Any nerve traversing the involved compartment will become hypoxic, often causing numbness and tingling in the nerve distribution.
The level of pain can often be judged by increasing requests for ever-stronger analgesia, or increasing use of patient-controlled analgesia (PCA) systems. Note: Prior to discharge from the hospital, parents or caregivers should be taught to return for assessment if the child's pain is increasing.Ĭommonly there is a relatively pain-free interval, perhaps a few hours, following fracture treatment, before such pain develops. Persistent crying, or failure to settle, is a concerning sign.
COMPARTMENTS OF HAND SERIAL
Close serial clinical observation will allow judgment of response to analgesics. It is particularly difficult to evaluate the degree of pain in younger children. In a conscious and alert patient, there will be unrelenting, worsening pain, greater than expected for the particular injury, and not related to limb position. The diagnosis of this severe complication rests on two factors: a high index of suspicion and a thorough understanding of its variable clinical presentation. Such reperfusion injury is another cause of compartment syndrome. After blood flow is restored, capillaries leak and ischemic muscle swells. Muscles tolerate short periods of hypoxia, but after a few hours, progressive necrosis begins.Īn arterial injury may cause compartmental tissue ischemia. (MPP has also represented as ΔP, to indicate the difference between diastolic blood pressure and intramuscular pressure.) This difference in pressure reflects tissue perfusion far more reliably than the absolute intramuscular pressure. The critical measurement is muscle perfusion pressure (MPP), the difference between diastolic blood pressure (dBP) and measured intramuscular tissue pressure. There are no similar published studies in children. A number of adult studies have shown that if tissue pressure rises to within 30 mm Hg of diastolic arterial pressure, compartmental capillary blood flow is significantly obstructed and severe hypoxia occurs in muscle and nerve tissue. When the tissue pressure approaches the diastolic pressure, capillary blood flow ceases. The capillary filling pressure is essentially diastolic arterial pressure. Compartment syndrome occurs when the tissue pressure within a closed osteo-fascial muscle compartment rises above a level required to maintain blood flow through the capillaries and into the venous drainage system.
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