Compartmental Syndromes.

Edited By: Winston J. Warme, MD, Frederick A. Matsen III, M.D.
Last updated Thursday, February 10, 2005

About this article

Fronticepiece

". . .I'll just see what this bottle does. I hope it'll make me grow large again, for really I'm quite tired of being such a tiny little thing."

It did so indeed, and much sooner than she had expected: before she had drunk half the bottle, she found her head pressing against the ceiling, and had to stoop to save her neck from being broken. She hastily put down the bottle, saying to herself "that's quite enough-I hope I shan't grow anymore-As it is, I can't get out at the door-I do wish I hadn't drunk quite so much!" Alas! It was too late to wish that! She went on growing and growing, and very soon had to kneel down on the floor: in another minute there was not even room for this, and she tried the effect of lying down with one elbow against the door, and the other arm curled round her head. Still she went on growing, and as a last resource, she put one arm out of the window, and one foot up the chimney, and said to herself, "Now I can do no more, whatever happens. What will become of me?"

(Reprinted with permission from The Annotated Alice: Alice's Adventures in Wonderland Through the Looking Glass, by Lewis Carroll, illustrated by John Tenniel, with an Introduction and Notes by Martin Gardner. Published by Clarkson N. Potter, New York, t960, p. 57.)

Library of Congress Cataloging in Publication Data

Matsen, Frederick A. Compartmental syndromes.

Includes bibliographical references and index.

1. Compartment syndrome. I. Title. [DNLM: 1. Anterior compartment syndrome. WE550 M434c] RC951.M33 616.1'31 80-14840 ISBN 0-8089-1260-7

2. by Grune & Stratton, Inc.

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher.

Grune & Stratton, Inc. 111 Fifth Avenue New York, New York 10003

Distributed in the United Kingdom by Academic Press, Inc. (London) Ltd. 24/28 Oval Road, London NW 1

Library of Congress Catalog Number 80-14840 International Standard Book Number 0-8089-1260-7 Printed in the United States of America

To my wife, Anne, my children, Susanna, Erick and Laura, my parents, Al and Ceil, and my late friend, Dick Krugmire

Acknowledgments

It is always a pleasure to thank associates for their invaluable help. I must first acknowledge Dr. D. Kay Clawson, who stimulated my interest in compartmental syndromes while I was one of his residents and encouraged me to set up the Limb Viability Laboratory, and Dr. Victor H. Frankel, under whose chairmanship the laboratory has grown and prospered.

One of the mainstays of the laboratory since its inception was the late Richard B. Krugmire, Jr., who graciously volunteered hundreds of after-work and weekend hours for these investigations. His friendship and encouragement saw me through many challenging times. Dick's many contributions to our investigations are evidenced in this book; his memory lives in its pages.

It can easily be seen that Dr. Geoffrey Sheridan has contributed much to the fund of knowledge on compartmental syndromes and to the laboratory. His work on animal model systems and clinical observations on the timing of surgical decompression form much of the basis for our current management of patients at risk for compartmental syndromes. As a medical student, Keith Mayo gave us a great deal of help in the development of the infusion system for tissue pressure measurement. His legs also joined mine, Sheridan's, and Krugmire's in providing "normal volunteers for many of the human studies.

Sarah Sato has done triple duty serving as my clinical secretary, as secretary for the Limb Viability Laboratory, and as an encouraging friend. Without her help much of this work could not have been accomplished. Racheal King is the Limb Viability Laboratory's research technologist par excellence; among her contributions I must acknowledge that she is the one who can keep the mass spectrometer working. Laurie Glass has edited this book and many of the papers on which it is based. She demonstrated a wonderful ability to comprehend this information and to assure its lucid presentation. Her many hours of constructive criticism have been invaluable. Dale Leuthold has produced most of the illustrations for this book. Her quick grasp of the concepts to be illustrated and her precise artwork have greatly facilitated the presentation of this material. There are many other friends, both doctor and patient, who have greatly enhanced my understanding of this subject. With an apology for not citing all of their names, I would like to thank them for their help.

Finally, I graciously acknowledge the support of the National Institutes of Health Grants No. ROI AM18642-01, -02, -03; the Orthopaedic Research Education Foundation Grants No. 244 and 266; and the Prosthetic Research Study under the directorship of Dr. Ernest M. Burgess. This support has been essential to our progress.

