By Waleed M. Awwad, MD, FRCSC Compartment Syndrome By Waleed M. Awwad, MD, FRCSC

Compartment Syndrome Occurs when pressure in a fixed body compartment increases to level that exceeds venous pressure, compromising venous blood flow, and limiting capillary perfusion. Leads to muscle ischemia and necrosis.

Compartment Syndrome Contributing Factors External: Internal: Conditions that reduced size of muscle compartment (casts/splints); occlusive dressing; eschar of burns. Internal: Conditions that increase compartment volume: bleeding, swelling, fluid extravasation into tissue.

Compartment Syndrome Suspect with long bone fx, crush injuries. Presents as pain out of proportion to physical findings, +/- hypoesthesia, pulselessness (late).

Compartment Syndrome Remember the 6 P’s Pain, paresthesias, paralysis, pallor, pulselessness, poikilothermia (cool limb).

Compartment Syndrome History of injury. Pain: Out of proportion to injury Tough, because you need to know how much pain is “appropriate”. Paresthesias: Later on. Ddx: Neuropraxia from direct trauma.

Compartment Syndrome Physical examination. Pain with passive stretch. Pressure or tense swelling. Paresis? Very late!. Pulses? Almost always INTACT! If absent, consider other disease process. Emboli, direct arterial interruption.

Compartment Syndrome Measure intra-compartmental pressure when considering compartment syndrome.

Compartment Syndrome Management. Decreases pressure by opening “closed space”. Limb should be flat. Emergency fasciotomy. Often, will leave skin open because of severe swelling of muscles. Delayed primary closure or skin graft.

Compartment Syndrome Sequelae. Irreversible damage within hours To which structures in the compartment? Contractures (Volkmann’s). Paralysis. Myoglobinuria and renal failure. Limb loss.

Compartment Syndrome Simple Fracture Vs Comminuted Fractures. Open Fractures. Pain with Passive stretching.

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