Compartment syndrome Flashcards
What is compartment syndrome?
Elevated interstitial pressure in a closed osteofascial compartment that results in microvascular compromise (restriction of capillary blood flow) + necrosis
What may precipitate compartment syndrome?
Fractures
Ischaemia reperfusion injury in vascular patients
What are the 2 most common fractures carrying the complication of compartment syndrome?
Supracondylar fractures
Tibial shaft fractures
Give 2 symptoms of compartment syndrome
Pain esp. on movement (even passive
Parasthesia
What signs characterise the pain in compartment syndrome?
Pain out of proportion to the injury/ clinical picture
Excessive use of breakthrough analgesia
What signs may be found on examination in compartment syndrome?
Pallor
Arterial pulsation may still be fit as necrosis occurs as a result of microvascular compromise
Presence of tightness in muscle compartment
Describe investigations for compartment syndrome
Intracompartmental pressure measurement
Pressure >20mmHg are abnormal
Pressure >40mmHg is diagnostic
What would be seen on x-ray in compartment syndrome?
Normal X-ray
Which 3 measures may be measured in compartment syndrome, indicating muscle cell lysis and necrosis?
Creatine kinase: High
Urine myoglobin: High
Troponin: High
Describe acute management of compartment syndrome
- Dressing release (casts/ occlusive dressings) if present
- FASCIOTOMY + analgesia (Ibuprofen, Morphine sulphate)
- Aggressive IV fluids
Within which time frame should fasciotomy for compartment syndrome be performed?
Within 6h of onset
(Lower amputation + mortality)
When is amputation indicated in a patient with compartment syndrome?
If delayed dx leads to significant muscle necrosis
Why are aggressive IV fluids required in management of compartment syndrome?
Myoglobinuria may occur following fasciotomy + result in renal failure
