Acute Traumatic Compartment Syndrome of The

7/28/2019 Acute Traumatic Compartment Syndrome of The

1/17

P R E S E N T E D B Y

W I N D I P E R T I W I2 0 0 7 0 3 1 0 1 2 8

S U P E R V I S I N G D O C T O R

D R . L . H A R T O K O B . , S P . O T

Acute Traumatic CompartmentSyndrome of the

Leg in Children: Diagnosis andOutcome

(M. Flynn, MD, Ravi K. Bashyal, MD, Meira Yeger-McKeever, MD, Matthew R. Garner, MD,

Franck Launay, MD, and Paul D ; THE JOURNAL OF BONE AND JOINT SURGERY, 2011)


2/17

COMPARTMENT SYNDROME

Compartment syndrome represent elevatedcompartment pressures within a soft tissue envelopeof an extremity and commonly follows significant

trauma and increased pressures lead to ischemia andmay lead to irreversible injury to muscle and nerve.


3/17


4/17

E

T

IO

L

OG

Y


5/17

PATHOPHYSIOLOGY


6/17

CLINICAL FINDING

The classic features of ischaemia are the five Ps:

Pain

Paraesthesia

Pallor Paralysis

Pulselessness.


7/17

DIAGNOSIS

Diagnosis of compartment syndrome can be made by theclinical finding and the confirmation of the diagnosis can bemade by measuring the intracompartmental pressures.


8/17

TREATMENT

The threatened compartment (or compartments) must be promptlydecompressed.

The P should be carefully monitored; if its less than 30 mmHg,immediate open fasciotomy is performed.

In the case of the leg, fasciotomy means opening all fourcompartments through medial and lateral incisions.

The wounds should be left open and inspected 2 days later:

a. if there is muscle necrosis, debridement can be carried out;

b.If the tissues are healthy, the wounds can be sutured(without tension)

or skin-grafted.


9/17


10/17

ACUTE TRAUMATIC COMPARTMENT SYNDROMEof the LEG in CHILDREN : DIAGNOSIS and

TREATMENT

BACKGROUND

The most common clinical case for compartment syndrome inchildren is acute compartment syndrome in the leg

METHODS

43 cases of acute traumatic syndrome collected over 17 yearperiod. All children with acute traumatic compartment

syndrome underwent fasciotomy. The mechanism of injury, date and time of injury, time to

diagnosis, compartment pressures, time to fasciotomy, andoutcome at the time of the latest follow-up were recorded


11/17

42 patients and all were treated with fasciotomy. The study group included 37 male and 5 female patients

ranging in age from 4 months to 17 years old.

Thirty-five (83%) of the forty-two patients presented

following a motor-vehicle accident Thirtyfive (83%) of the forty-two patients sustained an

ipsilateral tibial fracture, five (12%) sustained an ipsilateralfemoral fracture, and two (5%) sustained a gunshot wound

with no fracture.


12/17

Symptoms at the time of diagnosis varied.

a. Increasing leg pain was noted in forty cases(93%) ,

b. paresthesias were noted in eleven cases (26%),

c. muscle weakness was noted in seven cases (16%),

d. absent or diminished pulses were noted in six cases (14%).

Compartment pressures were measured prior to fasciotomy in thirty-three (77%) of the forty-three cases. In all thirty-three cases,intracompartmental pressures of>30 mm Hg were measured in at least

one compartment.


13/17


14/17


15/17

DISCUSSION

In this research, all patients underwent fasciotomy

There were no cases of infection.

All patients who had fasciotomy within 27 hours after theinjury had full functional recovery at the time of the latestfollow-up,

In summary, acute traumatic compartment syndrome ofthe leg in the skeletally immature patient is an acutesurgical emergency that demands prompt fasciotomy on

diagnosis.

And good results can be achieved even when fasciotomy isperformed in the acute swelling phase, often twenty-four toforty-eight hours after the initial injury in pediatric

patients.


16/17


17/17

Acute Traumatic Compartment Syndrome of The

Documents

Transcript of Acute Traumatic Compartment Syndrome of The