SINDROM KOMPARTEMEN

Oleh :
dr. Yolan Novia Ulfah

Pembimbing :
dr. Faisal Fachsan,M.Kes, MM, Sp.OT, FICS
 SYNDROME COMPARTMENT

Compartment syndrome is
defined as a condition in which a
closed compartment pressure
increases to such an extent that
the microcirculation of the
tissues in that compartment is
Acutediminished
: tanda kegawatan medis yang ditandai
dengan pembengkakan dan nyeri yang terjadi
dengan cepat

Chronic: bukan merupakan suatu kegawatan

medis dan seringkali dikaitkan dengan nyeri
ketika aktivitas fisik seperti olahraga
Raza H, Mahapatra A. “Acute Compartment Syndrome in Orthopedics: Causes, Diagnosis, and Management”. Hindawi Publishing Corporation Advances in Orthopedics, 2014; vol 15
(8).
 ANATOMI
sekelompok gejala yang disebabkan
peningkatan tekanan dari suatu edema
progresif di dalam kpmpartemen osteofasial
yang kaku dan secara anatomis mengganggu
sirkulasi otot dan saraf intrakompartemen
sehingga dapat menyebabkan kerusajan
jaringan intrakompartemen
Compartment adalah kelompok dari
otot, saraf dan pembuluh darah di
ektremitas .
dibungkus oleh tulang dan fasia
serta otot-otot yang masing-masing
dibungkus oleh epimisium

Salter RB. Textbook of Disorders and injuries of the musculosceletal system. 3rd edition. USA: Lippincott Williams and Wilkins; 1999
Brinker MR. Review of Orthopaedic Trauma. USA W.B. Saunders; 2001
 Kompartment Extremitas Atas-
Lengan atas
• Anterior
M. biceps brachii, brachialis, choracobrachialis
dibatasi os humerus, septum intermusculer
lateral dan medial yang dipersarafi oleh N.
musculocutaneus dan diperdarahi oleh A.
brachialis dan V. chepalica.

• Posterior
• M. triceps brachii, anconeus dibatasi
oleh tulang humerus, septum
intermusculer lateral dan medial yang
dipersarafi oleh N.radialis dan
diperdarahi oleh arteri brachialis dan Figure 1. Cross-section Medial Calf. Adapted from “Grey’s Anatomy,”
2009. Retrieved from : https://radiopaedia.org/images/24012

vena chepalica
 Kompartment Extremitas Atas-
Lengan bawah
Anterior: M. pronator teres, fleksor digitorum
superficial, fleksor carpi radialis, palmaris longus,
fleksor carpi ulnaris, ekstensor carpi radialis, dan
brachioradialis. Dibatasi oleh tulang radius dan septa
profunda yang dipersarafi oleh N. radialis serta
diperdarahi oleh A. radialis dan V. chepalica.

Lateral: M.pronator quadrates, fleksor digitorum

profundus, fleksor policis longus. Dibatasi oleh tulang
radius, ulna, dan membrana interossea yang dipersarafi
N. medianus dan N. ulnaris, serta diperdarahi oleh A.
ulnaris.

Posterior: M. extensor digitorum, extensor digiti

minimi, extensor carpi ulnaris, supinator, abductor Figure 1. Cross-section Medial Calf. Adapted from “Grey’s Anatomy,”
2009. Retrieved from : https://radiopaedia.org/images/24012

pollicis longus, extensor pollicis brevis, extensor

pollicis longus, dan extensor indicis. Dibatasi oleh
 Kompartment Extremitas Bawah -
• Anterior
Calf
• Tibialis anterior, extensor muscles of
toes, anterior tibial artery, and deep
peroneal nerve
• Lateral
• Peroneus longus and peroneus brevis,
superficial peroneal artery
• Deep Posterior
• Tibialis posterior, flexor digitorum
longus, and flexor hallus longus
• Superficial Posterio
• Gastrocnemius, plantaris
muscle and soleus muscle.
Sural nerve
• Lithotomy positions
Figure 1. Cross-section Medial Calf. Adapted from “Grey’s Anatomy,”
2009. Retrieved from : https://radiopaedia.org/images/24012
 Kompartement Ekstremitas Bawah – Thigh
• Anterior
• Vastus lateralis, vastus
intermedius, srtorius, and
recutus femoris
• Femoral nerve/artery
• Medial
• Pectineus, external
obturator, gracilis muscles
• Adductors
• Obturator nerve
• Posterior
• Semimembranous,
semitendinosis, and biceps
femoris Figure 2. Cross-section Medial Calf. Adapted from “Grey’

