Compartments, the Stryker,

1
Compartments, the Stryker, You

• Consensus is Pcompartment gt 30 mm Hg likely
  requires intervention
• ?P (DBP Pcompartment)
• measure of Pperfusion
• Pts w/ Pcompartment lt 40 mm Hg can develop CS if
  ?P elevated (i.e. gt 30)
• Keeping extremity level w/ heart decreases limb
  MAP w/o increasing Pcompartment
• Ischemic injury is basis for CS
• Supplement O2 to increase pPO2
• 6 hrs ischemic time is currently accepted upper
  viability limit
• Myonecrosis assoc. w/ CS s/p envenomation is
  multifactorial
• fasciotomy may not prevent myonecrosis
• aggressive Rx w/ antivenom decreases limb
  hypoperfusion
• consider delayed fasciotomy, if at all

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Possible Etiologies

• Increased contents
• Hematoma
• Trauma
• fracture
• envenomation
• burns
• Increased use
• exercise
• tetany
• seizure
• eclampsia
• Edema
• nephrotic syndrome
• ischemia-reperfusion injury
• Iatrogenic
• Orthopedic surgery
• Intraarterial drug injection

• Decreased volume
• Hematoma
• Trauma
• crush injury entrapment
• compression during sleep/intoxication
• Iatrogenic
• prolonged lithotomy
• MAST, casts, splints, dressings
• excessive traction in line
• tight closure of fascial defect
• IV infiltration

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Compartment Sensory Motor Painful Passive Motion Tenseness
Forearm Dorsal Volar --- Ulnar / Median N. Digit Extension Digit Flexion Digit Flexion Digit Extension Dorsal Forearm Volar Forearm
Hand Interosseus --- Interossei Add/Abduct MCPs Dorsal Hand btwn MCPs
Upper Arm Flexor Extensor Ulnar / Median N. Radial N. Biceps / Dist. Flexors Triceps / Forearm Ext. Elbow Extension Elbow Flexion Anterior Upper Arm Posterior Upper Arm
Leg Anterior Sup. Posterior Deep Posterior Deep Peroneal N. --- Posterior Tibial N. Toe Ext. / Tib ant. Soleus / Gastroc. Toe Flex. / Tib post. Toe Flexion Foot Dorsiflexion Toe Extension Ant. Leg Calf Dist. Med. Leg (btwn Tib. Achilles tendon)
Gluteal Sciatic (rare) Gluteals, piriformis, tensor fascia lata Hip Flexion Buttock
Foot Digital Nerves Foot Intrinsics Toe Flex. / Ext. Dorsal / Plantar Foot
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• Open sterile assembly
• Place needle on tapered end of well chamber and
  syringe on opposite side
• Place assembly into monitor, clear side of well
  chamber up

5

• Purge assembly of air
• Injecting NS w/ Stryker at 450
• Zero unit in position in which measurement will
  be taken
• Sterile prep of site
• Infiltrate local superficially
• Enter compartment perpendicularly, level w/ heart
• Inject 0.3 of 1 cc saline
• Read measurement on display when equilibrates
• Re-Zero unit for each new measurement

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Enter compartments at junction of proximal
middle thirds of forearm
Volar Compartment btwn PL tendon radial
surface of ulna depth 1-2 cm
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Dorsal Compartment 1-2 cm lat to posterior
aspect of ulna depth 1-2 cm
Mobile Wad Compartment lateral to radius depth
1-1.5 cm
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Enter compartments at junction of proximal
middle thirds of lower leg
Lateral compartment posterior border of fibula
depth 1-1.5 cm
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Deep posterior compartment posterior to medial
border of tibia in direction of posterior border
of the fibula depth 2-4 cm
Superficial posterior compartment posteriorly
directly over center of gastrocnemius depth
1-1.5 cm
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Compartment Contents Evaluation
Anterior Deep Peroneal N. Anterior Tibial Art. Dorsal Flex. Ankles Toes Sensation at 1st dorsal web space DP Pulse
Lateral Superficial Peroneal (fibular) N. Foot Everters Sensation at dorsal foot
Superficial posterior Sural N. Plantar Flex. of Ankle Sensation to lat. portion of inf. 1/3 of leg, lat. portion of 5th digit
Deep posterior Tibial N. Posterior Tibial Peroneal Art. Plantar Flex. of toes Sensation to plantar foot PT Pulse
Anterior compartment 1 cm lateral to anterior
tibial border depth 1-3 cm
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Additional Compartments

• Foot
• Medial, Lateral, Interosseous
• Gluteal
• 18-G spinal needle
• Depth 4-8 cm
• Insert perpendicularly at point of max. tenderness

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• Improvised mercury or saline/sterile H2O
  manometers may also be zeroed used to measure
  Pcompartment
• Convert mmHg ? cm H2O back!
• References
• JR Roberts and J Hedges, eds. Clinical
  Procedures in Emergency Medicine, 4th ed.
  Saunders October 24, 2003.
• CB Custalow. Color Atlas of Emergency Department
  Procedures, 1st ed. Saunders August 27, 2004.