Compartment Syndrome

Question 1

Why do you still feel palpable pulses in the acute setting of a compartment syndrome?

Answer 1

because these vessels are extra-compartmental

Question 2

at what pressure do we worry about compartment syndrome?

Answer 2

> 30mmHg

Question 3

how do we measure compartment pressure?

Answer 3

multistick needle catheterization

Question 4

Where should needle stick catheterization be performed when measuring compartment pressures?

Answer 4

1. between each of the metatarsals for each of the interosseous compartments
2. advance the needle further in the 1st IM space to measure the adductor compartment pressure
3. insert needle laterally, plantar to 5th met to obtain lateral compartment pressures
4. medially, 4cm inferior to medial malleolus over ABH to obtain medial compartment pressure

Question 5

true or false: compartment syndrome is a surgical emergency. Why?

Answer 5

true. if not recognized promptly, can cause muscle ischemia, necrosis and irreversible damage.

Question 6

when obtaining compartment pressures, should you use local anesthetic prior to inserting the catheter? why or why not?

Answer 6

NEVER inject LA prior to inserting the catheter bc the anesthetic fluid will increase the interstitial pressure and give a falsely elevated compartment pressure reading.

Question 7

What are the S/S associated with compartment syndrome?

Answer 7

pain (on passive stretch )
paresthesia- change in sensation
pallor
poikilothermia- inability to control temp 
paralysis

Question 8

what is normal compartment pressure?

Answer 8

0-8 mmHg

Question 9

how many anatomic compartments are in the lower leg?

Answer 9

4 (anterior, lateral, superficial posterior, deep posterior)

Question 10

What additional lab tests could you order if you suspect compartment syndrome?

Answer 10

UA- see if myoglobin is being released and being filtered to kidneys
-check creatine kinase
-BUN/Creatinine
electrolytes

Question 11

what injuries is ACS most commonly associated with?

Answer 11

Lisfranc and metatarsals- 41%

calcaneal fx- 17%

Question 12

what are some complications of ACS?

Answer 12

inadequate decompression
Volkman’s contracture
infection
myoglobinuric renal failure

Question 13

what is the conservative treatment for chronic compartment syndrome?

Answer 13

stop athletic activity for 2-3 weeks

gradual return to activity/change to non-provocative activity