Acute compartmental compression (CEK) due to fracture

Acute compartment compression due to fracture is a dangerous and not uncommon complication of fracture. Compression of the space after fracture can cause serious consequences, the risk of amputation, even life-threatening. Early diagnosis and treatment are important in reducing the risk of complications.

Acute compartmentalization (CEK) is an increase in pressure in the tissues of the septum (space bounded by bone, fascia, fascia, and intermuscular septum), where blood vessels and nerves innervate. passing, the increased pressure in the cavity causes the blood vessels to be compressed to not supply the lower extremities. This leads to muscle necrosis and nerve paralysis.
Acute compartment compression due to fracture is a dangerous complication that occurs after fracture. Especially common after forearm or shin fractures. Cavity compression is common in closed fractures.

Patients after fracture show symptoms such as:
Unusual pain: It feels like the whole limb is damaged, compressing the cavity, feeling very painful when palpating, performing contractions. muscles or when passively moving the fingers. The affected limb area is swollen, blisters may appear on the skin. Measurement of limb circumference showed a marked increase in circumference compared to the healthy side. This is an early sign of acute fracture-induced compression of the compartment, seen in all patients, so it is important to be aware of this symptom in patients with fractures Paralysis or dysfunction of the fingers or toes Sensory disturbances: The patient feels numbness, loss of sensation is getting worse. Changes in skin temperature: The skin below the cavity is compressed due to reduced nutrition from blood vessels, so it is often cold The patient's radial and ulnar pulses are more difficult to detect, then become more severe, and finally these two pulses are not captured in the patient's forearm. In case of compression of the cavity due to a fracture of the lower leg: The pulse of the dorsal and calcaneal canals is higher than that of the healthy side or the pulse cannot be captured in severe cases.

In patients who, after a fracture, re-emerge suggestive of an acute compartment compression condition, the patient's compartment pressure should be measured.
How to measure pressure in the cavity by the Whitesides method
Prepare measuring tools including: Measuring tools: A nozzle with three prongs, a 20ml syringe, an 18-gauge needle, a plastic wire to connect the valve to the syringe and mercury sphygmomanometer, isotonic saline serum bottle. Steps to measure: Take 10ml of gas into the syringe. Fill the tube with about 2ml of isotonic saline and connect it to the needle No. 18. Connect the equipment including the sphygmomanometer, syringe and lead to the 3-prong valve. Open the lines of the 3-prong valve. Disinfect, spread gasoline in the area where the pressure of the cavity needs to be measured. Insert a needle perpendicularly through the skin and weigh into the cavity. Observe the fluid in the tube and the mercury in the sphygmomanometer. At that time, the column of mercury will gradually increase, until it is equal to the pressure in the cavity, the fluid in the connecting tube will move. The pressure level in the mercury column at the time the fluid in the connecting tube moves is a measure of the cavity pressure. Measure the compartments in the injured limb in turn. Each cavity at the limbs needs to be measured at 2 different locations. Interpret results If the cavity pressure < 10 mmHg is normal. If the cavity pressure is ≥ 10 mmHg, there is an increase in compartment pressure. If the cavity pressure is ≥ 30 mmHg, emergency surgery is indicated to open the scale to release the compression.

Depending on the degree and stage of acute compartment compression, appropriate treatment measures can be taken, which can be conservative treatment between surgery.
Threatened compression phase, in case of compartment compression for less than 6 hours and low pressure in the cavity. The main treatment is conservative treatment. The conservative treatment methods include: Remove the indirect causes of external compression: Cut the powder, cut the bandage, cut the sutures... Use pain relievers, reduce edema. Prescribe high: However, pay attention not to give it too high, if it is too high, it will make the situation of compression of the cavity worse. Monitor the progression of the disease, if after 2 hours the symptoms do not decrease. Then do not continue conservative treatment but need surgery to decompress. The post-compression period lasts from 6-15 hours, if the cavity pressure is greater than 30mmHg, it is necessary to quickly decompress by surgical methods, skin incision and wide fascia. Late stage > 15 hours: Usually the limb area has been destroyed, necrotic. This usually requires decompression and amputation. The risk of cardiovascular collapse due to prolonged compression needs to be handled.

Need to be examined carefully to avoid omission, early detection of suspected cases of cavity compression Should not be tight bandaging, increasing the risk of compartment compression Elevate the broken limb moderately and should exercise early to reduce swelling Acute compartment compression due to fracture should be detected and treated early. After the trauma occurs, if there are signs of suspicion of compartment compression. It is necessary to immediately go to reputable medical facilities for early examination, diagnosis and treatment to avoid possible dangerous complications.
Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured to visit. examination and treatment of acute compartment compression (CEK) due to fracture at the Hospital.

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