Compartment syndrome

Question 1

Definition

Answer 1

elevated interstitual pressure within a closed facial compartment resulting in microvascular compromise

Question 2

Sites

Answer 2

leg, foream, thigh

Question 3

Causes

Answer 3

• Increased internal pressure - blleding, swelling, iatrogenic infiltration, trauma
• Increased external pressure - cast/bandages, full thicknes burns, impaired concious

Question 4

Clinical features

Answer 4

• Pain- out of proprotion to that expected from injury and on passive stretchin
• pallor- capillaries shut down
• parasthesia - compression of nerves
• paralysis
• pulseess

Sweating, shiny skin

Question 5

Pathophysiology

Answer 5

1. pressure within compartment exceeds pressure within capillaries
2. muscle becomes ischaemic and develops odema through increased endothelial permeabilit
3. ischaemic muscle release myoglobin, makes it worse
4. necrosis begins in ischaemic muscle at 4 hours
5. Neuropraxia, can recover if relieved early
6. arterial supply is compensatied late

Question 6

Time frame

Answer 6

• 1hr - nerve conduction, muscle viable
• 4 hr- neurpraxiia, reversible msucle ischaemia
• 8 hr - Nerve ataxia and irreversible changes, irrevrsible muscle ischaemia

End stae- stiff fibrotic muscle compartments, impaired nerve function, loss of function

Question 7

Treatment

Answer 7

• stop any pressure on outside of limb
• peri-operative
  
  • correct fluid loss
  • myoglobinuria can cause renal failrue
• surgical
  
  • leave wounds open
  • excisee any dead muscle
  • full length decompression of all compartments
• Late presentation
  
  • splint
  • fasciotomy will predispose to infection