COMPARTMENT SYNDROME DONE BY ASIM MAKHDOM 25Nov2008 ORTHOPEDIC

COMPARTMENT SYNDROME DONE BY : ASIM MAKHDOM 25/Nov/2008 ORTHOPEDIC H. O

Background ntracture : olkmann. 1872 (documented nerve injury and subsequent contracture from CS following supracondylar fracture. That injury remains known as Volkmann contracture. ) Approximately 50 years after von. Volkmann, Jepson described ischemic contractures in dog hind legs resulting from limb hypertension after experimentally induced venous obstruction

in the 1970 s, the importance of measuring intracompartmental pressures became apparent.

Definition Compartment syndrome (CS) is a limbthreatening and life-threatening condition observed when perfusion pressure falls below tissue pressure in a closed anatomic space

Location

maintain a high level of suspicion when dealing with complaints of extremity pain

e Pathophysiology perfusion until no oxygen is available for cellular

Tissue perfusion is determined by measuring capillary perfusion pressure (CPP) minus the interstitial fluid pressure (TP=CPP-IFP) (Normal cellular metabolism requires 5 -7 mm. Hg oxygen tension )

this is easily maintained with the CPP averaging itial pressure 4 -6 mm Hg SO racompartmental pressures greater than 30 lly agreed to require intervention

At this point, blood flow through the no oxygen ischemic injury release of chemical mediator Increased ICP Muscle necrosis Nerve injury Decreased PH myoglobin RF Death

Frequency

Mortality/Morbidity depends on both the diagnosis and the time from plete recovery of limb function if otomy was performed within 6 hours

SEX

HX The traditional 5 Ps (ie, pain, paraesthesia, pallor, poikilothermia, pulselessness) are not diagnostic of CS. Literature warns that, with the exception of pain and paraesthesia, these traditional signs are not reliable, and the presence or absence of them should not affect injury management

Importantly, note that these symptoms assume a conscious patient who did not suffer any additional injury that hinders sensory input (eg, spinal cord injury

Determine the mechanism of injury. -Penetrating injuries (eg, gunshot wounds, stabbings) Often cause arterial injury, which can quickly lead to CS -Venous injury - May cause CS (do not be misled by palpable pulses)

Anticoagulation therapy 1 - simple venipuncture in an anticoagulated 2 - MINOR TRUMA

Physical EXAM passive stretching of the muscles, is the earliest clinical indicator of CS

SENSORY EXAMPLE THEN MOTOR deep peroneal nerve

(Etiology and diff)

lab 1 - metabolic profile 2 - creatinine/ urine myoglobin 3 - serum myoglobin 4 - PT /PTT 5 - urine analysis

imaging 1_x-ray 2_u/s to rule out other diff

Compartment pressure measurement the most helpful test and should be done ASAP

MANAGEMENT 1_ oxygen mask 2_ don’t elevate the affected limb more than 35 cm arterial pressue by 23 mm. Hg and no change in the ICP 3_hydaration 4_fasciotomy(definitive therpy)

when the fascitomy applied ؟؟

Delta-p is a measure of perfusion pressure (diastolic blood pressure minus intracompartmental pressure). Originally used in dogs, delta-p measurements of less than 30 mm Hg were used by Mc. Queen (1996) for fasciotomy. As a result, several patients with intracompartmental pressures of 40 mm Hg or greater were observed because the delta-p was greater than 30 mm Hg. Criteria were used in 116 patients without sequelae. The converse also is true, since patients with intracompartmental pressures less than 30 mm Hg but with high delta-p values have developed CS.

Complications damage - Cosmetic deformity post fasciotomy

prognosis

Patient education

Patient education Really we should apply this to all discharged pt.

THANKS FOR EVERY ONE