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58 Cards in this Set
- Front
- Back
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compartment syndrome
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increase in interstitial fluid pressure in a closed osseofascial compartment that becomes greater than capillary hydrostatic pressure
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compartment syndrome is most often associated with what trauma
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fracture
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what is the typical age in compartment syndrome
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less than 35
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what percent of calcaneal fractures have compartment syndrome
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10
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what is the partial pressure of oxygen needed by tissues for metabolism
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5-7mmHg
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what is normal perfusion pressure at the capillaries
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25mmHg
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what is the cycle of events with compartment syndrome
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event leads to increased fluid within closed space
capillary flow ceases hypoxia leading to cell damage lactic acidosis leading to further myoneural damage increased permeability and even more fluid in space |
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compartments of the foot
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medial
lateral central 3 interosseous 4 calcaneal 1 |
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things in the medial compartment
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abductor hallucis
flexor hallucis brevis FHL tendon |
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borders of the medial compartment
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superior-inferior surface of 1st met shaft
medial-plantar fascia extension lateral-intermuscular septum inferior-plantar fascia |
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structures in lateral compartment
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abductor digiti minimi
flexor digiti minimi |
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boundaries of the lateral compartment
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superior-5th met shaft
medial-intermuscular septum lateral-plantar fascia inferior-plantar fascia |
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what are the three central compartments
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deep
intermediate superficial |
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structures in the deep central compartment
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adductor hallucis
peroneal tendons posterior tibial tendon |
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structures in the intermediate central compartment
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quadratus plantae
FDL lumbricales |
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structures in the superficial central compartment
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FDB
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central compartment boundaries
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superior-tarsometatarsal structures
medial and lateral-intermuscular septums inferior-plantar fascia |
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structures in interossei compartments
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interossei
arterial arches and nerves |
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boundaries for interossei compartments
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interosseous fascia
metatarsals |
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signs of chronic compartment syndrome
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pain following exertion relieved by rest
pain out of proportion progressive, severe pain and numbness |
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how many times should you measure the pressure
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3 times
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when should pressure be measured with chronic compartment syndrome
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pre-exercise
1 minute into exercise 5 minutes into exercise |
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do not treat chronic compartment syndrome with this
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compression
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what is treatment for chronic compartment syndrome
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rest, ice, elevation
NSAIDs limit activities |
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when would you preform fasciotomy
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if pressure is > 30-40mmHg
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causes of compartment syndrome in the foot
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crush injuries
penetrating injuries fractures burns envenomation ankle sprains MVA |
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what patients are at increased risk for compartment syndrome
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those with bleeding disorder or on anticoagulation medications
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non traumatic causes of compartment syndrome
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venous obstruction
bleeding disorders external compression increase in activity infection |
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signs of compartment syndrome
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pain not relieved by immobilization or reduction
pain that requires increasing amounts of analgesics tense swelling pain out of proportion |
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most sensitive tests for compartment syndrome
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pain with passive mostion and decreased 2 point discrimination
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5 p's
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Pain
Pallor Pulselessness Paresthesias Paralysis |
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is pulselessness useful in diagnosis
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no
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normal compartmental pressure
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4mmHg +/- 4mmHg
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techniques for measuring compartmental pressure
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stryker and ace pressure monitors
Needle technique Wick catheter NIRS |
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where do you check pressure of the medial compartment at
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4cm inferior to medial malleolus
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where do you check pressure of the superficial compartment
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plantar arch
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where do you check pressure of lateral compartment
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just inferior to 5th met base
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where do you check pressure for the interosseous and adductor compartments
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1st and 2nd interspaces
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when do you begin to see nerve deficits
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30min
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when do you see irreversible damage to nerves
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12-24hrs
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when do sensory changes begin
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2-3 hours before motor
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what percent of fibers show damage after 8 hrs of ischemia
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90%
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when does muscle necrosis begin
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after 4hrs
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what labs do you order
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CBC, CMP, urine or serum myoglobin level, PT/PTT, serum creatine phosphokinase
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what is initial treatment of compartment syndrome
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ATLS
start on oxygen IV hydration relieve external presure mannitol and hyperbaric oxygen |
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do not do this as part of initial treatment for compartment syndrome
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elevate affected extremity
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what compartment can be accessed with medial approach
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all compartments
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which compartments are best accessed with medial approach
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medial, lateral, superfiscial
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what is the method for decompression of interosseous and adductor compartments
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2 dorsal incisions
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how are the compartments decompressed from a medial approach
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medial, calcaneal, superficial, and lateral
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where are the incisions placed in dorsal approach
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medial to 2nd met and lateral to 4th met
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when should fasciotomy be preformed
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before any other procedure
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which fractures are reduced after skin is closed and healed
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calcaneal fractures
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post op care for fasciotomy
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incision left open
wounds packed with sterile wet to dry dressings and changed daily patient in posterior splint NWB delayed primary closure antibiotics ROM exercises |
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when must fasciotomy be done
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within 6-8 hrs of ischemic onset
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complications of compartment syndrome
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claw toes
amputation renal damage secondary to myoglobin rls cardiac arrhythmia secondary to acidosis and hyperkalemia |
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conservative treatment for neglected CS
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digital splint
physical therapy stretching and ROM |
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surgical treatment for neglected CS
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hammertoes to amputation
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