Compartment Syndrome - Orthopaedic Trauma - Lecture Slides, Slides of Orthopedics

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Compartment Syndrome

Compartment Syndrome

A condition in which increased pressure

within a limited space compromises the

circulation and function of the tissues

within that space.

History

• Volkmann 1881
• Richard von Volkmann published an article in which he attempted to describe the condition of irreversible contractures of the flexor muscles of the hand to ischemic processes occurring in the forearm
• Application of restrictive dressing to an injured limb

History

• Hildebrand 1906
• First used the term Volkmann ischemic

contracture to describe the final result of any

untreated compartment syndrome, and was

the first to suggest that elevated tissue

pressure may be related to ischemic

contracture.

History

• Murphy 1914
• First to suggest that fasciotomy might prevent

the contracture. Also, suggested that tissue

pressure and fasciotomy were related to the

development of contracture

History

• Ellis 1958
• Reported a 2% incidence of compartment

syndrome with tibia fractures, and increased

attention was paid to contractures involving

the lower extremities

Compartment Syndrome

Etiology

Compartment Size

• tight dressing; Bandage/Cast
• localised external pressure; lying on limb
• Closure of fascial defects

Compartment Content

• Bleeding; Fx, vas inj, bleeding disorders
• Capillary Permeability; » Ischemia / Trauma / Burns / Exercise / Snake Bite / Drug Injection / IVF

Compartment Syndrome

Etiology

• Fractures- closed and open
• Blunt trauma
• Temp vascular

occlusion

• Cast/dressing
• Closure of fascial

defects

• Burns/electrical
  • Exertional states
  • GSW
  • IV/A-lines
  • Hemophiliac/coag
  • Intraosseous IV(infant)
  • Snake bite
  • Arterial injury

Blunt Trauma

• 2 nd^ most common cause
• About 23% of CS
• 25% due to direct blow

McQueen et al; JBJS Br 2000

Incidence

• McQueen et al; JBJS Br 2000
• 164 pts with CS, 149 male, 15 female
• Most pts were usually under 35
• 69% with associated fx, about half were tibial

shaft

• 23% soft tissue injury without fx
• Ranges of 2-12% have been published

Patient Positioning

• Leaving the calf free when the leg is placed in

the hemilithotomy position instead of using a

standard well-leg holder

• Increases the difference between the diastolic

blood pressure and the intramuscular

pressure

• May decrease the risk of compartment

syndrome

Meyer, Mubarak JBJS 2002

Compartment Syndrome

Pathophysiology

• Normal tissue pressure
  • 0-4 mm Hg
  • 8-10 with exertion
• Absolute pressure theory
  • 30 mm Hg - Mubarak
  • 45 mm Hg - Matsen
• Pressure gradient theory
  • < 20 mm Hg of diastolic pressure – Whitesides
  • McQueen, et al

Compartment Syndrome

Diagnosis

• Pain out of proportion
• Palpably tense compartment
• Pain with passive stretch
• Paresthesia/hypoesthesia
• Paralysis
• Pulselessness/pallor

Clinical Evaluation

“Pain and the aggravation of pain by passive

stretching of the muscles in the

compartment in question are the most

sensitive (and generally the only) clinical

finding before the onset of ischemic

dysfunction in the nerves and muscles.”

Whitesides AAOS 1996