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MBBS 3: Surgery > Compartment Syndrome > Flashcards

Compartment Syndrome Flashcards

1
Q

What is compartment syndrome?

A

Acute compartment syndrome (ACS) occurs when pressure rises within confined space
> critical reduction of blood flow to tissues

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2
Q

What are the results of late presentation/missed diagnosis of ACS?

A
  1. myonecrosis
  2. rhabdomyolysis
  3. contracture
  4. sensory loss
  5. Infection
  6. amputation
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3
Q

Pathophysiology of ACS?

A
  1. In damaged tissue, rising pressure
    > reduction in flow to muscle
  2. Reduction in flow > tissue ischemia
  3. Tissue ischemia > More cellular injury and release of osmotically active cellular contents into interstitial fluid
  4. Release of fluid > further increase in pressure
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4
Q

Timing of consequences?

A
  1. 2-4 hours: reversible muscle damage > loose nerve conduction
  2. 4-6 hours: variable muscle damage > nerve neurapraxia
  3. > 6 hours: irreversible muscle damage > irreversible nerve damage
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5
Q

Risk factors?

A

Trauma
1. Fracture (69%)
2. Crush Syndrome
3. Soft Tissue Injury
4. traumatic injury with high energy forces e.g. sports injury
5. low energy atraumatic injuries e.g. overdose
Note:
Tibia most common involved bone

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6
Q

Can an open fracture get compartment syndrome?

A

yes
- Does not “self-fasciotomize”
- Risk higher due to higher- energy soft tissue injury

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7
Q

Can an open fracture get compartment syndrome?

A

yes
- Does not “self-fasciotomize”
- Risk higher due to higher- energy soft tissue injury

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8
Q

Conditions increasing the volume of compartment contents?

A
  1. Revascularization
    - reperfusion injury
  2. Blood thinners/Medications
  3. Exercise
  4. Burns
  5. Injection injuries
  6. Fluid infusion (including arthroscopy)
  7. Osteotomy
  8. Snake bite
  9. Acute hematogenous osteomyelitis
  10. Fracture
  11. Soft tissue injury
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9
Q

Conditions reducing compartment volume?

A
  1. burns
  2. repair of muscle hernia
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10
Q

Medical comorbidity with ACS?

A
  1. diabetes
  2. hypothyroidism
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11
Q

Name specific high risk injuries that can cause compartment syndrome?

A
  1. High energy long bone fractures
    - Tibial fractures 2-10%
  2. Bleeding diathesis/anticoagulation
  3. Polytrauma with transfusions
  4. Medial knee fracture-dislocations
  5. Schatzker VI plateau fractures
    Any patient with altered pain perception should be watched carefully
  6. Regional anesthesia
  7. Altered consciousness – intubated, ICU
  8. PCA / pain medication
  9. Associated nerve injury
  10. Children (unreliable exam
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12
Q

Risk factors for Tibia fractures?

A
  1. Age (strongest predictor): 12-29 years
  2. Male sex especially
    - Potential cause: higher muscle mass and less “room to swell”
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13
Q

Which compartment does ACS occur in in tibia fractures?

A
  1. Anterior compartment most common
  2. followed by deep posterior
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14
Q

Diagnosis of ACS?

A

clinical diagnosis
1. Physical exam in awake patient = benchmark for diagnosis
2. Intracompartmental pressure readings = useful adjunct

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15
Q

Classic signs/symptoms of compartment syndrome?

A

6 P’s
1. Pain on passive stretch/out of proportion
2. Pressure/swelling
3. Paresthesia
4. Paralysis
5. Pallor
6. Pulselessness

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16
Q

What are the late findings of ACS?

A
  1. Paresthesia
  2. Paralysis
  3. Pallor
  4. Pulselessness
17
Q

What are compartment pressure measurements?

A

Most common method is ΔP:
Diastolic BP – compartment P
ΔP<30 is suspicious for ACS

18
Q

Initial treatment of ACS?

A
  1. Split or remove tight dressings
    - Including cast padding/webril
  2. Continuous close observation
  3. Keep limb at level of heart (avoid extreme elevation)
  4. Oxygen saturation to improve availability to muscle
  5. Correct systemic hypotension
19
Q

Treatment for suspected/confirmed ACS?

A

When there is high suspicion of compartment syndrome: THOROUGH AND COMPLETE FASCIOTOMY OF AFFECTED COMPARTMENTS
- Incomplete release  dead muscle

20
Q

What are fasciotomy caveats?

A
21
Q

Fasciotomy sites?

A
  1. Gluteal
  2. Thigh
  3. Leg
  4. Foot
  5. Arm
  6. Forearm
  7. Hand
22
Q

Aftercare for ACS: Wound management options?

A
  1. Wound vac
  2. Vessel Loops
23
Q

After care for ACS: wound closure options?

A
  1. Primary
    - May require multiple trips to the OR
  2. Primary with pie crust
  3. Split thickness skin graft
    - sensory and cosmetic issues
24
Q

Complications of compartment syndrome?

A
  1. Volkmanns ischemic contracture
    - end stage of acute compartment syndrome; irreversible muscle necrosis
  2. Infection
  3. Permanent neurological injury
  4. Chronic pain
  5. Nonunion of associated fractures
  6. Amputation
  7. In-hospital increased stay, complications > malpractice claims

MBBS 3: Surgery (42 decks)

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