2. Compartment Syndrome (AJM)

Question 1

compartment syndrome: pathophysiology

Answer 1

acute, localized increased pressure in an enclosed space –> interstitial pressure of the compartment may exceed the hydrostatic pressure of the capillaries –> ARTERIAL SUPPLY TO A SPACE SHUTS OFF and tissue starts dying

Question 2

where does compartment syndrome occur?

Answer 2

any compartment; remember, there are 4 compartments in lower leg and a variable # of compartments in the foot

Question 3

what causes compartment syndrome?

Answer 3

it is usually secondary to acute trauma; (closed fractures, crush injuries, etc); can also be caused by injections, closed reductions, surgeries etc

Question 4

what is NORMAL PRESSURE w/in a compartment?

Answer 4

0-5 mmHg

Question 5

what is the critical threshold to be considered compartment syndrome?

Answer 5

we are worried at ~20 mmHg, and all will reach a diagnosis at >30 mmHg

Question 6

how is this measured?

Answer 6

measured with a wick catheter, slit catheter, or STIC catheter

Question 7

how does a STIC catheter work?

Answer 7

works based on resistance; inject fluid into the compartment and how much resistance you feel as you’re injecting it tells you how much pressure there is

Question 8

P’s of compartment syndrome

Answer 8

(1) Pain, (2) Poikilothermia, (3) Paresthesia, (4) Paralysis, (5) Pulselessness, and (6) Pallor.

Also included pain out of proportion & uncontrolled w/ narcotics, pain w/ passive dorsiflexion of the toes, pressure

Question 9

treatment for compartment syndrome

Answer 9

fasciotomy or decompression; must be performed quickly as it’s a surgical emergency

Question 10

how to perform fasciotomy in the lower leg?

Answer 10

there are 4 compartments (anterior, lateral, superficial posterior, and deep posterior), and you can decompress them all with 2 incisions (anterior-lateral and posterior-medial)

Question 11

how to perform a fasciotomy in the foot?

Answer 11

usually a 3 incision approach; though some people think there are 0 compartments. … MOST people think there are at least 3 compartments ; (medial, central, and lateral plantar food compartments)

Question 12

VOLKMANN’S contractures: define

Answer 12

COMPLICATION that can result after calcaneal fractures; can present several weeks to months later; toes start contracting from damage to the quadratus plantar;

more generally, the affected limb often becomes dysfunctional and painful, and may lose sensibility.

Question 13

describe the location of the incisions for a fasciotomy of the foot

Answer 13

3 incision approach:

(1) dorsal aspect of 2nd MT (to get into 1st/2nd intermetatarsal space)
(2) dorsal aspect of 4th MT (can get into 3rd/4th intermet space)
(3) separate medial incision along the foot (can get into medial and central compartment of the foot)

Question 14

describe closure techniques after fasciotomy?

Answer 14

usually AVOID trying to primarily close it; instead, recommend NPWT, skin grafts, or other closure devices

Question 15

poikilothermia: define

Answer 15

the inability to regulate one’s body temperature.