8/12/2019 Textbook Compartment Syndrome Fix

1/18

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

8/12/2019 Textbook Compartment Syndrome Fix

2/18

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.

8/12/2019 Textbook Compartment Syndrome Fix

3/18

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.

8/12/2019 Textbook Compartment Syndrome Fix

4/18

Etiology Fractures (open &

closed)

Arterial injury & vascular

occlusion Burns

Exercise

Casting

Thomson J C. Hand. Netters

Concise Atlas of Orthopaedic

Anatomy.

8/12/2019 Textbook Compartment Syndrome Fix

5/18

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.

8/12/2019 Textbook Compartment Syndrome Fix

6/18

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.

8/12/2019 Textbook Compartment Syndrome Fix

7/18

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.

8/12/2019 Textbook Compartment Syndrome Fix

8/18

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.

8/12/2019 Textbook Compartment Syndrome Fix

9/18

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.

8/12/2019 Textbook Compartment Syndrome Fix

10/18

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.

8/12/2019 Textbook Compartment Syndrome Fix

11/18

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

8/12/2019 Textbook Compartment Syndrome Fix

12/18

Differentialdiagnosis

Comp syndr Arterialocclusion

Neuropraxia

Pressure increase

in compartment+ - -

Pain on passivestretch + + -

Paresthesia or

anesthesia+ + +

Paresis or paralysis + + +

Pulses intact + - +

8/12/2019 Textbook Compartment Syndrome Fix

13/18

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

8/12/2019 Textbook Compartment Syndrome Fix

14/18

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.

8/12/2019 Textbook Compartment Syndrome Fix

15/18

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.

8/12/2019 Textbook Compartment Syndrome Fix

16/18

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

8/12/2019 Textbook Compartment Syndrome Fix

17/18

8/12/2019 Textbook Compartment Syndrome Fix

18/18