COMPARTMENT SYNDROME
COMPARTMENT SYNDROME
- The limbs contain muscles in compartments enclosed by bones, fascia and interosseous membrane.
- A rise in pressure within these compartments due to any reason.
- May jeopardize the blood supply to the muscles and nerves within the compartment.
- Resulting in what is known as “compartment syndrome”.
Causes:
- The rise in compartment pressure can be due to any of the following reasons:
- Any injury leading to oedema of muscles.
- Fracture haematoma within the compartment.
- Ischaemia to the compartment, leading to muscle oedema.
Consequences:
- The increased pressure within the compartment compromises the circulation leading to further muscle ischaemia.
- A vicious cycle is thus initiated and continues until the total vascularity of the muscles and nerves within the compartment is jeopardized.
- This results in ischaemic muscle necrosis and nerve damage.
- The necrotic muscles undergo healing with fibrosis, leading to contractures.
- Nerve damage may result in motor and sensory loss.
- In an extreme case, gangrene may occur.
Diagnosis:
- Diagnosed early by high index of suspicion.
Injuries with a high risk of developing compartment syndrome are as follows:
- Supracondylar fracture of the humerus
- Forearm bone fractures
- Closed tibial fractures
- Crush injuries to leg and forearm.
Stretch test:
- This is the earliest sign of impending compartment syndrome.
- The ischaemic muscles when stretched, give rise to pain.
- It is possible to stretch the affected muscles by passively moving the joints in direction opposite to that of the damaged muscle’s action.
- (e.g., passive extension of fingers produces pain in flexor compartment of the forearm).
- Other signs include a tense compartment, hypo aesthesia in the distribution of involved nerves, muscle weakness etc.
- Compartment syndrome can be confirmed by measuring compartment pressure.
- A pressure higher than 40 mm of water is indicative of compartment syndrome.
- Pulses may remain palpable till very late in impending compartment syndrome.
Treatment:
- Effective early preventive measures like limb elevation, active finger movements etc. can prevent this serious complication.
- Early surgical decompression is necessary in established cases.
This can be performed by the following methods:
- Fasciotomy: The deep fascia of the compartment is slit longitudinally (e.g., in forearm).
- Fibulectomy: The middle third of the fibula is excised in order to decompress all compartments of the leg.
Exam Important
- Fractures is the commonest cause of anterior compartment syndrome.
- Pain on passive stretch is reliable sign of compartment syndrome.
- Most common cause of acute compartment syndrome in children is Fracture supracondylar humerus
- Foot inversion causes weakness in deep posterior compartment syndrome.
- Dorsiflexion of foot causes pain in deep posterior compartment syndrome.
- In posterior compartment syndrome Toe dorsiflexion can cause pain.
- Interstitial pressure > capillary pressure in compartment syndrome.
- Indication for surgical compartment release in compartment Syndrome in any compartment is absolute pressure greater than 30 mm Hg.
- Hyperesthesia is seen in compartment syndrome.
- Fasciotomy is earliest management in compartment syndrome.
- Hyperbaric oxygen is useful in compartment syndrome.
- Fasciotomy, Splitting of tight pop cast & Reexploration are relevant in compartment syndrome.
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