COMPARTMENT

SYNDROMES

dr. Jufri Latief, Sp.B., Sp.OT

Bagian Ortopedi & Traumatologi

Fakultas Kedokteran Universitas Hasanuddin
Makassar, 2006
 DEFINITION
Increase pressure within a comfined space
(osteofascial space) that leads to
microvasculary compromise and ultimately
to cell death or tissue death
 ETIOLOGY
1. Trauma
Fracture
Hematoma
Gunshot (stab wounds)
Animal/Insect bites/Snack
bites
Post ischemic swelling
Crush injuries
Vascular damage
Electric injuries
2. Edema related
Nephrotic syndrome
Frosbite (trauma dingin)
Burns
Over use injuries (over
training)
Prolonged tourniquet
Mast trousers (celana
ketat)
3. Coagulopathies
Genetic / hemophilia
Iathrogenic
Acquired coagulopathies
4. Others
External compression / most
trousers, cast, thight dressings)
Thight closure of fascial defects
Burn-hypo / hiperthermia /
combustio
Lost of conciousness (drug
overdose resulting in lying on
limb four hours)
Infected : clostridiu perfringeus /
walchii (gas ganggren)
 ANATOMICAL LOCATION
Forearm
The most common site
Anterior compartment of the leg
Abdominal compartment syndrome
Hand and wrist compartment
syndrome
Thigh compartment syndrome
Foot compartment syndrome
 PATOPHYSIOLOGY
Vascular congestion capillary
beds occludedmuscle & nerve
ischemiatransudation of colloid
plasma into the surrounding tissues
increase of tissue pressurearterial
impaired (ellipsoid theory)
 CLINICAL PRESENTATION
Pain (pain out of proportion)
Paresthesias / anesthesia (dont pin prick test,
because fibers smallerst, use two point
discrimination test)
Passive strestch severe pain
Pressure tenderness
PulsessnesThis is least releable of the
examination are frequently not affective (a
disorders microvasculature, major vessel)
 DIAGNOSIS
Clinical presentation
Measurement
Whick catheter technique
Slit catheter technique
Stic catheter technique
Continous infusion technique
Needle manometer technique
Normal pressure = 20-30 mmHg
>30 mmHg need fasciotomy
Necrosis of the muscle happened 8 hours in 30 mmHg intra compartement
pressure
Lab
CPK, B.U.N., creatinin, aldolase, SGOT, LDH
Urine
Myoglobinuria, oliguria
EMG
SSEP
 PROPER INITIAL
MANAGEMENT
Constrictive dressing should be removed or splint
Circumferential cast should be valued
Limb should be placed at the level of the heart
 DEFINITIVE TREATMENT
Fasciotomy = skin & fascia are left open on > 30
mmHg pressure
Prophylactic fasciotomy should be performed on
Tibial osteotomy
Leg lenghtening
Arterial repair
Open tibial fracture
Genereous fluids (IVFD)
Alkalization urine by : bicarbonates or
acetazolamide
Antibiotic
 COMPLICATION
Local
ischemic contracture
General
Renal failure
Cardiac arrest
Septicemia / septic shock
Death
 Patophysiology and cause death of compartment
syndromes
Trauma / injury

Swelling / increases pressure in osteofascial

space

Microcirculation cuts off

Hypoxia Sistemic complication

Fasciotomy Cell / tissue death Infection

Pressure released K+ Release from cell Septicemia

Referfussion Hyper kalemia Septic shock

Myoglobulin in the muscle

released Cardiac arrest

Precitates in the renal tubule

Renal Failure