Acute Compartment Syndrome in Orthopedics:Causes, Diagnosis, and Management

Presented by: Arsan Rusli

Akhmad MuhajirResti Amelia

Ike Widyawati F.Muh. Zhafran Darwis

Advisorsdr. Aries F Hutabaratdr. Johannes Toban

Dr. Ery Willdan

Supervisordr. Muhammad Andry Usman T., PhD, Sp.OT

ORTHOPEDIC AND TRAUMATOLOGY DEPARTMENTHASANUDDIN UNIVERSITY

(Hasnain Raza and Anant Mahapatra Hindawi Publishing Corporation Advances in Orthopedics Volume 2015)

JOURNAL READINGON APRIL, 2016

Introduction

Pathophysiology

Epidemiology

Clinical Diagnosis

Intracompartment Pressure Monitoring

Infrared Spectroscopy

Intracompartment pH Monitoring

Fasciotomy

Wound Management after Treatment

Medicolegal Aspect

Conclusion

ACUTE COMPARTMENT SYNDROME IN ORTHOPEDICS: CAUSES, DIAGNOSIS, AND MANAGEMENT

Journal Reading Orthopedic and Traumatology Department Hasanuddin University

Dr. Volkmann, a German doctor in 1881 described ACS by reporting the hand contracture which was a consequence of this particular condition

Petersen in 1888 reported the management of ACS

Missed and left untreated it can lead to serious damage to the soft tissues of the limb including muscles, nerves, and vessels.

INTRODUCTION

Journal Reading : Acute Compartment Syndrome in Orthopedics: Causes, Diagnosis, and ManagementOrthopedic and Traumatology Department Hasanuddin University

PHATOPHYSIOLOGY Two factors are

responsible for this condition:• Decrease in a

compartment volume,

• Increase in the contents of a compartment,

Compartment syndrome is defined as:a condition in which a closed compartment’s pressure increases to such an extent that the microcirculation of the tissues in that compartment is diminished

Journal Reading : Acute Compartment Syndrome in Orthopedics: Causes, Diagnosis, and ManagementOrthopedic and Traumatology Department Hasanuddin University

PHATOPHYSIOLOGY

local trauma and soft tissue

destruction > bleeding and edema

Raised pressure at the venous

capillary end

Increases hydrostatic

pressure

Leading to arteriolar

compression

Hence reducing or diminishing

perfusion of the tissues.

Soft tissue ischemia, anoxia and death of the

cells.

Journal Reading : Acute Compartment Syndrome in Orthopedics: Causes, Diagnosis, and ManagementOrthopedic and Traumatology Department Hasanuddin University

PHATOPHYSIOLOGY

Extent of muscle death

the duration of ischemia

temperature of the tissues

the available residual

microcirculation

Pressures 40 to 80mmHg sustained for 4 hours do not cause permanent nerve dysfunction but, when applied for 12 hours or more, permanent neurological changes occurred

lower local temperature slow down the ischemic process

Sufficient collateral blood supply slow down the ischemic process

Journal Reading : Acute Compartment Syndrome in Orthopedics: Causes, Diagnosis, and ManagementOrthopedic and Traumatology Department Hasanuddin University

EPIDEMIOLOGY

The most common site of ACS

• Leg which is followed by forearm, arm, thigh, foot, gluteal region, hand, and abdomen.

Various risk factors are related to compartment syndrome

• Age• Type and site of injury

Males are more prone to develop ACS which is ten times higher than females

Incidence of ACS in open and closed fractures is equal.

Journal Reading : Acute Compartment Syndrome in Orthopedics: Causes, Diagnosis, and ManagementOrthopedic and Traumatology Department Hasanuddin University

EPIDEMIOLOGY

33%

25%

20%

6%

16%

Risk Factor: Type and site of injury

closed tibial shaft fracture

blunt and crushed soft tissue limb trauma

radius and ulna shaft fractures

Foot injuries in road traffic accidents

others

Journal Reading : Acute Compartment Syndrome in Orthopedics: Causes, Diagnosis, and ManagementOrthopedic and Traumatology Department Hasanuddin University

EPIDEMIOLOGY

Acute compartment syndrome can also result from non-accidental causes like medical condition, such us• nephrotic syndrome, • viral myositis, • hypothyroidism,• bleeding disorders, • malignancies, and• diabetes mellitus

Ruptured Baker’s cyst is also reported as a rarer cause of ACS

Journal Reading : Acute Compartment Syndrome in Orthopedics: Causes, Diagnosis, and ManagementOrthopedic and Traumatology Department Hasanuddin University