compartment syndrome

PENDAHULUANSindroma compartment is a condition where an increase in interstitial pressure

in a limited space, that is, in a closed compartment osteofasial. The room contains the muscles,
nerves and blood vessels. When intrakompartemen pressure increases, blood perfusion to the
tissue will decrease and the muscles in the compartment will be ischemic. Common clinical signs
are pain, paresthesias, paresis, accompanied pulse missing. (1,2,3) Compartment syndromes can
be classified into acute and chronic, depending on the cause of increased compartment pressures
and duration of symptoms. A common cause of acute compartment syndrome is a fracture, soft
tissue trauma, arterial damage, and burns. While chronic compartment syndrome can be caused
by repetitive activities eg run. (1) INSIDENDi American, anterior distal lower extremities is the
most widely studied for compartment syndrome. Considered as the second most frequent to the
trauma of about 2-12%. From research McQueen (2000), compartment syndrome is diagnosed
more often in men than women, but it does have a bias, where men are more often injured
trauma. McQueen examine 164 patients diagnosed with compartment syndrome, 69% are related
to fracture and most are fractures of the tibia. According Qvarfordt, a group of patients with leg
pain, 14% of patients with anterior compartment syndrome. Compartment syndrome is found 1-
9% of fractures in the legs. (4.5) ANATOMIFascia separates muscle fibers in one group.
Compartment is an enclosed area bounded by bones, interosseous membrane and fascia
involving muscle tissue, nerves and blood vessels. (6) In the region of the brachium, the
compartment is divided into two parts: (9.10) 1. Volar compartment: the flexor muscles of the
wrist and fingers, ulnar nerve and nerve median.2. Dorsal compartment: the extensor muscles of
the wrist and fingers, interosseous nerve posterior.Pada antebrachium region, the compartment is
divided into 3 parts: (9.10) 1. Volar compartment: the flexor muscles of the wrist and fingers,
ulnar nerve and nerve median.2. Dorsal compartment: the extensor muscles of the wrist and
fingers, posterior.3 interosseous nerve. Mobile wad: muscle extensor carpi radialis longus,
extensor carpi radialis brevis muscle, muscle brachioradialis.Pada wrist joint region, the
compartment is divided into six sections: (9.10) 1. Compartment I: muscle abductor pollicis
longus and extensor pollicis muscle brevis.2. Compartment II: extensor carpi radialis brevis
muscle, the extensor carpi radialis muscle longus.3. Compartment III: extensor pollicis muscle
longus.4. Compartment IV: extensor digitorum communis muscles, the extensor muscles
indicis.5. Compartment V: minimi.6 digit extensor muscle. Compartment VI: extensor carpi
muscles ulnaris.Pada regio cruris, the compartment is divided into four parts: (9.10) 1. Anterior
Compartment: tibialis anterior and extensor muscles toes, profunda.2 peroneal nerve. The lateral
compartment: peroneus longus and brevis muscle, peroneal nerve superfisial.3. Superficial
posterior compartment: the gastrocnemius and soleus muscles, nerves sural.4. The deep posterior
compartment: tibialis posterior and flexor muscles toes, tibial nerve. ETIOLOGIPenyebab
compartment syndrome is pressure within the compartment is too high, more than 30 mmHg.
The cause of the increased pressure intrakompartemen is an increase volume of fluid in the
compartment or decrease the volume of the compartment. (9) The increase in the volume of fluid
in the compartment can be caused by: (9) Increased permeability of capillaries, as a result of
shock, burns, trauma directly.

Increased capillary pressure, as a result of exercise or the presence of venous obstruction.
Muscle hypertrophy.
Bleeding.
Infusion infiltration.
Decreased volume compartment can be caused by: (9) bandage too tight.