Foreword

The readers of this text are indebted to Dr. Matsen for this beautiful summation work on compartmental syndromes. While the author states that this text is "not a chronological review of the history of compartmental syndromes," it certainly beautifully and completely covers the subject. Every physician, especially the orthopaedic surgeon who deals with so much trauma, must be totally familiar not only with the concept of compartmental syndromes but with the diagnostic criteria and the proper treatment. Certainly the majority of the data in this book concerns acute compartmental syndromes, but a very important aspect, the recurrent compartmental syndrome, is nicely covered by Dr. Veith.

Matsen points out that because of inadequate literature indexing, it is difficult to locate relevant articles on this subject. This text, because of its extensive bibliography on each chapter, will become the classic reference on the subject.

I have participated with Dr. Matsen in teaching conferences over the past three years and know him to be a dedicated and careful contributor. His work in the Limb Viability Laboratory at the University of Washington has led to this creative text which will be of value for many years to come. He and his colleagues are to be congratulated for this significant contribution.

Charles A. Rockwood, Jr., M.D. Professor and Chairman Division of Orthopaedics University of Texas Medical School at San Antonio

Preface

Writing this book provided an opportunity to relate what seems to be important about compartmental syndromes. It is not a review of the literature, for that would be more confusing than informative. It is not a chronological review of the history of compartmental syndromes because history took many wrong turns that need not be recounted. Rather, this is a practical book designed to provide the clinician, the physiologist, the resident physician, and the student with a detailed view of this most interesting and important condition.

Most of the investigative data presented in this volume originated in the Limb Viability Laboratory at the University of Washington. Similarly, many of the clinical observations have been made in the University of Washington's affiliated hospitals, particularly the University Hospital, Harborview Medical Center, and Children's Orthopedic Hospital. This book represents a synthesis of this laboratory and clinical experience and other available data in a form that I hope will be useful to clinician and scientist alike.

The book begins with a short section setting forth the problems encountered in dealing with compartmental syndromes. Next, Chapter 1 gives a definition of the compartmental syndrome that I hope will obviate much of the confusion that surrounds this condition. Chapter 2 defines "tissue pressure," which may be another confusing concept. Different techniques for the measurement of tissue pressure are also described in this chapter. Included is a practical guide to the use of the infusion technique, which I find most useful for continuously monitoring patients at risk for compartmental syndromes. Chapter 3 is devoted to the pathophysiology of increased tissue pressure. Of particular concern is the mechanism by which increased tissue pressure compromises local circulation. In Chapter 4 the factors affecting the tolerance of tissue for increased tissue pressure are discussed. These factors determine the susceptibility to a compartmental syndrome and suggest some methods by which this susceptibility may be lessened. Chapters 5 and 6 present the common etiologies and anatomical locations of compartmental syndromes. Of primary importance is the observation that increased tissue pressure from any cause in any location may potentially produce a compartmental syndrome.

Chapter 7 reviews the diagnosis of compartmental syndromes, emphasizing the importance of clinical symptoms and signs. Adjunctive diagnostic techniques of tissue pressure measurement and direct nerve stimulation are discussed as well. Chapter 8 presents the treatment of compartmental syndromes and deals not only with techniques of surgical decompression but also with management of associated fractures and wound closure following surgical decompression. Chapter 9 presents the sequelae of compartmental syndromes such as contractures, paralysis, infection, and myoglobinuric renal failure.

Our experience has yielded some preventive measures that may reduce the incidence of compartmental syndromes. These are presented in Chapter 10. Chapter 11 synthesizes the important practical points in a clinical approach to patients at risk for acute compartmental syndromes. This approach is designed to minimize the frequency of compartmental syndromes and to assist in their prompt diagnosis and effective treatment.

Chapters 7 through 11 are concerned primarily with acute compartmental syndromes. In Chapter 12 Dr. Robert G. Veith discusses recurrent compartmental syndromes due to intensive use of muscles. These conditions are becoming more important with the increasing interest in endurance sports such as long-distance running, walking, and canoeing. Chapter 13 enables readers to test their knowledge on some challenging diagnostic and treatment problems.

If you are a clinician, I hope this book will help you better understand the compartmental syndrome so that you may prevent your patients from falling victim to its sequelae. If you are a scientist, I hope this book will stimulate your interest in this unique example of local circulatory failure, which has too long been ignored by those who potentially hold the keys to understanding it. I am most interested in your views on the information presented here and would gladly welcome any correspondence from you.

Frederick A. Matsen III, M.D.

Surgery for Compartmental Syndromes at the University of Washington

Disclaimer

This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.

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