BY Ivander P Fitri Florentina Linda Muchlisha Nurbaeti Bakhtiar Putri A.

Michiko C111 08 285 C111 08 221 C111 08 216 C111 08 145 C111 08 175

Advisor : dr. Risqi T. Tuahuns dr. Helmiyadi Kuswardhana dr. Sebastian Mihardja

Orthopaedic and Traumatology Department Medical Faculty of Hasanuddin University Makassar 2013

Definition
Compartment syndrome is a condition that results from

increased tissue-fluid pressure within a defined fascial space. The end result is muscle and nerve ischemia and necrosis.

Robert. R, Scott C., Steven J. Compartment Syndromes. Emergency Orthopedic the Extremities. 5th Ed.

Epidemiology
The most common locations for compartment

syndrome are the forearm and leg. Less common are the foot, upper arm and thigh.

Robert. R, Scott C., Steven J. Compartment Syndromes. Emergency Orthopedic the Extremities. 5th Ed.

Etiology
Fractures (open &

closed)
Arterial injury & vascular

occlusion
Burns Exercise Casting
Thomson J C. Hand. Netters Concise Atlas of Orthopaedic Anatomy.

Patophisiology
Any situation that causes a decrease in compartment size or increase in compartment pressure can initiate compartment syndrome .
ICP capillary blood perfusion cannot maintain

tissue viability.
The local tissue ischemia leads to local edema, which

increases intracompartmental pressure

Jobe M.T. Compartment Syndromes and Volkmann Contrature. Cambells Operative Orthopaedics. 11th Ed.

Compartment of the forearm

Superficial

volar FCU,FDS, PL, FCR, PT Deep volar FDP, FPL, Pronator quadratus. Superficial dorsal AN, EDC, EDM, ECU. Mobile Wad BR, ECRL, ECRB. Deep dorsal Supinator, APL, EPB, EPL, EIP

Thomson J C. Hand. Netters Concise Atlas of Orthopaedic Anatomy.

Compartment of the hand

Thenar APB, FPB,

Opponens pollicis Adductor Adductor pollicis Hypothenar PB, ADM, FDMB, ODM Intrinsics Lumbricals Interosseous - DIO - PIO

Thomson J C. Hand. Netters Concise Atlas of Orthopaedic Anatomy.

Compartment of the leg

Anterior compartment extensor muscle: TA,

EDL, EHL, PT, anterior tibial a and v., peroneal. n.

deep

Lateral compartment PL, PB, superficial

peroneal n.

Posterior compartment

- Superficial superficial flexor muscle: soleus, gastrocnemeus, plantaris - Deep deep flexor muscle: FDL, TP, FHL, popliteus, posterior tibial a and v , tibial n peroneal a and v.

Thomson J C. Hand. Netters Concise Atlas of Orthopaedic Anatomy.

Sign & Symptoms

Classic signs 5 P
Pain

Severe extremity pain out of proportion to injury Early sign, worse with passively stretching involved

muscle
Pallor

Heppenstall R .B, McCombs P.R, DeLaurentis D.A. Compartment Syndrome. Rockwood and greens: Fracture in adults. 6th. Volume I.

 Paresthesia or

anesthesia to light touch

Paralysis

Pulselessness

Not present in early cases

Heppenstall R .B, McCombs P.R, DeLaurentis D.A. Compartment Syndrome. Rockwood and greens: Fracture in adults. 6 th. Volume I.

Tissue Pressure Measurements

Infusion technique
The necessary equipment includes: a blood pressure manometer 20 mL syringe three-way stopcock 18-G needle normal saline 2 intravenous extension tubes Interpretation Comp. Synd (+) pressure greater than 30 mmHg

Robert. R, Scott C., Steven J. Compartment Syndromes. Emergency Orthopedic the Extremities. 5th Ed.

Differential Comp syndr diagnosis

Pressure increase in compartment Pain on passive stretch Paresthesia or anesthesia Paresis or paralysis Pulses intact

Arterial occlusion
+

Neuro praxia
-

+ +

+
+ +

+
+ -

+
+ +

Preventive & Treatment

Preventive

Decompressing : Remove all bandages, casts, and dress. 2. Elevation max. 30 minutes
1.

Treatment Surgical : Fasciotomy : in 4 hours muscle damage in 8 hours IRREVERSIBLE damage

Appleys System of Orthopaedics and fractures

Fasciotomy of Hand
Incisions : 3 incisions (2 dorsal and 1 carpal tunnel release) can release all compartments. Dorsal (1) : Over 2nd metacarpla, dissect on both sides; release radial 2 interosseous ( 2 dorsal, 1 palmar) Dorsal (2) : Over 4th metacarpal. Dissect on both sides; release ulnar 4 interosseous ( 2 dorsal, 2 palmar) Medial : Release transverse carpal ligament, then thenar, hypothenar, & adductor compartments.

Thomson J C. Hand. Netters Concise Atlas of Orthopaedic Anatomy.

Fasciotomy of Forearm
Palmar incision Release the entire anterior compartment Dorsal incision Release the entire posterior compartment and mobile wab
Thomson J C. Hand. Netters Concise Atlas of Orthopaedic Anatomy.

Fasciotomy of Leg
Anterolateral Centered over the intermuscular septum between the anterior and lateral compartments Medial Centered over the posterior tibial border/septum between the superficial and deep posterior compartments
Thomson J C. Hand. Netters Concise Atlas of Orthopaedic Anatomy

Complications
Permanent nerve damage
Volkmann's Ischemic Contracture Infection

Amputation
Death

Robert. R, Scott C., Steven J. Compartment Syndromes. Emergency Orthopedic the Extremities. 5th Ed.