![]() Identifying high-risk patients and prompt diagnosis and treatment are critical. Compartment syndrome is a leading cause of medical malpractice lawsuits, with an unusually high percentage settled for the plaintiff (Bhattacharyya, 2004 Prasarn, 2009). Prolonged ischemia can result in irreversible damage to muscles, nerves, and the skin. Elevated compartment pressure decreases perfusion, causing muscle necrosis and nerve ischemia. With prompt diagnosis and treatment, good long term clinical results can be expectedĬompartment syndrome is an orthopedic emergency.Compartment syndrome is a clinical diagnosis and compartment measurements should only be performed in an obtunded patient or when the diagnosis is not clear.Agitation, anxiety, and an increase in analgesic needs may be the first signs of compartment syndrome in children. ![]() Children with supracondylar humerus fractures, forearm fractures, and tibia fractures are at increased risk and should be monitored closely.Compartment syndrome is one of the few orthopaedic emergencies.This can help reduce the size of the defect to be covered.Study Guide Compartment Syndrome Key Points: Careful use of elastic retention sutures (elastic vessel loop woven through skin staples) can help counteract skin contraction, and be tightened progressively as swelling resolves. This is only permissible if it can be achieved without any skin tension it is inadvisable in smokers, who have impaired capacity for soft-tissue healing.įasciotomy wound edges tend to retract and become difficult to close. It is tempting to the surgeon to try early secondary skin suture, rather than skin-graft coverage, once the swelling has subsided. The simplest and safest technique is to cover the healthy soft-tissue defect with a split skin graft: at a later date, when the limb contours have returned to normal, the grafted area can be excised and secondary skin closure performed without tension. Once any skeletal injury is under control, the fasciotomy wound(s) healthy and the swelling of the soft tissues has sufficiently regressed, consideration must be given to achieving skin coverage. Reperfusion injury is another cause of compartment syndrome. After blood flow is restored, capillaries leak and ischemic muscle swells. An arterial injury may cause compartmental tissue ischemia.Muscle tolerates short periods of hypoxia, but after a few hours, progressive necrosis begins.(MPP has also been called "Delta P", to indicate the difference between diastolic blood pressure and intramuscular pressure.) This difference in pressure reflects tissue perfusion far more reliably than the absolute intramuscular pressure. The critical measurement is muscle perfusion pressure (MPP), the difference between diastolic blood pressure (dBP) and measured intramuscular tissue pressure.if diastolic arterial pressure is not more than 30 mm Hg above tissue pressure, compartmental capillary blood flow is significantly obstructed and severe hypoxia occurs in muscle and nerve tissue.When tissue pressure approaches the diastolic pressure, capillary blood flow ceases. The capillary filling pressure is essentially diastolic arterial pressure. This critical level is the tissue pressure which collapses the capillary bed and prevents low-pressure blood flow through the capillaries and into the venous drainage. Compartment syndrome occurs when the pressure within a closed osteo-fascial muscle compartment rises above a critical level.
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