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Compartment syndrome

On the human body, the limbs can be divide into segments, such as the arm and the forearm of the upper limb, and the thigh and the leg of the lower limb. more...

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If these segments are cut transversely, it is apparent that they are divided into multiple sections. These are called fascial compartments, and are formed by tough connective tissue septa.

These compartments usually have a separate nerve and blood supply to their neighbours. The muscles in each compartment will often all be supplied by the same nerve.

Compartment syndrome

Knowledge of these compartments not only simplifies the learning of innervation, it is also important in situations where pressure can build up in one compartment and potentially damage the contents.

This problem is called compartment syndrome and can happen acutely (sometimes caused by a fracture) or gradually, as with an athlete's overuse of a muscle.

Because the connective tissue that defines the compartment does not stretch, a small amount of bleeding into the compartment, or swelling of the muscles within the compartment can cause the pressure to rise greatly. Increased pressure within the compartment compresses the nerves, and also decreases blood perfusion. The pressure in the capillaries is approximately 30mm Hg. If the pressure in the compartment rises above this level the blood supply to the muscles can be completely cut off leading to death of the tissue in the compartment. This is a medical emergency requiring immediate treatment by fasciotomy to allow the pressure to return to normal. Because the pressure in the large blood vessels of the limbs is much greater than the compartment pressure required to cause death of the tissue, a patient whose muscles are dying from compartment syndrome, and who is in danger of losing their limb will usually have intact pulses. Severe pain is the most common symptom of acute compartment syndrome.

When compartment syndrome is caused by from repetitive heavy use of the muscles, as in a runner, it is known as chronic compartment syndrome (CCS). This is usually not an emergency, but the loss of circulation can cause temporary or permanent damage to nearby nerves and muscle.

While CCS was first identified in the 1980s, it has been increasingly recognized as a significant source of chronic leg pain. A common indicator of the condition is muscle fatigue and pain in the calf region after sustained physical exercise (such as running). Once the exercise is stopped, the pain gradually disappears.

CCS can be tested for using by gauging the pressure within the muscle compartments. If the pressure is sufficiently high, a fasciotomy may be required.

Fascial compartments of the body

The thigh is usually divided into three compartments:

  • Anterior - supplied by the femoral nerve, contains the knee extensors and hip flexors.
  • Medial - supplied by the obturator nerve, contains the hip adductors.
  • Posterior - supplied by the sciatic nerve, contains the knee flexors and hip extensors.

The (lower) leg is divided into three compartments also:

Read more at Wikipedia.org


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SURGICAL TREATMENT OF COMPARTMENT SYNDROME OF THE LEG COMPLICATED BY MUSCLE NECROSIS AFTER APONEUROTOMY
From Journal of Bone and Joint Surgery, 1/1/04 by Abou, A M

Purpose: Compartment syndrome of the leg is an exceptional (0.8% of leg fractures) hut serious complication with a risk of muscle necrosis. The purpose of this work was to propose an original therapeutic approach to compartment syndromes that have progressed to the stage of muscle necrosis.

Material and method: Between November 1999 and January 2001. we treated eleven patients with acute compartment syndrome of the leg. There were ten men and one women, mean age 38 year (range 19-70). The causal mechanism was fracture of the two leg bones in nine patients (during the study period. 129 leg fractures were managed in the unit). For two patients the causal mechanism was prolonged compression. The compartment syndrome was present at admission in seven patients and developed after nailing in two. Emergency aponeurolomy was performed in all cases.

Results: Mean follow-up was six months, range 3-26 months. Outcome was favourable in six patients and the aponeurotomy was closed between day 5 and 10 (mean day 7), associated with a skin graft in some patients. Muscle necrosis developed in four patients. These patients were treated by wide muscle excision and immediate wound closure with aspiration drainage. followed by a prolonged adapted antibiotic regimen. Complete healing with total regression of the infectious syndrome was achieved. Partial recovery of sensory and motor function was obtained in all cases. One patient required a cross-leg flap for cover after infectious necrosis. One other patient aged 57 years died a few hours after aponeurotomy due to cardiac failure of undetermined origin.

Discussion: Compartment syndrome is a recognised surgical emergency. all authors recommend emergency aponeurotomy. There is no standard treatment after progression to muscle necrosis.

Conclusion: Muscle necrosis is not uncommon despite aponeurotomy (4 out of 11 patients in our series). In case of muscle necrosis, we propose wide excision and immediate wound closure associated with adapted antibiotics. Despite the muscle excision, partial recovery of sensorial and motor function of the foot was achieved several months after the initial treatment.

A.M. Abou. Chaaya. M. Moukhalalati. A. Bazeli, A. Vinasse. P. Cottias

Centre Hospitalier de Saint-Denis, 2, rue du

Docieur-Delafontaine, 932115 Saint-Denis ceilex,

France

Copyright British Editorial Society of Bone & Joint Surgery 2004
Provided by ProQuest Information and Learning Company. All rights Reserved

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