Compartment syndrome - is increased tissue pressure within a tight fascial compartment, resulting in tissue ischemia.
- commonly occurs in the anterior lower leg.
Pathology:
- compartment syndrome is the self progressive cascade of events, begin with tissue edema that usually occur following injury.
- when edema occur in anterior or posterior fascial compartment, there is limit room for tissues expansion and compartment/interstitial pressure increase.
- when compartment pressure exceeded 20 mmHg, tissue perfusion decrease or cease.
- because 20 mmHg is very low than arterial blood pressure, cellular flow can be occluded before pulse loss.
- as a result of occluded blood flow tissues ischemia develop and further worsening edema in a vicious cycle.
Aetiology:
Common cause of compartment syndrome include,
- fractures
- severe contusion
- rarely spiders and snakes bites
Symptoms :
- the early symptom are the progressive pain, worse in leg muscles stretching.
- later symptoms of ischemia are "5 P's" which includes ,
Diagnosis:
- commonly occurs in the anterior lower leg.
Pathology:
- compartment syndrome is the self progressive cascade of events, begin with tissue edema that usually occur following injury.
- when edema occur in anterior or posterior fascial compartment, there is limit room for tissues expansion and compartment/interstitial pressure increase.
- when compartment pressure exceeded 20 mmHg, tissue perfusion decrease or cease.
- because 20 mmHg is very low than arterial blood pressure, cellular flow can be occluded before pulse loss.
- as a result of occluded blood flow tissues ischemia develop and further worsening edema in a vicious cycle.
Aetiology:
Common cause of compartment syndrome include,
- fractures
- severe contusion
- rarely spiders and snakes bites
Symptoms :
- the early symptom are the progressive pain, worse in leg muscles stretching.
- later symptoms of ischemia are "5 P's" which includes ,
- Pain
- Paresthesias
- Paralysis
- Pallor
- Pulselessness
- measure compartment pressure ( normal is <_ 20mmHg ) by using wick catheter.
Treatment:
- for <40 mmHg raised compartment pressure, Antipain drugs, elevation and spilnting can be done.
- for >40 mmHg increased compartment pressure, immediate fasciotomy is done to relieve pressure.
- in some cases pulselessness or pallor develop, indicating necrosis. Amputation is needed in cases of necrosis.
Complications:
- necrosis
- infection
- amputation
- rhabdomyolysis.
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