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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
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
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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.
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Compartment of leg
Sites of body involved:
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
f
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.
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.