Lower Limb Flashcards
Q: What is the definition of acute compartment syndrome (ACS)?
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.
Q: What happens if compartment syndrome is left untreated? Complications of ACS?
Systemic: Rhabdomyolysis, AKI, Hyperkalaemia & cardiac arrhythmias, Death
Local: Tissue necrosis, permanent functional impairment, Volkmann’s contracture
Q: Approach for managing compartment syndrome?
A: The ABCDE approach following ATLS/CCRISP principles.
Q: What key factors should be covered in the history of a patient with suspected compartment syndrome?
Baseline: Age, sex, occupation, hand dominance, hobbies, social history, smoking/alcohol status, mechanism and timing of injury.
PMHx/DHx: FIT
AMPLE
Q: causes of compartment syndrome?
Trauma
Prolonged immobility (long lie)
Extravasation
Burns.
Q: What are common symptoms of compartment syndrome?
6 Ps: Pain: The first symptom, usually out of proportion to the injury
Paresthesia
Poikilothermia
Pallor
Paralysis
Pulselessness
Focused Examination for Compartment Syndrome
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.
Q: Why is pain on passive stretch an important sign in compartment syndrome?
A: It suggests increased compartment pressure and impending ischemia.
Investigations for Compartment Syndrome
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.)
Q: What is the definitive treatment for compartment syndrome?
A: Emergency decompression with fasciotomy.
Q: What acute management steps should be taken for compartment syndrome?
(O FAATT W)
Oxygen
Fluids
(Antibiotics)
Analgesia
Tetanus prophylaxis
Tubes (IV cannula, catheter)
Wound care
Q: What are the components of the prepping for theatre for compartment syndrome?
(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
Q: What is the purpose of fasciotomy in compartment syndrome?
A: To relieve pressure in the compartments, restore blood flow, and prevent tissue ischemia and necrosis.
Q: Describe lower limb fasciotomy incisions for compartment syndrome?
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
How do you assess muscle viability during fasciotomy for compartment syndrome?
4 Cs: A: Color, Contractility, Consistency, Capacity to bleed.
Q: Post-operative plan following fasciotomy for compartment syndrome?
Continue IV fluids, manage analgesia, elevate the limb, provide VTE prophylaxis, and perform a second-look procedure at 48 hours.
Which muscles are in the anterior compartment?
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Peroneus tertius
What are the nerves and vessels in the anterior compartment of the leg?
Anterior tibial artery and vein
Deep peroneal nerve.
Which muscles are found in the lateral compartment of the leg?
A: Peroneus longus
Peroneus brevis.
Q: Which nerve supplies the lateral compartment of the leg ?
A: Superficial peroneal nerve.
Which muscles are in the superficial posterior compartment?
A: Soleus, gastrocnemius, and plantaris.
What is the primary nerve supplying the superficial posterior compartment?
A: Tibial nerve.
Which muscles are in the deep posterior compartment?
A: Popliteus, flexor hallucis longus, flexor digitorum longus, and tibialis posterior.
Which artery and vein are within the deep posterior compartment
A: Posterior tibial artery and posterior tibial vein.
Q: Why is delayed primary closure often necessary after fasciotomy for compartment syndrome?
A: To allow swelling to subside and prevent further complications, ensuring adequate wound healing.
Q: What is the purpose of continuous IV fluids post-fasciotomy in patients with rhabdomyolysis due to compartment syndrome?
A: To maintain urine output at 1-2 mL/kg/hr and prevent acute kidney injury.
