Lower Limb

Question 1

Q: What is the definition of acute compartment syndrome (ACS)?

Answer 1

A: ACS is a limb and potentially life threatening condition where increased pressure within a closed space compromises nutrient blood flow to muscles and nerves, leading to tissue ischaemia.
ACS is a surgical emergency requiring prompt diagnosis and treatment to prevent irreversible damage and complications.

Question 2

Q: What happens if compartment syndrome is left untreated? Complications of ACS?

Answer 2

Systemic: Rhabdomyolysis, AKI, Hyperkalaemia & cardiac arrhythmias, Death
Local: Tissue necrosis, permanent functional impairment, Volkmann’s contracture

Question 3

Q: Approach for managing compartment syndrome?

Answer 3

A: The ABCDE approach following ATLS/CCRISP principles.

Question 4

Q: What key factors should be covered in the history of a patient with suspected compartment syndrome?

Answer 4

Baseline: Age, sex, occupation, hand dominance, hobbies, social history, smoking/alcohol status, mechanism and timing of injury.
PMHx/DHx: FIT
AMPLE

Question 5

Q: causes of compartment syndrome?

Answer 5

Trauma
Prolonged immobility (long lie)
Extravasation
Burns.

Question 6

Q: What are common symptoms of compartment syndrome?

Answer 6

6 Ps: Pain: The first symptom, usually out of proportion to the injury
Paresthesia
Poikilothermia
Pallor
Paralysis
Pulselessness

Question 7

Focused Examination for Compartment Syndrome

Answer 7

Look, Feel, Move:
Look: Fully expose the limb, remove restrictive dressings, inspect for swelling, color changes, and wounds.
Feel: NV status (pulses, distal sensation), warmth, and compartment texture (soft/firm), pain, and crepitus.

Question 8

Q: Why is pain on passive stretch an important sign in compartment syndrome?

Answer 8

A: It suggests increased compartment pressure and impending ischemia.

Question 9

Investigations for Compartment Syndrome

Answer 9

Bedside: Urinalysis (myoglobinuria) and ECG (hyperkalaemia).
Bloods: FBC, U&Es, CK, CRP, Clotting, G&S, and VBG.
Imaging: Plain XR
Invasive: Compartment Pressures (>30mmHg or within 30mmHg of diastolic blood pressure.)

Question 10

Q: What is the definitive treatment for compartment syndrome?

Answer 10

A: Emergency decompression with fasciotomy.

Question 11

Q: What acute management steps should be taken for compartment syndrome?

Answer 11

(O FAATT W)
Oxygen
Fluids
(Antibiotics)
Analgesia
Tetanus prophylaxis
Tubes (IV cannula, catheter)
Wound care

Question 12

Q: What are the components of the definitive/operative plan for compartment syndrome?

Answer 12

(NMC TABB)
NBM
Mark
Consent: “Lower Limb Fasciotomies”
Theatre Coordinator
Anaesthetics/ITU
Boss: Call the boss.
Brief: PPPSS
 Patient. Procedure. Position: Supine, TQ, Flowtron on contralateral
 Sets: General plastics set, 10 blade, monopolar
 Specialist equipment: Vac dressing

Question 13

Q: What is the purpose of fasciotomy in compartment syndrome?

Answer 13

A: To relieve pressure in the compartments, restore blood flow, and prevent tissue ischemia and necrosis.

Question 14

Q: Describe lower limb fasciotomy incisions for compartment syndrome?

Answer 14

Mubarak 2 incision technique (1977)
1 cm medial to the medial cutaneous border of the tibia, releasing the deep and superficial posterior compartments.
2 cm lateral to the lateral cutaneous border of the tibia, releasing the anterior and lateral compartments.

Release along entire length of the compartment

Question 15

How do you assess muscle viability during fasciotomy for compartment syndrome?

Answer 15

4 Cs: A: Color, Contractility, Consistency, Capacity to bleed.

Question 16

Q: Post-operative plan following fasciotomy for compartment syndrome?

Answer 16

Continue IV fluids, manage analgesia, elevate the limb, provide VTE prophylaxis, and perform a second-look procedure at 48 hours.

Question 17

Which muscles are in the anterior compartment?

Answer 17

Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Peroneus tertius

Question 18

What are the nerves and vessels in the anterior compartment of the leg?

Answer 18

Anterior tibial artery and vein
Deep peroneal nerve.

Question 19

Which muscles are found in the lateral compartment of the leg?

Answer 19

A: Peroneus longus
Peroneus brevis.

Question 20

Q: Which nerve supplies the lateral compartment of the leg ?

Answer 20

A: Superficial peroneal nerve.

Question 21

Which muscles are in the superficial posterior compartment?

Answer 21

A: Soleus, gastrocnemius, and plantaris.

Question 22

What is the primary nerve supplying the superficial posterior compartment?

Answer 22

A: Tibial nerve.

Question 23

Which muscles are in the deep posterior compartment?

Answer 23

A: Popliteus, flexor hallucis longus, flexor digitorum longus, and tibialis posterior.

Question 24

Which artery and vein are within the deep posterior compartment

Answer 24

A: Posterior tibial artery and posterior tibial vein.

Question 25

Q: Why is delayed primary closure often necessary after fasciotomy for compartment syndrome?

Answer 25

A: To allow swelling to subside and prevent further complications, ensuring adequate wound healing.

Question 26

Q: What is the purpose of continuous IV fluids post-fasciotomy in patients with rhabdomyolysis due to compartment syndrome?

Answer 26

A: To maintain urine output at 1-2 mL/kg/hr and prevent acute kidney injury.