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COMPARTMENT SYNDROME

PRESENTED BY :

ARI ANDINIANA ZAHARINA HASYIMNUR NAJWA SARONIDEWI YUNITA DONERMUHAMMAD IDHAM

ADVISOR :DR SALMAN AL WAHABYDR FENDYDR IRA NONGDR RIZAN

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DefinitionCompartment syndrome is a condition characterized

by raised pressure within a closed space with a potential to cause irreversible damage to the contentsof the closed space

Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma,

Basic Science, Management and Reconstruction 4 th edition. p: 341-363

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A Transverse Section Through The forearm

Anatomy

Greys anatomy

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PathophysiologyIncreased

compartment content

Decreased

compartment size

Shock

Elevation of extreamity

Increased intracompartmental pressure

vasopsamsIncreased

venouspressure

Increasedcapillarypressure

Increasedexudation

Decreasedperfussionpressure

Decreased tissueperfussion

Muscle andnerve necrosis

Increased capillarypermeability

Decreased arteriolar pressure

Closure of arterioles

Decreased arteriolar transmuralpressure difference

Prasarn, M. Ouellette,E. Acute Compartment Syndrome of The Upper Extremity. J Am Acad Orthop Surg . 2011. p: 49-53

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Nerve Ischemia

1 hour - normal conduction 1- 4 hours - neuropraxic damage reversible 8 hours - axonotmesis and irreversible change

Hargens et al. JBJS 1979

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Pain- Passive muscle stretching- Out of proportion- Progressive

- Not relieved by immobilization Pallor / paleness Pulselessness Parasthesia

- Secondary to nerve ischemia Paralysis (Weakness)

- Ischemic muscles lose function

Sign and Symptoms

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Look : swollen compartment, bullae (+), the overlying skin can be shiny Palpation : tenderness (+), pain referred to a compartment on passive

stretching

Physical examination

Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma,

Basic Science, Management and Reconstruction 4th

edition. p: 341-363

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pain referred to a compartment on passive stretching of the digits

Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma,

Basic Science, Management and Reconstruction 4th

edition. p: 341-363

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NVD : hypesthesia in the territory of the rst webspace, presence of normal capillary refill and palpable

Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma,

Basic Science, Management and Reconstruction 4th

edition. p: 341-363

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Compartment Pressure Measurement

Normal ICP of healthy muscle is 10-12 mmHg. Compartment pressures can be measured to aid in the

diagnosis Values of absolute pressure greater than 30 mm Hg or

those within 20 mm Hg of the diastolic pressure shouldraise suspicion of a compartment syndrome

Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma, Basic Science, Management and Reconstruction 4 th edition. p: 341-363

Miller MD, Thompson SR, Hart JA. Compartment syndrome . In Miller MD, Thompson SR, Hart JA edittors, Review of

Orthopaedics Sixth Edition. Elsevier. p; 578 Prasarn, M. Ouellette,E. Acute Compartment Syndrome of The Upper Extremity. J Am Acad Orthop Surg . 2011. p: 49-53

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Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma, Basic Science, Management and Reconstruction 4 th edition. p: 341-363

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Treatment

Elevation

Fasciotomy

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Treatment

Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma, Basic Science, Management and Reconstruction 4 th edition. p: 341-363

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Fasciotomy Compartment syndrome occur in almost any muscular area Principles- Release all compartment in a limb- Leave all layers open- Stabilize rigidly fractures underneath- Debride necrotic tissue- Second look in 48 hr for more necrotic tissue

Twaddle BC, Amendola A . Compartment Syndromes, In: Browner, Jupiter, Levine, Tralton, Krettek editors. Skeletal Trauma, Basic Science, Management and Reconstruction 4 th edition. p: 341-363

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Complications

1. Volkmans Ischemic Contracture2. Infection

3. Amputation

Prasarn, M. Ouellette,E. Acute Compartment Syndrome of The Upper Extremity. J Am Acad Orthop Surg . 2011. p: 49-53

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THANK YOU