Compartment Syndrome - PowerPoint PPT Presentation

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Compartment Syndrome

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Compartment Syndrome By Waleed M. Awwad, MD, FRCSC Compartment Syndrome Occurs when pressure in a fixed body compartment increases to level that exceeds venous ... – PowerPoint PPT presentation

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Title: Compartment Syndrome


1
Compartment Syndrome
  • By
  • Waleed M. Awwad, MD, FRCSC

2
Compartment Syndrome
  • Occurs when pressure in a fixed body compartment
    increases to level that exceeds venous pressure,
    compromising venous blood flow, and limiting
    capillary perfusion.
  • Leads to muscle ischemia and necrosis.

3
Compartment Syndrome
  • Contributing Factors
  • External
  • Conditions that reduced size of muscle
    compartment (casts/splints) occlusive dressing
    eschar of burns.
  • Internal
  • Conditions that increase compartment volume
    bleeding, swelling, fluid extravasation into
    tissue.

4
Compartment Syndrome
  • Suspect with long bone fx, crush injuries.
  • Presents as pain out of proportion to physical
    findings, /- hypoesthesia, pulselessness (late).

5
Compartment Syndrome
  • Remember the 6 Ps
  • Pain, paresthesias, paralysis, pallor,
    pulselessness, poikilothermia (cool limb).

6
Compartment Syndrome
  • History of injury.
  • Pain Out of proportion to injury
  • Tough, because you need to know how much pain is
    appropriate.
  • Paresthesias Later on.
  • Ddx Neuropraxia from direct trauma.

7
Compartment Syndrome
  • Physical examination.
  • Pain with passive stretch.
  • Pressure or tense swelling.
  • Paresis? Very late!.
  • Pulses? Almost always INTACT!
  • If absent, consider other disease process.
  • Emboli, direct arterial interruption.

8
Compartment Syndrome
  • Measure intra-compartmental pressure when
    considering compartment syndrome.

9
Compartment Syndrome
  • Management.
  • Decreases pressure by opening closed space.
  • Limb should be flat.
  • Emergency fasciotomy.
  • Often, will leave skin open because of severe
    swelling of muscles.
  • Delayed primary closure or skin graft.

10
Compartment Syndrome
  • Sequelae.
  • Irreversible damage within hours
  • To which structures in the compartment?
  • Contractures (Volkmanns).
  • Paralysis.
  • Myoglobinuria and renal failure.
  • Limb loss.

11
Compartment Syndrome
  • Simple Fracture Vs Comminuted Fractures.
  • Open Fractures.
  • Pain with Passive stretching.

12
Thank You
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