Compartment Syndromes



Compartment Syndromes


Fraser Leversedge



I. Definition



  • A condition in which interstitial tissue pressures within an osteofascial compartment are elevated to sustained, nonphysiologic pressures.


  • Compartment syndrome may be considered as incipient, acute, late (delayed diagnosis), chronic/exertional, or from extrinsic compression such as from a constricting cast or splint.


II. Pathophysiology



  • In general, increasing pressure within a confined space will compromise the circulation and function of its contents.


  • The law of Laplace determines the equilibrium about the vessel wall:

    PiPo = T/R

    where Pi is the pressure inside vessel

    Po is the pressure outside vessel

    T is the vessel wall tension

    R is the radius of vessel


  • Local blood flow (LBF) is determined by the following equation:

    LBF = (PaPv)/R

    where Pa is the arterial pressure

    Pv is the venous pressure

    R is the local vascular resistance


  • Progressive pathologic alteration in compartmental physiology is described below:

    Increased compartment pressure


    Venous outflow obstruction


    Increased capillary permeability


    Increased intracompartmental pressure


    Decreased arterial perfusion


    Decreased tissue oxygenation


    Reversible ischemia


    Irreversible ischemia



III. Pertinent Anatomy

Multiple osteofascial compartments have been described for the upper extremity (below); however, subcompartmentalization of these compartments, such as the flexor digitorum profundus within the volar forearm compartment, has been observed clinically.



  • Brachium/arm (Fig. 27.1)



    • Deltoid (anterior, middle, and posterior subcompartments)


    • Anterior compartment


    • Posterior compartment


  • Antebrachium/forearm (Fig. 27.2)



    • Dorsal compartment (superficial & degs)


    • Volar compartment (superficial & degs)


    • Mobile wad


  • Hand (Fig. 27.3)



    • Carpal tunnel/distal ulnar tunnel


    • Thenar compartment


    • Hypothenar compartment


    • Dorsal and palmar interosseous compartments


    • Digit


IV. Compartment Syndrome: Etiology



  • There are many potential etiologies for the condition of compartment syndrome, including



    • Fracture or soft tissue injury (trauma)


    • Prolonged limb compression


    • Arterial injury


    • Reperfusion injury


    • Snakebite injury


    • Electrical burns


    • Hematologic disorders


    • Infections


    • Iatrogenic: excessive tourniquet ischaemia



      • Limb lengthening


      • Closure of fascial defects


      • Constrictive cast/splint/dressing


      • Complications of intraoperative positioning


      • Intermittent, exercise induced


  • Remember: Compartment syndrome can develop in the presence of an open wound.






Figure 27.1 Cross-sectional illustration demonstrating the compartments of the upper arm. (Reprinted with permission. Copyright 2009: Leversedge FJ, Goldfarb CA, and Boyer MI.)







Figure 27.2 Cross-sectional illustration demonstrating the compartments of the forearm. (Reprinted with permission. Copyright 2009: Leversedge FJ, Goldfarb CA, and Boyer MI.)






Figure 27.3 Cross-sectional illustration of the compartments of the hand. (Reprinted with permission. Copyright 2009: Leversedge FJ, Goldfarb CA, Boyer MI.)



V. Diagnostic Considerations



  • History of injury



    • Consider both intrinsic (intracompartmental bleeding/swelling) and extrinsic (tight cast or dressing) factors, which may elevate intracompartmental pressures.


    • External compression, such as from a constricting cast or splint, can contribute to the elevation of intracompartmental pressure.


  • Clinical evaluation

May 23, 2016 | Posted by in Hand surgery | Comments Off on Compartment Syndromes
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