2. Compartment Syndrome N540B Spring 2007 Mary Gaspar

3. Overview of Compartment Syndrome Compartment syndrome occurs when blood supply is dramatically reduced to muscles in a closed body space, known as a compartment. Compartments are found in the hand, forearm, upper arm, abdomen, buttock and leg. The muscles most frequently involved are those on the front of the lower leg or palm side of the forearm.

4. Bleeding from a bone fracture Burn eschar Casts applied too tightly Crush injuries Leaking of IVF into the compartment Seizures that involve the muscles in a compartment Snake bite Swelling of the muscle itself Common causes of CS include:

5. What’s going on in the body? Compartments are groups of muscles surrounded by inelastic fascia. Increased pressure within a muscle compartment causes decreased blood supply to affected muscles. Any swelling of muscles leaves no room for expansion and blood supply is progressively shut off. If affected muscles are deprived of blood supply for > 6 hours, nerve and muscle tissue can be permanently damaged.

6. Hallmark Symptoms of Compartment Syndrome Severe pain or parasthesia disproportionate to the injury Increase in pain after pain medication has been administered. In severe cases there may be decreased sensation, weakness and paleness of the skin.

7. History and Physical Exam: Look for the 6 P’s Subjective info: Pain Pressure Parasthesia Objective info: Pallor Pulselessness Paresis

8. Why is compartment syndrome an emergency? If not diagnosed and treated promptly there can be permanent nerve injury and loss of muscle function. Permanent nerve injury can occur after 12-24 hours. In severe cases limbs may need to be amputated because all of the muscles in the compartment have died from lack of O2.

9. Diagnosis A swollen limb, tense on palpation, in an intrinsic minimus position strongly indicates compartment syndrome. Diagnosis is based on high degree of clinical suspicion

10. Treatment A surgical procedure known as fasciotomy may be used to open the membrane leading to the affected muscles. Pressure is relieved and the blood flow can return to normal. Often the skin needs to be left open for a few days. It can be closed with sutures or a skin graft after swelling diminishes.

11. Prognosis Accurate and prompt diagnosis is necessary to assure a good outcome. Only 8% of patients will regain function if surgery is delayed. Little or no return of function can be expected if dx and tx are delayed. Surgery performed days after injury contraindicated due to severe infection and difficulty in managing necrotic muscle. If surgery performed within 12 hours after onset of acute CS, prognosis is good.

12. References: http://orthoinfo.aaos.org/fact/thr_report. cfm?thread_id=287&topcategory=Genera l%20Information http://orthoinfo.aaos.org/fact/thr_report. cfm?thread_id=287&topcategory=Genera l%20Information http://www.emedicine.com/EMERG/topic7 39.htm http://www.emedicine.com/EMERG/topic7 39.htm http://www.rice.edu/~jenky/sports/cmpt. html http://www.rice.edu/~jenky/sports/cmpt. html http://health.allrefer.com/health/compart ment-syndrome-info.html

13. Test Question Iva Tript fell in her home and fractured her leg. She was found by her neighbor 36 hours after her fall. Her lower extremity was pale, numb and without peripheral pulses. Which of the following constitutes appropriate treatment for Iva’s diagnosis of compartment syndrome? A. Cast her leg, give her medicine for pain and have her return for follow-up in 1 week. B. Fasciotomy to be performed within 12 hours of hospital admission and her prognosis for recovery of function is good. C. Surgery to regain function of her leg is no longer possible. Her leg must be amputated. D. Iva is a candidate for surgery but should be informed that her chances of regaining function are about 8%.