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20 Cards in this Set
- Front
- Back
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What is Compartment Syndrome?
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- elevated tissue pressure within a closed fascial space
- reduces tissue perfusion- ischemia - Results in cell death (necrosis A TRUE ORTHOPEDIC EMERGENCY |
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What causes Compartment Syndrome?
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- Decreasing compartment size (tight bandage, lying on limb)
- Increasing Compartment Content (bleeding, capillary permeability) - Fractures - Temp vascular occlusion - Burns - Exertional states - Hemophiliac - Intraosseous IV - Snake bite - Arterial Injury |
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What is the most common cause of Compartment Syndrome?
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- Fracture
- risk is proportional to degree of injury - most common in a comminuted grade III |
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What is the 2nd most common cause of compartment syndrome?
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Blunt Trauma
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What is the muscle tissue survival rate in Compartment syndrome?
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- Reversible at 3 to 4 hours
- Variable Damage at 6 hours - Irreversible at 8 hours |
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What is the survival rate of nerves in Compartment Syndrome?
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- Loose nerve conduction at 2 hours
- Neuropraxia at 4 hours - Irreversible changes at 8 hours |
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What are the symptoms for compartment syndrome?
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- PAIN OUT OF PROPORTION
- palpable tense compartment - pain with passive stretch - Paresthesia (later) - Paralysis (later) - Pulselessness (later) |
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How is Compartment Syndrome Diagnosed?
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- Pain and aggravation of pain by passive stretching of muscles in the compartment and palpation
- PAIN - Pressure measurement with STRYKER NEEDLE MANOMETER in all compartments (in most law suits the compartments were never measured) |
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What are the differential diagnosis for compartment syndrome?
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- Arterial occlusion
- Peripheral Nerve Injury - Muscle Rupture |
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What are the 4 compartments of the lower leg?
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Anterior
- EHL, EDC, Tibialis Anterior, Peroneus Tertius Lateral - Peroneus longus and brevis Deep Posterior - Tibialis Posterior, FHL, FDL Superficial Posterior - Gastrocnemius, Soleus *Anterior and posterior have higher pressures |
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What are the criteria for a Fasciotomy?
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- within 30 mm Hg pressure in compartment
- Greater than 30 mm Hg do more exams first |
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What is the medical management for Compartment Syndrome?
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- Make sure patient isn't hypotensive
- Supplemental Oxygen - Remove circumferential bandages and cast (85 to 95% reduction) - Place at level of heart - Alert or Anesthesia - FASCIOTOMY - Stabilize fracture |
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What is a Fasciotomy?
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- prophylactic release of pressure before permanent damage occurs. Will not reverse damage
- safe, reliable, effective - The ONLY treatment for compartment syndrome when performed in time |
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What to do in a lower leg fasciotomy?
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Double incision
- one incision over anterior and lateral compartments - one incision behind posteromedial aspect of tibia |
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What to do in a forearm Fasciotomy?
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- Protect median nerve, brachial artery, and tendons after release
- Consider dorsal release |
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What to do in a Foot Fasciotomy?
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- Dorsal incision to release the interosseous and adductor
- Medial incision- to release the medial, superficial lateral and calcaneal compartments |
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What to do in a Hand Fasciotomy?
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- nonspecific aching of the hand with fracture or crush
- disproportionate pain - loss of MP extension and PIP flexion - Can't measure tissue pressure - 10 separate Osteofascial compartments - Dorsal Interossei (4) Palmar Interossei (3) Thenar and hypothenar (2) Adductor Pollicis (1) |
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What to do in a Thigh Fasciotomy?
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- Lateral incision to release anterior and posterior compartments
- May need Medial incision for adductor compartment |
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Wound management after a Fasciotomy
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- Bulky compression dressing and a splint
- Vacuum Assisted Closure - Foot should be placed in neutral to prevent contracture - Incision can be closed after 3 to 5 days (simple absorbent dressing and semipermeable skinlike membrane in the interim) - May need skin graft - Get complete coverage in 7 to 10 days |
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Complications related to Compartment Syndrome
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- Volkmann's Contracture
- Weak dorsiflexors - Claw toes - Sensory loss - Chronic pain - Amputation |