• Sciatic nerve
Anatomy,” 2009. Retrieved from :
https://radiopaedia.org/images/24012
„„
ETIOLOGI
Peningkatan tekanan
kompartement
• Fraktur
• Trauma langsung jaringan
otot
• Luka bakar
Penurunan luas ruang kompartemen
• „Kompresi tungkai terlalu ketat saat
imobilisasi fraktur
• Luka bakar yang menyebabkan
kekakuan/ konstriksi jaringan ikat
sehingga mengurangi ruang
kompartemen.
.
Aprianto P. Sindrom Kompartemen Akut Tungkai Bawah. Jurnal CDK. 2017; 44 (6).
 Place Your Picture Here

ETIOLOGI

Peningkatan Tekanan Pada Struktur

Kompartement :

Donaldson J, Haddad B, Khan WS. The Pathophysiology, Diagnosis and Current Management of AcuteCompartment Syndrome. The Open Orthopaedics Journal.  2014; 8 (1) 185-193.
 FAKTOR RESIKO
Bone Fracture (2/3 of Cast/Splint on
patients) broken bone
Tibia/radius most
commonly seen Trauma OR - same
position for > 8
hrs Lithotomy

Increased Men in their

Muscle Mass 30’s
PATOFISIOLOGI
Perfusi Tekanan Otot =
Tekanan Diastolik – Tekanan
Intramuskular

2 Prinsip :
Penurunan Volume Kompartmen
Peningkatan Tekanan
Kompartement
PATOFISIOLOGI
PATOFISIOLOGI
Increasing Inter Compartmental Pressure

Raised Inter Compartmental Pressure

(ICP) > 30mmHg basis for treatment

ICP > 40mmHg = surgical emergency

.

Untreated, within 6-10 hours, the

outcome of persistent high
compartmental pressures is muscle
infarction, tissue necrosis, and nerve
injury
 MANIFESTASI KLINIS

PAIN PARE PALL

STHE OR
SIA

PARA PULS
LYSIS ELESS
NES
Raza H, Mahapatra A. “Acute Compartment Syndrome in Orthopedics: Causes, Diagnosis, and Management”. Hindawi Publishing Corporation Advances in Orthopedics, 2014; vol 15 (8)
 PAIN
• Pain that is out of proportion
to the injury

• Pain with passive stretch of

muscle

• Persistent deep ache or

burning

FIRST presenting symptom

PARESTHESIA
• A condition in which you feel
sensation of numbness or prickling

• Pins & Needles

• Early contained to one

compartment
• Late globally within limb
 PALLOR

• Rarely present
• Often times, redness
progresses to pallor
• Sign of vascular injury
and quickly leads to
ischemia
• LATE stage – emergent
intervention require
PULSELESSNESS

• The existence of distal pulses DO

NOT exclude compartment
syndrome
• Check above and below area of
concern
• Late stage – indicates
progression

https://upload.wikimedia.org/wikipedia/commons/thumb/ d/d1/Pulse_sites-
en.svg/220px-Pulse_sites-en.svg.png
 PARALY SIS
• Complete loss of muscle function for one or more muscle groups

• Very late finding indicating nerve damage

http://drawingbooks.org/lutz1/source/images/000088.png
 DIAGNOSIS

Pain,
Parasthesia, CPK
Paralysis,
Pulseness,,
Start Pallor SINDROM
KOMPARTEMEN

ANAMNESIS Tekanan Urine

Kompartemen Myoglobulin
 Diagnosis

Stryker Manometer
• Normal : 0 - 10
mmHg
• Pressures > 30- 40mmHg
menandakan peningkatan
tekanan kompartemen

https://www.slideshare.net/drrohitvikas/compartment-syndrome-14077010
TERAPI

Fasciotomy

8 jam iskemik dapat

menyebabkan
kerusakan otot
secara irreversible
 Fasciotomy

Incision prior to
fasciotomy

Fasciotomy in progress – muscle

is still beefy red and viable
 FOLLOW UP

 The postoperative wound check is at 3-

5 days.

 Suture removal occurs at 10-14 days (if

Medical
Presentation the wounds are closed).

 Patients may need skin grafting or

traction dermoplasty if the skin defect

is large.
KOMPLIKASI
 Motor deficits ie foot drop, Volkmann
contracture
 Infection, with potential amputation
 Hyperaesthesia & painful dysesthesia:
medication ie phenytoin,
carbamazepine, gabapentin
 Recurrent CS, due to scarring - athletes
 Systemic complications: acute renal
failure, sepsis, Adult Respiratory
Distress Syndrome
Thank You