36. Compartment syndrome of the lower extremity – diagnosis and treatment

Question 1

What can cause compartment syndrome?

Answer 1

Most commonly: repetitive and extensive muscle use Injury
1. bleeding from fractures
2. crushing (fluid from the dying cells, blood from muscle tissue vessels)
3. direct vessel injury
4. iatrogenic: fixators, casts, dressings.
5. burns – skin adheres to muscle.

Question 2

What is the pathomechanism of compartment syndrome?

Answer 2

increased pressure (usually caused by inflammation) within a confined space (fascial compartment) in the body impairs blood supply.
Without prompt surgical treatment, it may lead to nerve damage and muscle death.

Question 3

What are the most commonly afflicted compartments to compartment syndrome?

Answer 3

This condition is most commonly seen in the anterior compartment and posterior compartment of the leg.

Question 4

What are the complications of compartment syndrome?

Answer 4

HYPERKALEMIA
MYOGLOBINEMIA

Question 5

What are the symptoms of compartment syndrome?

Answer 5

the 6-P’s:
1. Pain – severe even at rest.
2. Pallor.
3. Parasthesia.
4. Paralysis.
5. Pulslessness
6. Poikilothermia

Question 6

How can you diagnose compartment syndrome?

Answer 6

CK elevation
K+ elevation
Doppler ultrasound

Pressure → measure compartment and subcutaneous pressures using the pressure transducer modules (with a simple IV catheter and needle) that are attached to anaesthetic machines.

When diastolic BP – Compartment pressure=< 30 mmHg compartment syndrome.

Question 7

How can you treat compartment syndrome?

Answer 7

1. Immediate removal of casts and dressings.
2. Fasciotomy + leave the wound open (delayed primary closure) or skin grafting.