Compartment syndrome

Question 1

How would you classify compartment syndrome

Answer 1

surgical emerency

Question 2

Define compartment syndrome

Answer 2

painful condition caused by increased intersititial pressure within closed osetofascial compartment that impairs local circulation. Defined as the pressure in the compartment >30mmhg or within 30mmhg close to diastolic pressure.

Question 3

Causes

Answer 3

2 types
1. Traumatic injuries - most common is tibial fracture - high energy injuiry which increases bleeeding in compartment, blood builds up -> increasing compartment pressure -> reduces perfusion arteries and arterioles bring to compartment

2. chronic exertional compartment syndrome - Can occur in athletes - in those who walk a lot or use calf a lot in a repetitive stress way - muscles become so big in compartment in a fairly short time that when the muscles are working it increases compartment pressure and that in itself causes pain and reduced perfusion

Question 4

preventative measures

Answer 4

1. Traumatic type
   - prevent injuries
   - make sure bandages or plasters for fractures not too tight and legs
   - make sure legs are elevated so they do not swell up
2. chronic exertional compartment syndrome
   - train in a graded manner to prevent muscles getting big too quickly
   - balance training with stretching before and after exercise

Question 5

symptoms of compartment syndrome

Answer 5

• 3 Ps
• PAIN, PAIN, PAIN
• pain disproportionate to injury they have and pain disporportioante to analgesia they are receiving and analgesia requirements keep going up

5Ps of limb ischaemia
- pain, paraesthesia, pallor, paralysis and (pulsnessless as a very late sign)
- paraesthesia and paralysis (loss of nerve) and pulsnessless (loss of pulse) are late signs

Question 6

cellulitis vs compartment syndrome

Answer 6

cellulitis - soft tissue infection of subcutaneous tissues
- redness
- warmth
- fever
- CRP raised
- pain when touching skin
Main differentiator - WILL NOT GET PAIN on passive movement of toes or hands in cellulits

Pain of passive movement in comparment syndrome due to tendons moving in a tense compartment

Question 7

Investigations for compartment syndrome

Answer 7

Mainly clinical diagnsois - TAKE A GOOD HISTORY
- but can measure compartment pressures IF UNCERTAIN - specific pressure monitors placed into compartments of leg, arm, forearm
- >30mmHg - implies compartment syndrome
- OR within 30mmHg of diastolic pressure

FBC
Renal function - Rhabdomyolyiss can cause renal failure
Serum Creatine Kinase - muscles necrosed - 1000s - 100,000s - indicating rhabdomyolis

if suspecting infection - inflammatory markers - WCC, CRP , ESR

Question 8

Management of compartment syndrome

Answer 8

definitive treatment - theatre and immediate fasciotomy

if it is a post surgery surgery
- remove bandages
- split plasters so nothing compressed externally

Answer 9

ischaemia
- muscle necrosis - irreversible
- ischaemia of nerves - paralysis
- vessels

Question 10

tips

Answer 10

• ## HISTORY