PATOGENESISPerkembangan compartment syndrome depends not only on the pressure

intrakompartemen but also systemic blood pressure. The pathophysiology of compartment
syndrome involving local hemostasis normal tissue which leads to increased tissue pressure,
decreased capillary blood flow and local tissue necrosis due to hypoxia. (1) When the pressure
within the compartment exceeds the blood pressure in the capillaries and cause capillary
collapse, nutrients can not flow out to the cells and the metabolism can not be excluded. In just a
few hours, the cells are not getting the food will be damaged. First of all the cells will experience
swelling, then the cell will stop releasing chemicals that cause further swelling. Swelling
growing causes increased pressure. (12, 13) which passes through the capillary blood flow will
stop. Under these circumstances oxygen delivery will also be stopped. Hypoxia causes the cells
to release of vasoactive substances (eg, histamine, serotonin), which increases endothelial
permeability. Capillaries in the event of loss of fluid resulting in increased tissue pressure and
aggravate damage to surrounding tissue and muscle tissue necrosis. (5) DIAGNOSISSindroma
compartment can be diagnosed based on knowledge of risk factors, subjective complaints and the
presence of physical signs and clinical symptoms. The risk factors in compartment syndrome
include severe fractures and trauma to the soft tissue, the use of bandages. (15,16) Clinical
symptoms are commonly seen in the compartment syndrome includes 5 P, namely: (17) 1. Pain
(pain): pain in the fingers or toes during passive stretching of the muscles are affected, when
there is trauma langsung.2. Pallor (pale): skin feels cold when on palpation, skin color is usually
pale, gray or keputihan.3. Paresthesias: usually asymptomatic heartburn and itching in the area
lesi.4. Paralysis: usually begins with the inability to move the joints, is a sign of a slow
diketahui.5. Pulselesness (decrease or loss of pulse): due to a disturbance arterial.Pengukuran
perfusion pressure is one of the additional compartments in helping to establish the diagnosis.
Compartment pressure measurements are usually performed in patients with decreased
awareness of physical examination did not give satisfactory results. Compartment pressure
measurements can be done using injection techniques or wick catheter. (15,16) compartment
pressure measurement procedures, among others: (19) a. Mechanical injeksi.Jarum size 18 is
connected with 20 cc syringe through the copy and the air duct. These channels are then
connected to a standard mercury manometer. After the needle is injected into the compartment,
the air pressure in the syringe to be increased so that the meniscus copy-air seemed to be moving.
Then the pressure in the compartment can be read on the manometer raksa.b. Kateter.Wick Wick
engineering plastic catheter and sheath are connected to the transducer and recorder. Catheter and
the jar is filled by a three-way connected with the transducer. It is necessary to ensure that no air
bubbles in the system because it gives a low yield or obscure measurements. Tip of the catheter
should be able to stop a water meniscus that can be ascertained and it is known that in such
networks bypassed a large trocar, then the needle is withdrawn and the catheter is wrapped into
kulit.TERAPIPenanganan compartment syndrome include: 1. Medical Therapy / non surgical.
(11) • Placing foot level of the heart, to maintain the height of the compartment are minimal,
elevation avoided because it can reduce blood flow and will more aggravate ischemia. • In case
of a decrease in the volume of the compartment, the cast must be opened and the pads kontriksi
removed. • Correcting hypoperfusion by way of crystalloid and blood products. • Provision of
mannitol, vasodilator drugs known as inhibitors or sympathetic. 2. Surgical treatment /
operatif.Fasciotomi is the operative treatment of compartment syndrome with fracture
stabilization and repair of blood vessels. The success of the decompression for improvement of
perfusion is 6 hours. (11) Therapy for acute and chronic compartment syndrome is usually
surgery. Long incision is made on the fascia to relieve increased pressure inside. The wound is
left open (covered with a sterile dressing) and closed at a second operation, usually 5 days later.
if there is a muscle necrosis, do debridement, otherwise healthy tissue, the wound can be in
sewing (without strain), or a skin graft may be needed to close this wound. (8,20) The indications
for Fasciotomy are: (21) 1. There are clinical signs of the syndrome kompartemen.2.
Intrakompartemen pressure exceeded 30 mmHg. Fasciotomy THE REGIO CRURISAda 3
Fasciotomy approach to compartment regio cruris: fibulektomy, single incision Fasciotomy
perifibular, and Fasciotomy double incision. Fibulektomi is a radical procedure and is rarely
done, and if there is, including the indication of acute compartment syndrome. Single incision
may be used for soft tissue of the extremities. Double incision technique is more safely and
effectively. (1.19) Fasciotomy single incision (davey, Rorabeck, and Fowler): Made incision
lateral, longitudinal line of the fibula, all from the distal head of the fibula to 3-4 cm proximal to
the lateral malleolus. The skin was opened in the anterior and not to injure the superficial
peroneal nerve. Created fasciotomy of the anterior longitudinal and lateral compartments. Next
the skin is opened to the posterior and do Fasciotomy superficial posterior compartment. The
