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Compartment Syndrome

Mr.K.R.Rajesh, FRCS, MS, 2000

 

Defined as a condition in which the circulation and function of tissues within a closed space are compromised by an increased pressure within that compartment (Rockwood & Green).

A prerequisite for the development of increased tissue pressure is an envelope restricting the volume available to the enclosed tissue. Such envelopes include the epimysium, the fascia, the skin, and casts or other circumferential dressings. Examples of fascial envelopes include those surrounding the volar compartment of the forearm, the anterior compartment of the leg, and the deep posterior compartment of the leg.


Does this mean that C.S. (as it is affectionately known) occurs only in closed injuries?

Blick,Brumback,Poka - JBJS Am 1986 Dec ;68(9):1348-53 -198 open fractures. Incidence of C.S 9.1% and directly proportional to degree of injury -hence more in comminuted and type 3 open fractures.

This is because the muscles are still in their own separate compartments; tightly invested with the fascia covering them.

Volksmann (1881) suggested that paralysis and contracture of limbs "too tightly bandaged" resulted from ischemic change of the muscles.

Matsen (Compartment syndrome-a unified concept.Clin Orth, 113: 8-14,1975) suggested the following mechanism.

(1) Decreased compartment size - tight dressing

localised external pressure

closure of fascial defects

(2) Increased compartmental contents

Bleeding -vasc injury, bleeding disorders

­ ­  capillary permeability-

  • post ischemic swelling
  • exercise
  • trauma
  • burns
  • Intra-arterial drugs

­  capillary pressure

  • exercise, venous obstruction,
  • Muscle hypertrophy
  • Infiltration of infusions
  • Nephrotic syndrome

 




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