Compartment Syndrome Flashcards
1
Q
ESSENCE
A
Pressure within fascial compartment is abnormally elevated, cutting off blood flow to conents of compartment
2
Q
AETIOLOGY
Risk factors
A
- Acute injury
- Bone fractures
- Crush injuries
- Bleeding disorders
- Compression support
- Intense muscular activity
3
Q
CLINICAL FEATURES
Presentation
A
- 5 Ps
- Pain - disproportionate to underlying injury, worsening by passive stretching
- Paresthesia
- Pale
- Pressure (high)
- Paralysis (late and worrying feature)
4
Q
How is presentation differentiated from acute limb ischaemia
A
Pulselessness not a feature of compartment syndrome, is a feature of acute limb ischaemia
5
Q
INVESTIGATIONS
First choice
A
- Usually clinical diagnosis
- Can do compartment pressure measurement
6
Q
MANAGEMENT
General principles
A
- Escalate to orthopaedic registrar/consultant
- Remove any external dressing
- Elevate leg
- Maintain good BP
- Surgery - emergency fasciotomy (definitive management)
7
Q
MANAGEMENT
When should emergency fasciotomy be done
A
As soon as possible after injury (eg within 6 hours)
8
Q
What happens during fasciotomy
A
- Fascia cut down entire length releasing pressure
- Compartment explored to identify and debride any necrotic muscle tissue
- Wound left open and covered in dressing
- Usually requires few trips to theatre over several weeks
- Skin graft may be required
9
Q
Cause of chronic compartment syndrome
A
Usually associated with exertion
10
Q
Symptoms of chronic compartment syndrome
A
- relate to specific location of affected compartment
- Pain
- Numbess
- Paresthesia
- Made worse by activity and resolve by rest
11
Q
COMPLICATIONS
A
- Limb loss
- Phantom pain post amputation
- Acute renal failure - due to myoglobin from breakdown of muscles
- Sensory deficits - due to nerve ischaemia
- Wound infection
