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d

Impending Volkmann’s ischemia is detected by 6Ps

• Pain

• Pallor

• Paresthesia

• Paralysis

• Pulselessness

• Positive passive stretch test

c

The earliest of the ‘classic’ features are

pain (or a ‘bursting’ sensation), altered sensibility

and paresis (or, more usually, weakness in active

muscle contraction).

Skin sensation should be carefully and repeatedly checked.

Ischaemic muscle is highly sensitive to stretch,

so when the toes or fingers are passively

hyperextended, there is increased pain in the calf

or forearm

Fractures of the arm or leg can give rise to severe ischaemia even if there is no damage to a major vessel. Bleeding, oedema or inflammation (infection) may increase the pressure within one of the osteofascial compartments; there is reduced capillary flow which results in muscle ischaemia, further oedema, still greater pressure and yet more profound ischaemia – a vicious circle that ends, after 12 hours or less, in necrosis of nerve and muscle within the compartment. Nerve is capable of regeneration but muscle, once infarcted, can never recover and is replaced by inelastic fibrous tissue (Volkmann’s ischaemic contracture)

Pathophysiology

External or internal constrictions →

↑ Arterial spasm or occlusion →

Causes muscle ischemia →

↑ Capillary permeability →

↑ Intramuscular edema →

↑ Intramuscular pressure →

Further arterial compromise → Muscle necrosis →

Replaced by collagen → Contractures

e

Confirmation of the diagnosis

can be made by measuring the intracompartmental pressure Methods to Record Intracompartmental Pressure

In any patient with forearm or leg injuries who has a tense compartment and if the patient is unreliable or unresponsive(unconscious),

the intracompartmental pressure should be recorded by using a needle manometer,

wick or slick, the pressure

is measured close to the level of the fracture.

VOLKMANN’S ISCHEMIA OR

COMPARTMENTAL SYNDROMES

a

Management

with The Author

Write Your Book

”INTRODUCTION

What is compartment?

Muscle are arranged in different compartments and surrounded by one fascia,

this arrangement is called osteofascial compartment.

Normal compartment pressure: 5-15 mmHg

Bushra Jamal Mohsen, B4

Istabraq Faris Radhi, B3

Tuqa Akram Mohsen, B3

6 August 2023

Types of compartment syndrome:

Early complications may present as part of the primary Injury or may appear only after a few days or weeks..

Is an elevation of interstitial pressure in a closed osseofascial compartment that results in microvascular compromise

and may cause irreversible damage to the contents

of the space.

Add subtitle here

Acute compartment syndrome

Medical emergency.

Is associated with trauma to the affected compartment.

Can lead to permanent muscle damage.

Chronic compartment syndrome

Known as exertional compartment syndrome.

Not a medical emergency.

Most often caused by exercise & relieve by rest

References

Compartment of leg

Sites of body involved:

1)Textbook of Orthopedics,Fourth Edition

John Ebnezar,MBBS D’Ortho, DNB (Ortho), MNAMS (Ortho), DAc, DMT, PhD

1. Anterior and deep posterior compartments of the

Legs.

2. Volar compartment of the forearm

3. Buttocks, shoulder, hand, foot, arm and lumbar

Paraspinous muscles are relatively rare sites

b

A fracture at this level is always dangerous.

2) Apley and Solomon’s Concise System of Orthopaedics and Trauma

FOURTH EDITION

f

Etiology of compartment syndrome

1) Trauma

fractures (most common)

Blunt trauma

Crush injuries

Gunshot wounds

2) Tight dressings .

3) Tight casts or splints.

4) Circumferential burn. .

5) Bleeding disorder or arterial injury .

6) Infection & inflammation .

Complication:

1.Myonecrosis.

2.Volkmann ischemic contracture .

3.Neurovascular injury.

4.Infection.

5.Amputation .

6.Rhabdomyolysis .

7.Myoglobinuric renal failure .

8.Death .

Management of Acute stage:

It is a surgical emergency.

1.All encircling tight bandages are removed, if present.

2.The limb should be nursed flat (elevating the limb causes a further decrease in end-capillary pressure and aggravates the muscle ischaemia).

3. If there is no improvement, record the pressure within the compartment,

. If it is more than 30 mm Hg, an emergency surgical decompression is done by fasciotomy.

.If the pressure is less than

30 mm Hg, continuous monitoring is done.

If the intracompartmental pressure is more than 30 to 40 mmHg

or

A differential pressure (ΔP) ( the difference between the general diastolic pressure and the compartment

pressure ) of less than 30 mmHg 

is an indication for immediate compartment decompression.

The wounds should be left open

and inspected 2 days later: if there is muscle necrosis, debridement can be done;

if the tissues are healthy, the wound can be sutured (without tension), or skin grafted.

Remember If 5 Ps help in detection of acute cases, 5 Ps also form clue to the management:

1

• Pressure to be relieved either external or internal.

If facilities for measuring compartmental pressures are not available, the decision to operate will have to be made on clinical grounds.

If three or more of the ‘classical’ signs are present,

the diagnosis is almost certain.

If the signs are equivocal, the limb should be examined at 15 minute intervals and if there is no improvement within 2 hours of splitting the dressings,

fasciotomy should be performed.

2

• Pressure to be monitored within the compartment.

• Pulse to be recorded continuously.

3

4

• Passive stretch test indicates the severity

5

• Putting the fracture back into its position.

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