Ulul Azmi Rumalutur

111 2016 2040

Pembimbing : dr. M. Ali Hasti, Sp.OT
Acute Compartment Syndrome occurs when
there is elevated pressure in a closed fascial
(osteofascial) space, resulting in a critical
reduction of blood flow to the tissues
contained within.
Compartment of Forearm
Compartment of the leg
 According to The Royal Infirmary of
Edinburgh series the annual
 incidence of acute compartment syndrome
(ACS) is 3.1 per 100 000 people (7.3 per 100
000 men and 0.7 per 100 000 women, i.e. a
10-fold increase in men).
 Age is a major risk factor for developing ACS.
Patients younger than 35 years of age are
more likely than older patients to develop
ACS following the same type of injury.
Acute Compartment
Syndrome

Exertional Compartment
syndrome

Crush Syndrome
 Increased pressure
Reduced Increased external
on the compartment
Compartment Size pressure
structure
• excessive internal • Prolonged • Bleeding or
traction on compression of the vascular trauma
extremity fractures extremities • Increased capillary
• Closure of fascia • Wrap too tight permeability
defects • Lie on your arms • Excessive muscle
• gips use
• Burns
• operation
• snake bites
• venous obstruction
Normal tissue pressure

• 0-4 mm Hg
• 8 - 10 mm Hg with exertion

Absolute compartment pressure

theory
• 30mmHg - Mubarak and Hargens
• 45 mmHg - Matsen

AV gradient theory

• LBF = Pa - Pv / R
• <30mmHg diastolic pressure
 Muscle Nerve

• 3 - 4 hrs = • 2 hrs = loose

reversible nerve
damage conduction
• 6 hrs = variable • 4 hrs =
damage Neuropraxia
• 8 hrs = • 8 hrs =
irreversible irreversible
damage damage
 Pain Pallor

Pulselessness Paresthesia

Paralisis
 Radiographs
 MRI USS not routine
 Arterial doppler flow
 Pulse Oximetry
 Pressure measurements
 Suspected CS
 Equivocal or unreliable exam
 Clinical adjunct
 Raised tissue pressure is primary event in
ACS, changes in ICP will precede the clinical
signs and symptoms.

 Confirm clinical exam, Suspected

compartment syndrome
 Patients on Ventilators
 Obtunded patient with tight compartments
 Regional anesthetic
 Vascular injury
 Alcoholics, drug additcts
Non-Medicamentosa

Medicamentosa

surgical
 Clinical findings
 Pressure absolute above 30mmHg, or within
20mmHg Diastolic
 Rising tissue pressure
 >6hours of total limb ischaemia
 High risk injury
 CONTRAINDICATION - Missed CS 24-48hrs
Arterial Occlusion

Peripheral nerve
injury

Muscle rupture
Necrosis of nerves
and muscles in an Volkmann
irreversible contracture
compartment

Muscle scarring,
contractures, and
Infection
other functions
affected.
 The prognosis of
compartment
syndrome depends
on the time of
diagnosis and action.