Compartment Syndrome

Question 1

What are musculoskeletal compartments?

Answer 1

They are groupings of muscles, nerves and blood vessels within the limbs

Question 2

What is musculoskeletal fascia?

Answer 2

It refers to the strong non-elastic connective tissue which acts to hold the tissues within the compartments into place

Question 3

What is the normal compartment pressure?

Answer 3

12 – 18 mmHg

Question 4

What is compartment syndrome?

Answer 4

It is defined as a surgical emergency in which there is increased pressure within the compartments

Question 5

What is the pathophysiological consequence of compartment syndrome?

Answer 5

This restricts blood flow to the compartment tissues, which can lead to necrosis

Question 6

Which five regions of the body tend to be affected by compartment syndrome?

Answer 6

Lower Leg

Forearm

Thighs

Abdomen

Gluteal

Question 7

Which region of the body is most commonly affected by compartment syndrome?

Answer 7

Lower Leg

Question 8

What eight risk factors are associated with compartment syndrome?

Answer 8

Surgical Procedures

Blunt Trauma

Reperfusion Injury

Crush Injury

Burns

Open/Closed Fractures

Constricting Bandages

Malignancy

Question 9

Which two fractures are most commonly associated with compartment syndrome?

Answer 9

Supracondylar fracture

Tibial shift fracture

Question 10

What are the five clincial features of compartment syndrome?

Answer 10

5 Ps

Severe, Intense Pain

Pulselessness

Pallor/Pink Discolouration

Paraesthesia

Paralysis

Question 11

Describe the pain associated with compartment syndrome

Answer 11

It tends to increase on passive movement

It is extreme, in which individuals require excessive use of breakthrough analgesia

Question 12

In compartment syndrome, pulses can be present. Why?

Answer 12

This is due to the fact that arterial pulsation may be felt

This is due to necrosis occuring as a result of microvascular compromise

Question 13

What is the gold standard investigation used to diagnose compartment syndrome?

Answer 13

Intra-Compartmental Pressure Monitoring

Question 14

What two intra-compartmental pressure montioring results indicate compartment syndrome?

Answer 14

Diastolic Blood Pressure & Compartment Pressure < 30mmHg

Intra-Compartmental Pressure > 40mmHg

Question 15

When is intra-compartmental pressure monitoring contraindicated?

Answer 15

When surgical management would be delayed

Question 16

What are the five immediate management options of compartment syndrome?

Answer 16

Removal of Circumferential Casts/Bandages

Maintenance of Limb Level With Body

IV Fluids

Analgesia Administration

Blood Pressure Maintenance

Question 17

What is the surgical management option of compartment syndrome?

Answer 17

Emergency Fasciotomy

Question 18

What is the gold standard management option of compartment syndrome?

Answer 18

Emergency Fasciotomy

Question 19

What is emergency fasciotomy?

Answer 19

It involves opening the affected fascial compartment in order to relieve pressure

Question 20

What complication is associated with emergency fasciotomy?

Answer 20

Acute renal failure

Question 21

How can acute renal failure develop as a result of emergency fasciotomy?

Answer 21

This is due to the development of rhabdomyolysis, in which muscle cell breakdown results in the release of myoglobin, creatine kinase and urea into the systemic circulation

Question 22

How to we prevent acute renal failure development following emergency fasciotomy?

Answer 22

We administer aggressive IV fluids

Question 23

What are the three complications associated with compartment syndrome?

Answer 23

Peripheral Neuropathy

Volkmann’s Contracture

Myositis