Compartment Syndrome

Last updated 03.11.12

 

Index

 

Definition

-   

 

Features

-  Surgical emergency

-  Limb & life threatening (ARF --> death)

-  Perfusion pressure < tissue pressure

-  Can occur in hand, forearm, upper arm, abdomen, buttock and entire lower extremity

 

Causes

-  Trauma

-  Burns

-  Intra-arterial injection

-  Long bone fracture

-  Vascular injury

-  Envenomations

-  Anti-coagulation therapy

-  Casts/Splints which are too tight

 

Associated S/S

-  Clinical Dx

-  Pain out of proportion to injury

-  May occur at rest without movement

-  Pain on passive stretching

-  Not improved with analgesia

-  Paresthesia: burning, tightness

-  Neurovascular compromise: peripheral pulses, decreased strength --> paralysis in limb

-  Irreversible nerv damage within 6 hours

-  Rhabdomyolysis

 

Ix

-  Intercompartmental pressure

-  U&E: ARF (rhabdomyolysis)

-  CK: raised

-  Urinalysis: rhabdomyolysis

-  Urine & serum myoglobin: rhabdomyolysis

-  Co-ags: PT, APTT

-  Plain film X-Ray of limb

-  Ultrasound + Doppler

 

Mx

-  Keep limb at level of body (ie: supine, no elevation)

-  Pressure release of casts/splints as needed

-  Circumferential casts

-  x2 cuts longitudinally 8mm --> split to 15mm

-  OR bilaterally to form x2 splints

-  Slabs: cut bandages/padding

-  Not relieved untl skin visible end to end

-  IV fluids

-  Fasciotomy: definitive therapy

-  Mx of rhabdomyolysis

 

Fasciotomy

 

 

 

References

 

RACS – ASSET Course 2013