COMPARTMENT SYNDROME - DNB Orthopaedics MS Orthopedics MRCS Exam GUIDE -

DNB Orthopaedics  MS Orthopedics  MRCS Exam GUIDE -

Orthopaedic Guidance for DNB Orthopaedics,MS Orthopaedics and Mrcs exams.Cme courses for orthopaedic surgeons.Davangere notes,solved question papers.DNB Ortho,MS Ortho MRCS,Exam Guide videos and notes 9087747888


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Saturday 31 March 2018



  • condition in which accumulating fluid and external compression – creates high pressure – within a closed osteofascial compartment – reducing perfusion of tissues with in that compartment – below a level necessary for viability
  • compartments with non compliant fascial or osseous structures most commonly involved
    • anterior and deep posterior compartments of leg
    • volar compartment of forearm
  • if pressure remains high for a long period : normal function of muscles, nerves affected – necrosis – permanent loss of functions – Volkmann's limb contracture occurs
Acute compartment syndrome
  • severe form – following trauma – intra compartmental pressure elevated to high level for long period – enough to impede capillary permeability
  • c/c exertional compartment syndrome : recurrence of increased pressure and exercise related
  • decrease in compartment size or increase in compartment pressure
  • capillary blood perfusion decrease
  • tissue viability compromised
  • local tissue necrosis – local tissue edema – further increase in pressure – vicious cycle

  • increase in compartment content volume
    • soft tissue injuries
    • osteotomies - #
    • bleeding disorders – burns – snake bite
    • c/c limb compression in drug addicts
    • post ischemic swelling following arterial occlusion
    • massive fluid resuscitation in critically injured
    • inadvertent use of hypertonic saline for regional anaesthesia
    • fluid pumps during arthroscopy
    • intra osseous fluid administration in children
  • decrease in compartment size
    • extrinsic
      • tight cast / bandage
      • non compliant eschar in severe burns
      • inadvertent closure of fascia
    • intrinsic
      • stretching of the relaxed compartment as in IM nailing in non union leg #
Clinical features and diagnosis
  • pain
  • swollen, tense and tender
  • altered sensation esp impaired two point discrimination and vibration sense
  • peripheral pulses palpable (unless major arterial injury) – skin circulation will be satisfactory – problem lies in capillary circulation
  • D/D
    • arterial injury : no pulse
    • peripheral nerve injury : no stretch pain
  • monitoring of compartment pressure
    • Whiteside technique
    • Wick catheter
    • Slit catheter
    • Stryker hand held apparatus
  • Fasciotomy if >30mm Hg (Mubarak)

  • impending compartment syndrome
    • release constrictive dressing
    • fluid replacement with crystalloid/colloid to maintain BP
    • blood transfusion
    • platelet and plasma replacement by maintenance of coagulability
    • limb kept at level of heart
      • produce maximum arteriovenous gradient
      • limb elevation : decrease arterial inflow without significant reduction in venous volume – further decrease perfusion
    • prophylactic fasciotomy : in high probability of developing compartment syndrome – if symptoms does not resolve with in 30-60 mts
  • compartment syndrome
    • fasciotomy
      • indications
        • normotensive with positive clinical finding
        • >30 mm Hg compartment pressure
        • duration of increased pressure unknown or >8hrs
        • with low BP and compartment pressure >20mm Hg
  • when in doubt compartment should be released
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