AcuteCompartmentSyndromeMrUsmanAhmedMBBSPhDFRCS(Orth)

Trauma&OrthopaedicRegistrarBirminghamOrthopaedicTrainingProgramme

AcuteCompartmentSyndromeOsseo-fascialcompartmentpressureraisesleadingtodecreasedperfusionandirreversiblemuscle&

nervedamage-

Compartmentpressurehigherthan30mmHgorwithin30mmHgofdiastolicbloodpressure

-Needsrapidassessment&management

-SurgicalEmergency

Causes&AreasAffected•  Acutefractures•  Crushinjuries•  DislocaNons•  Followinglimbsurgicalprocedures

•  Thereisalsochroniccompartmentsyndrome

•  Arm•  Hand•  Thigh•  Leg-Mostcommon•  Foot

•  Cranium•  Abdomen

Signs&Symptoms

•  PainoutofproporNontoclinicalsituaNon•  PainwithpassivestretchismostsensiNvefindingpriortoonsetofischemia

•  Palpabletenseswelling•  MorePain•  Latesigns–  ParaesthesiaandhypoesthesiaindicaNveofnerveischemiainaffectedcompartment

–  Paralysis&absentpulses

Diagnosis

•  Diagnosisisclinical•  Compartmentpressuresmeasurements– Availabilityofmeasuringkits– Dependsonuserfamiliarity

•  HighCKmayindicatemusclenecrosis– ButthisdemonstratesthatCompartmentSyndromehasbeenmissed.

Management•  Highindexofsuspicion–earlydiagnosisiscriNcal

•  Informregistrarimmediately•  Releasecompressionbandages/cast•  Rest•  Analgesia–recordcarefully– ExcessiveanalgesiauseisasignofpotenNalCS

•  PreparepaNentforsurgery•  PaNentwillneedfasciotomies.

LegCompartmentSyndrome

Fasciotomies•  Planfasciotomywith

plasNcsurgeons•  Longincisionsto

ensurecompleterelease

•  Oncerelease,coverthewounds

•  Returntotheatreforwoundreview&closure

•  PlasNcsurgeryforgraYingifneeded

FasciotomyofThigh&Leg

ForearmFasciotomies

Prep&Drapethelimb–Markthefullextentoftheincisions

Summary

•  Compartmentsyndromeisasurgicalemergency

•  PAIN–isthecriNcalsymptom– DefinetheextentandcharacterisNcs– Thecause&Nmelineofsymptoms

•  CallregistrarearlyeventoupdateaspartofongoingevaluaNon

Thankyou!

PresentaNonavailableonh[ps://www.bon.ac.uk