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8/12/2019 Textbook Compartment Syndrome Fix
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BY
Ivander P C111 08 285
Fitri Florentina C111 08 221Linda Muchlisha C111 08 216
Nurbaeti Bakhtiar C111 08 145
Putri A. Michiko C111 08 175
Advisor :
dr. Risqi T. Tuahuns
dr. Helmiyadi Kuswardhanadr. Sebastian Mihardja
Orthopaedic and Traumatology Department
Medical Faculty of Hasanuddin University
Makassar
2013
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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 theExtremities. 5thEd.
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Epidemiology The most commonlocations 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 theExtremities. 5thEd.
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Etiology Fractures (open &
closed)
Arterial injury & vascular
occlusion Burns
Exercise
Casting
Thomson J C. Hand. Netters
Concise Atlas of Orthopaedic
Anatomy.
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PatophisiologyAny situation that causes a decrease in compartment size
or increase in compartment pressure can initiatecompartment syndrome .
ICP capillary blood perfusion cannot maintain
tissue viability.
The local tissue ischemia leads to local edema, whichincreases intracompartmental pressure
Jobe M.T. Compartment Syndromes and Volkmann Contrature. CambellsOperative Orthopaedics.
11thEd.
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Compartment ofthe forearm
Superficial volar FCU,FDS, PL, FCR, PT
Deep volarFDP, FPL,
Pronator quadratus. Superficial dorsalAN, 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.
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Compartment of the hand
ThenarAPB, FPB,Opponens pollicis
AdductorAdductor pollicis HypothenarPB, ADM, FDMB,
ODM IntrinsicsLumbricals
Interosseous
- DIO
- PIO
Thomson J C. Hand. Netters Concise Atlas of Orthopaedic Anatomy.
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Compartment of the leg Anterior compartment extensor muscle: TA,
EDL, EHL, PT, anterior tibial a and v., deep
peroneal. n.
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.
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Sign & SymptomsClassic signs 5 P
Pain
Severe extremity painout 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.
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Paresthesia or
anesthesia to light
touch
Paralysis
Pulselessness
Not present inearly cases
Heppenstall R .B, McCombs P.R, DeLaurentis D.A. Compartment Syndrome. Rockwood and greens: Fracture in adults. 6th
. Volume I.
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Infusion technique
Robert. R, Scott C., Steven J. Compartment Syndromes. Emergency Orthopedic the Extremities. 5thEd.
Tissue Pressure Measurements
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 greaterthan 30 mmHg
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Differentialdiagnosis
Comp syndr Arterialocclusion
Neuropraxia
Pressure increase
in compartment+ - -
Pain on passivestretch + + -
Paresthesia or
anesthesia+ + +
Paresis or paralysis + + +
Pulses intact + - +
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Preventive & Treatment Preventive
1. Decompressing : Remove all bandages, casts, and dress.
2. Elevation max. 30 minutes
Treatment Surgical :
Fasciotomy :
in 4 hoursmuscle damagein 8 hoursIRREVERSIBLE damage
AppleysSystem of Orthopaedics and fractures
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Fasciotomy of Hand
Incisions : 3 incisions (2 dorsal and 1carpal tunnel release) can release allcompartments.
Dorsal (1) : Over 2ndmetacarpla, dissect on
both sides; release radial 2
interosseous ( 2 dorsal, 1 palmar) Dorsal (2) :
Over 4thmetacarpal. Dissect onboth sides; release ulnar 4interosseous ( 2 dorsal, 2 palmar)
Medial : Release transverse carpal ligament,
then thenar, hypothenar, &adductor compartments.
Thomson J C. Hand. Netters ConciseAtlas of Orthopaedic Anatomy.
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Fasciotomy of Forearm
Palmar incision
Release the entire anteriorcompartment
Dorsal incision Release the entire
posterior compartmentand mobile wab
Thomson J C. Hand. Netters ConciseAtlas of Orthopaedic Anatomy.
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Fasciotomy of Leg
Anterolateral Centered over the
intermuscular septumbetween the anterior andlateral compartments
Medial Centered over the
posterior tibialborder/septum betweenthe superficial and deep
posterior compartments
Thomson J C. Hand. Netters ConciseAtlas of Orthopaedic Anatomy
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