo.aaos.org/en/diseases--conditions/compartment-syndrome/
First Documentation
The first medical reference was in
1881, when German doctor Richard
von Volkmann described a permanent
contracture of the forearm related
to ischemia within muscle
compartments of the arm
Vaz,Maegan. 2017. Compartment Syndrome. Beverly : International Society of Plastic and Aesthetic Nurses https://ispan.org
• Compartments – grouping of muscles, nerves and
Anatomy Review blood vessels in the extremities
• Inelastic fascia encases the compartments, protects the

tissues, and maintains tissue shape
Pathophysiology
Etiology
Any event (external or internal) that increases the pressure within a compartment by
decreasing the capacity or increasing the volume
CHRONIC
ACUTE
• caused by exercise.
• A Fracture
• activities with repetitive motions,
• A badly bruised muscle
(running, biking, or swimming)
• Crush Injury
• usually relieved by discontinuing the
• Anabolic steroid use
exercise, and is usually not
• Constricting bandages
dangerous.

pain out of proportion to clinical situation is
usually first symptom
•may be absent in cases of nerve damage
•pain is difficult to assess in a polytrauma patient and
Symptoms impossible to assess in a sedated patient
•difficult to assess in children (unable to verbalize)
https://www.orthobullets.com/trauma/1001/leg-compartment-syndrome
ACUTE CHRONIC
• classic sign : pain, esp when the • pain or cramping during exercise.
muscle within the compartment is This pain subsides when activity
stretched. stops. It most often occurs in the leg.
• pain -> more intense than what • Numbness
would be expected from the injury
itself. Using or stretching the • Difficulty moving the foot
involved muscles increases the pain. • Visible muscle bulging
• There may also be tingling or burning
sensations (paresthesias) in the skin.
• The muscle may feel tight or full.
• late signs : numbness or paralysis.
Usually indicate permanent tissue
injury.

Clinical Examination (6P’s)
PULSE
PARALYSIS PARASTHESIA
PRESSURE PAIN
PALLOR
• Pain that is out of proportion
to the injury
• Pain with passive stretch of

muscle
PAIN • Persistent deep ache or

burning
•FIRST presenting symptom
Often not utilized – proper
equipment required and
user errors are common
>30-40 mmHg considered

diagnostic
PRESSURE
PARESTHESIA
• A condition in which you feel sensation

of numbness or prickling
• Pins & Needles

• Early contained to one compartment
• Late globally within limb
PALLOR
• Rarely present
• Often times, redness progresses to pallor
• Sign of vascular injury and quickly leads to
ischemia
• LATE stage – emergent intervention require
The existence of distal pulses DO
NOT exclude compartment
syndrome
Check above and below area of

concern
Late stage – indicates progression

PULSELESSNESS
PARALY SIS
• Complete loss of muscle function for
one or more muscle groups
• Very late finding indicating nerve
damage
Compartment Pressure 1975
Measurement Technique
>30 mmHg -> ACS
Slit Catheter (1993)

Stryker STIC Monitor
Department of Orthopaedic s AFMC

https://www.slideshare.net/drrohitvikas/compartment-syndrome-14077010
Management
Nonoperative
•observation
•indications
•diastolic differential pressure (delta p) is > 30
•presentation not consistent with compartment syndrome
•bi-valving the cast and loosening circumferential dressings
•indications
•initial treatment for swelling or pain that is NOT compartment syndrome
•splinting the ankle between neutral and resting plantar flexion (37 deg) can also decrease intracompartmental
pressures
•hyperbaric oxygen therapy works by increasing the oxygen diffusion gradient
• Operative
• emergent fasciotomy of all four compartments
• indications
• clinical presentation consistent with compartment syndrome
• compartment pressures within 30 mm Hg of diastolic blood pressure (delta p)
• intraoperatively, diastolic blood pressure may be decreased from anesthesia
• must compare intra-operative measurement to pre-operative diastolic pressure
• attempt to restore systemic blood pressure prior to measurement
• contraindications
• missed compartment syndrome
•
https://www.orthobullets.com/trauma/1001/leg-compartment-syndrome
• Surgical decompression with a
fasciotomy is the definitive
Fasciotomy treatment
• 8 hour ischemia time can cause

irreversible damage to muscles
• surgical procedure -> fascia is cut

to relieve tension or pressure
commonly to treat the resulting
loss of circulation to an area of
tissue or muscle
• a limb-saving procedure when
used to treat acute compartment
syndrome
Sources
• https://www.orthobullets.com/trauma/1001/leg-compartment-syndrome
• American Academy of Orthopaedic Surgeons
• Vaz,Maegan. 2017. Compartment Syndrome. Beverly : International Society of Plastic and
Aesthetic Nurses https://ispan.org
• Department of Orthopaedic s AFMC
https://www.slideshare.net/drrohitvikas/compartment-syndrome-14077010
THANK YOU 

Compartment Syndrome: Rahma Aulia Khairunnisa

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Compartment Syndrome: Rahma Aulia Khairunnisa

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Compartment

• May lead to irreversible

• not a medical emergency

American Academy of Orthopaedic Surgeons

• Inelastic fascia encases the compartments, protects the

American Academy of Orthopaedic Surgeons

American Academy of Orthopaedic Surgeons

• Pain with passive stretch of

PAIN • Persistent deep ache or

•FIRST presenting symptom

>30-40 mmHg considered

• A condition in which you feel sensation

• Pins & Needles

Check above and below area of

Late stage – indicates progression

>30 mmHg -> ACS

Slit Catheter (1993)

Department of Orthopaedic s AFMC

• 8 hour ischemia time can cause

• surgical procedure -> fascia is cut

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