Ch. 47 Severe Right Leg Pain After Tibia Fracture

Question 1

What is the differential diagnosis?

What is the most likely dx?

Answer 1

Most likely dx:

Lower extremity compartment syndrome

Question 2

What are the P’s of Compartment Syndrome? How do these P’s differ from Acute Limb Ischemia?

Answer 2

Compartment Syndrome:

Marked elevation in compartment pressure results in diminished capillary filling pressure. –> Resulting tissue ischemia produces:

• pain
• paresthesia
• pallor
• paralysis
• pulselessness (LATE SIGN)
• poikilothermia (loss of temperature regulation ability)

Acute limb ischemia produces similar symptoms, though loss of pulse is an EARLY result of a sentinel event (i.e. embolus, vessel disruption)

Question 3

What can tissue damage 2/2 compartment syndrome result in?

Answer 3

• Hyperkalemia
• Acidosis
• Myoglobinuria

Lead to end-organ damage, most commonly, kidney failure

Question 4

What is Volkmann’s Ischemic Contracture?

Answer 4

Sequela of untreated compartment syndrome

Classically seen in children following supracondylar fracture –> marked swelling of the forearm muscles

Associated brachial a. injury from the fracture –> ischemia

If untreated, compartment syndrome –> ischemic muscle that becomes fibrosed and contracted

Result: clawlike hand with flexion of the hand at the wrist + damaged nerves

Question 5

How is Abdominal Compartment Syndrome diagnosed?

Answer 5

Measure bladder pressures (>25-30 mmHg = highly suggestive of ACS)