Compartment Syndrome Flashcards
What are musculoskeletal compartments?
They are groupings of muscles, nerves and blood vessels within the limbs
What is musculoskeletal fascia?
It refers to the strong non-elastic connective tissue which acts to hold the tissues within the compartments into place
What is the normal compartment pressure?
12 – 18 mmHg
What is compartment syndrome?
It is defined as a surgical emergency in which there is increased pressure within the compartments
What is the pathophysiological consequence of compartment syndrome?
This restricts blood flow to the compartment tissues, which can lead to necrosis
Which five regions of the body tend to be affected by compartment syndrome?
Lower Leg
Forearm
Thighs
Abdomen
Gluteal
Which region of the body is most commonly affected by compartment syndrome?
Lower Leg
What eight risk factors are associated with compartment syndrome?
Surgical Procedures
Blunt Trauma
Reperfusion Injury
Crush Injury
Burns
Open/Closed Fractures
Constricting Bandages
Malignancy
Which two fractures are most commonly associated with compartment syndrome?
Supracondylar fracture
Tibial shift fracture
What are the five clincial features of compartment syndrome?
5 Ps
Severe, Intense Pain
Pulselessness
Pallor/Pink Discolouration
Paraesthesia
Paralysis
Describe the pain associated with compartment syndrome
It tends to increase on passive movement
It is extreme, in which individuals require excessive use of breakthrough analgesia
In compartment syndrome, pulses can be present. Why?
This is due to the fact that arterial pulsation may be felt
This is due to necrosis occuring as a result of microvascular compromise
What is the gold standard investigation used to diagnose compartment syndrome?
Intra-Compartmental Pressure Monitoring
What two intra-compartmental pressure montioring results indicate compartment syndrome?
Diastolic Blood Pressure & Compartment Pressure < 30mmHg
Intra-Compartmental Pressure > 40mmHg
When is intra-compartmental pressure monitoring contraindicated?
When surgical management would be delayed
What are the five immediate management options of compartment syndrome?
Removal of Circumferential Casts/Bandages
Maintenance of Limb Level With Body
IV Fluids
Analgesia Administration
Blood Pressure Maintenance
What is the surgical management option of compartment syndrome?
Emergency Fasciotomy
What is the gold standard management option of compartment syndrome?
Emergency Fasciotomy
What is emergency fasciotomy?
It involves opening the affected fascial compartment in order to relieve pressure
What complication is associated with emergency fasciotomy?
Acute renal failure
How can acute renal failure develop as a result of emergency fasciotomy?
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
How to we prevent acute renal failure development following emergency fasciotomy?
We administer aggressive IV fluids
What are the three complications associated with compartment syndrome?
Peripheral Neuropathy
Volkmann’s Contracture
Myositis
