Trauma

Question 1

What is compartment syndrome:

Answer 1

• Complication that occurs following fractures
• Or following ischaemia reperfusion injury

Question 2

Most common fractures that cause compartment syndrome

Answer 2

supracondylar
tibial shaft injuries

Question 3

What else can cause compartment syndrome

Answer 3

o Burns o Infection o Prolonged limb compression
o Muscle hypertrophy in athletes

Question 4

presentation of compartment syndrome

Answer 4

• Pain – especially on movement
• o Excess pain on passive movement – pain out of proportion, pain is so severe that pain medications are not effective o Increasing pain despite mobilisation
• Paraesthesia –> this suggests nerve ischaemia in affected compartment
• Pallor (may be present)
• Arterial pulsation may still be felt as necrosis occurs due to microvascular compromise
• Paralysis may occur –> late finding, full recovery is rare in this case
• Tenderness/swelling
• Peripheral pulses absent –> late finding, amputation is often ineviable

Question 5

Investigations of compartment syndrome

Answer 5

needle manomery to measure compartment pressure

> 20mmHg abnormal o >40mmHg diagnostic

Question 6

management of compartment syndrome

Answer 6

• Initial management: escalate to the orthopaedic registrar/consultant
• remove any external dressings or bandages
• elevate the leg to heart level
• maintain good blood pressure (avoid hypotension)
• emergency fasciotomy: