Compartment Syndrome

Question 1

Compartment

Answer 1

9 foot osteoligament

Question 2

Pathology

Answer 2

Volkmann’s ischemia

1. Injury
2. Tissue swelling + blood accumulation
3. Increase intercompartmental pressure (limited by fascia)
4. Decrease perfusion pressure
5. Local hypoxia
6. Cell membrane damage leads to further tissue edema

(after 8 hours irreversible damage to muscle)

• do not lose limb but fx of the limb

Question 3

Etiology

Answer 3

Closure of fascial defect
Tight dressing
Localised external pressure

Bleeding
Increase capillary permeability
- trauma, burns
Increase capillary pressure
- venous obstruction

Question 4

Common cause of compartment syndrome

Answer 4

Leg: Tibial plateau fracture (cancellous bone)
Foot: Calcaneal fracture, Lis Franc injury, multiple metatarsal bone fracture
Forearm: IV line extravasation
Thigh: Femoral artery cut

Question 5

Clinical features

Answer 5

1. Pain disproportionate, incapacitating, progressive
2. Pulseless
3. Pallor
4. Paraesthesia
5. Paralysis
6. Tense compartment
7. Passive stretch test (muscle undergoing ischemia)

Early

• Pain
• Tense compartment
• Paraesthesia

Question 6

Diagnosis

Answer 6

Clinically

Question 7

Management

Answer 7

1. High clinical suspicion
2. Ensure pt normotensive
3. Remove circumferential bandage and cast, replace with back slab, loosen bandage or dont put at all
4. Fasciotomy

Question 8

Fasciotomy

Answer 8

1. Long extensile incision
2. Release all compartment (one incision to release 2)
6. Give time for swelling to reduce
7. Close one wound, anothr one put SSG