boundary between the superficial and lateral compartments and the interval is extended upwards
by cutting the soleus of the fibula. Peroneal muscle and blood vessels pulled back. Later
identified the posterior tibialis muscle fascia to the fibula and do inisisi longitudinally. (1.19)
Fasciotomy double incision (Mubarak and Hargens): 20-25 cm long incision is made in the
anterior compartment, halfway between the fibula and tibia caput. Subcutaneous dissection is
used to expose the fascia compartment. Transverse incision is made in the lateral septum and
identification intermuskular superficial peroneal nerve in the posterior septum. Go towards the
anterior compartment proximally and distally on the anterior tibial line. Then do Fasciotomy the
lateral compartment toward proximal and distal tubules line created longiotudinal second
fibula.Insisi 1 cm behind the line of the posterior tibia. Extensive subcutaneous dissection is used
to identify the fascia. Vein and nerve saphenus pulled anteriorly. Transverse incision is made to
identify the septum between the deep and superficial posterior compartment. Gastrocsoleus
fascia is then opened along the compartment. Another incision is made in the flexor digitorum
longus and freed entire deep posterior compartment. After the posterior compartment is opened,
the identification of the posterior tibialis muscle compartment. If an increase in pressure in this
compartment, immediately opened. (1, 19) Fasciotomy THE REGIO
ANTEBRACHIUMPendekatan volar (Henry) Decompression volar compartment deep and
superficial flexors can be done with a single incision. Skin incision starting from the proximal to
the fossa antecubiti to the palmar carpal tunnel area. Compartment pressure can be measured
during the operation to confirm decompression. No use of tourniquets. Skin incision from the
medial to the biceps tendon, adjacent to the elbow and then to the radial side of the hand and
extended towards the distal sepenjang brachioradialis, continued to palmar. Then the superficial
flexor compartment is incised, starting at point 1 or 2 cm above the elbow downwards until the
wrist. (1.19) Then the radial nerve is identified under brachioradialis, they then pulled to the
radial direction, then the flexor carpi radialis and the radial artery is pulled to the side that will
expose the ulnar flexor digitorum profundus flexor pollicis longus, pronatus Quadratus, and
pronatus teres. Because of compartment syndrome usually involves the deep flexor
compartment, must decompression fascia around the muscle to ensure that adequate
decompression has done. (1.19) UlnarPendekatan Volar volar ulnar approach done in the same
way to approach Henry. Disupinasikan arm and medial incision starting from the top of the
biceps tendon, past the elbow fold, continuing down through the line of the ulnar forearm, and up
to carpal tunnel along the thenar fold. Superficial fascia of the flexor carpi ulnar is incised up to
the elbow aponeurosis and to carpal tunnel distally. Then look for the boundary between the
flexor carpi ulnaris and flexor digitorum sublimis. On the basis of the flexor digitorum contained
sublimis ulnar artery and nerve, to look for and protected. The fascia of the deep flexor
compartment then incised. (1.19) compartment DorsalSetelah approach superficial and deep
flexor forearm decompressed, should decide whether to Fasciotomy dorsal (extensors). It is
better determined by measurement of compartment pressure Fasciotomy intraoperatively after
flexor compartment. If there peningktan pressure on the dorsal compartment continues to
increase, Fasciotomy should be done with the forearm pronated position. Straight incision from
the lateral epicondyle to the midline of the wrist. The boundary between the extensor carpi
radialis brevis and extensor digitorum communist identified then do Fasciotomy. (1.19)
BANDINGDiferensial DIAGNOSIS diagnosis of compartment syndrome include tendinitis,
fatigue fractures and shin splints. This situation is connected by pain in the lower limbs due to
exercise. But give the same symptoms as compartment syndrome. (22,23) on tendinitis
Symptoms usually appear after exercise, pain is often caused by strain on the tendon. In the
fatigue fracture, the bone area which extends from one side attacked bone to another bone. At
shin splints, pain is usually only at the height of the medial tibia behind, often at a meeting in
half and the distal third of the tibia. (22,23) Complications (21.24) • Failure to reduce
intrakompartemen pressure can cause tissue necrosis, during perfusion capillary is still lacking
and causing hypoxia on the network. • contracture Volkmann is a deformity of the limbs which is
a continuation of compartment syndrome of acute who did not receive treatment for more than a
few weeks or months. • Infections. • hypesthesia and pain. • Complications which may arise from
the systemic compartment syndrome include acute renal failure, sepsis, and acute respiratory
distress syndrome (ARDS) fatal case of sepsis multisistem.PROGNOSISSindroma organ failure
in acute compartment tend to have an end result that is ugly. Muscle tolerance to ischemia is 4
hours. Irreversible damage occurs when more than 8 hours. If the diagnosis is delayed, can cause
nerve trauma and loss of muscle function. Although Fasciotomy done quickly and early, nearly
20% of patients experience sensory and motor deficits were persistent. (11) LIST PUSTAKA1.
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29th, 2007. Available at http://www.wikipedia.org. Accessed on June 4th 2007.23. Richard
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