acute compartment syndrome

Question 1

What is volkmann’s ischaemic contracture

Answer 1

Volkmann’s ischaemic contracture – the flexor muscles of the forearm become irreversibly ischaemic and then permanently contracted

Question 2

When does pain that is out of proportion to the injury a sign of

Answer 2

Compartment syndrome

Question 3

What is compartment syndrome

Answer 3

A condition in which the circulation to, and function of tissues in, a closed space are compromised by an increased pressure in that space

Question 4

What is the most common at risk site of compartment syndrome

Answer 4

lower leg
forearm
hand

Question 5

Why is compartment syndrome common in the lower limb

Answer 5

Because there are 4 compartments which have the potential to develop compartment syndrome

Question 6

What are the common causes of compartment syndrome

Answer 6

haemorrhage
fractures - can lead to haemorrhage

Question 7

What happens in compartment syndrome

Answer 7

soft tissue injury and bleeding which causes swelling - this leads to raised compartment pressure - leads to decreased tissue perfusion - leads to ischaemia and cell death which releases myoglobin which causes more swelling

Question 8

at pressure more than 30 mmHg describe how long it takes for muscle changes to become reversible, variable and irreversible

Answer 8

4 hours - reversible

6 hours - variable

8 hours - irreversible

Question 9

At pressure over 40mmHg describe how long it takes for conduction loss and axonotmesis

Answer 9

2 hours - conduction lost - causes tingling numbness

8 hours - axonotmesis - the internal structure of the nerve (axon) is damaged

Question 10

What is the presentation of compartment syndrome

Answer 10

Pain - out of proportion to the injury

Pain - on passive stretch

altered sensation

weakness

swelling

elevated compartment pressure

5 P’s:
pain
paralysis
pallor
paresthesia
pulselessness
apart from pain the others are late onset signs

Question 11

What test can be done for compartment syndrome in the lower leg

Answer 11

passively moving the toes - pulling on the muscles that normally flex and extend the toes - if it increases pain, it is a indicator of compartment syndrome

Question 12

What is the difference in diastolic blood pressure and compartment pressure which is diagnostic of compartment syndrome (Critical pressure)

Answer 12

less than 30 mmHg difference - critical pressure

Question 13

What is the treatment of compartment syndrome

Answer 13

open constrictive dressing to the skin

Emergency fasciotomy of affected compartment - division of the fascia

Question 14

For tibia compartment syndrome issue what where should incision be made

Answer 14

2 incisions 1-2 cm posterior to subcutaneous border of the tibia which decompresses all compartments

Question 15

Where is the best place to measure the pressure in compartment syndrome

Answer 15

At the fracture site - which is where the pressure is at it’s highest