Compartment Syndromes

Upper limb fasciotomyForearm Fasciotomy Closure

 

1.  Antebrachial Compartment Syndrome

 

Aetiology

 

Supracondylar fracture of humerus

Both bone forearm fractures

 

Examination

 

Tense compartments

Pain +++

Passive extension of the digits or wrist increases pain

Paresthesias in median nerve distribution

 

Forearm Fasciotomy 

 

Decompression extending from elbow to wrist

 

Compartments (3)

- mobile wad

- volar

- dorsal

 

Incision

- medial arm

- across elbow

- continue as Henry approach into forearm

- can continue into palm as CTD incision

 

Release

- lacertus fibrosus  (releases median nerve at elbow)

- fascia of forearm (releases superficial volar)

- deep fascial compartments (FCU / FDP / FPL)

- mobile wad

 

Remeasure dorsal compartment

- often decompression of volar compartment will reduce dorsal pressures

 

Consequences

 

Volkmann's ischemic contracture

- result of delayed diagnosis

- severe muscle fibrosis & neuropathy 

- clawing of fingers

 

Muscles most commonly affected

- FDP

- FPL

 

Transfers

- BR to FPL

- ECRL to FDP

 

Compartment Syndrome of Hand

 

Aetiology

 

Iatrogenic injuries

- arterial line or infiltration of IV medications

Crushing trauma

IV drug abuse

High pressure injections

- i.e. paint guns

 

Clinically

 

Hand compartment syndromes lack abnormalities in sensory nerves

- no nerves are found within compartment

- non specific aching of the hand

 

Increased pain, loss of digital motion, continued swelling 

- tight swollen hand in a intrinsic minus position

- MP extension and PIP flexion

- intrinsic tightness (increased PIPJ motion with MCPJ flexion v extension)

 

Pressure measurement 

 

Should have a lower threshold than in leg compartments 

- pressures greater than 15-20 mmHg is a relative indication for release

 

Compartments

 

10 separate osteofascial compartments 

- dorsal interossei (4) 

- palmar interossei (3) 

- adductor pollicis (1)

- thenar and hypothenar  (2)

 

Decompression

 

CTD

- release thenar / hypothenar / adductor pollicis

- 2 x dorsal incisions over MC 2 and 4