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R9 > Chapter 102 - Compartment syndrome and its management > Flashcards

Chapter 102 - Compartment syndrome and its management Flashcards

1
Q

Poiseuille’s Law

A

F = pi r^4 deltaP / 8nL F = capillary blood flow r = radius of capillary deltaP = pressure gradient pre-capillary arteriole to post-capillary venule

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2
Q

Matson’s critical closing pressure theory

A

Capillaries collapse after this pressure Disproven by Hartsock

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3
Q

Hartsock dynamic pressure ICP-MAP cutoff for likely capillary collapse

A

25.5 +/- 14 mmHg

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4
Q

Dynamic intracompartmental pressure threshold for 1) healthy tissue 2) injured tissue

A

MAP - ICP 1) < 30 mmHg 2) < 40 mmHg

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5
Q

Usual cutoff used for pressure threshold

A

MAP - ICP < 40 mmHg DBP - ICP < 10 mmHg

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6
Q

Causes of compartment syndrome

A

1) ischemia reperfusion 2) trauma 3) venous outflow obstruction (needs extensive multilevel DVT) 4) hemorrhage 5) fractures 6) crush injuries 7) iatrogenic

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7
Q

Mechanism of ischemia reperfusion leading to compartment syndrome

A

1) muscle injury 2) increase microvascular permeability 3) efflux of plasma protein 4) interstitial edema

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8
Q

Papalambros risk factors of compartment after limb ischemia

A

1) prolonged > 6 houors 2) younger age 3) insufficienct collaterals 4) hypertension 5) acute course of occlusion 6) poor backbleeding from distal vessels

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9
Q

Rate of fasciotomy after different type of vascular trauma

A

1) Arterial: 29.5% 2) Venous: 15.2% 3) Combined arterial + venous: 31.6% 4) Popliteal artery injury: 61%

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10
Q

Rate of fracture-induced compartment syndrome

A

1-29%

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11
Q

Risk factors associated with fractures that predispose compartment syndrome

A

1) anterior compartment of leg 2) flexor compartment of arm 3) communited fracture (means higher energy of injury)

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12
Q

Mechanism that crush injuries cause compartment syndrome

A

1) direct muscle injury 2) ischemia reperfusion 3) large volume crystalloids

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13
Q

Iatrogenic causes of compartment syndrome

A

1) extravasation of IV 2) bleeding 3) compression

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14
Q

Secondary compartment syndrome define

A

1) no direct trauma 2) diffuse microvascular permeability due to trauma-induced SIRS 3) massive fluid resuscitation

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15
Q

Clinical presentation of compartment syndrome

A

1) pain out of proportion 2) Pain with passive motion of muscles in compartment 3) paresis/parasthesia 4) tense compartment

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16
Q

How good is clinical presentation in terms of positive predictor and negative predictor for compartment syndrome

A

Poor positive predictor 11-15% Great rule out test 97-98%

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17
Q

Normal range of compartment pressures

A

< 10-12 mmHg

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18
Q

When to measure compartment pressure

A

1) equivocal cases 2) unconscious patient 3) pediatric patient

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19
Q

Causes of hand compartment syndrome

A

1) crush 2) fracture

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20
Q

Number of compartments in the hand

A

10

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21
Q

Thigh compartment syndrome cuase

A

Blunt trauma, crush, contusions

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22
Q

Which thigh compartment most likely to get compartment syndrome

A

Anterior

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23
Q

Gluteal compartment syndrome causes

A

1) hypogastric ligation or embolization 2) hip arthroplasty 3) prolonged compression

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24
Q

Symptoms of gluteal compartment syndrome

A

1) rhabdomyolysis 2) renal failure 3) sciatic nerve palsy

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25
Q

Mars protocol for first aid to hypoxic cells

A

1) maintain normal BP 2) remove constricting bandages 3) maintain limb at heart level 4) O2 supplement

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26
Q

Systemic sequelae presentations - elevation in these molecules

A

1) hyper K 2) myoglobin 3) PO4 4) CPK

27
Q

Effects of myoglobinuria

A

1) nephrotoxic/ renal vasoconstriction 2) tubular casts 3) heme cytotoxic effects

28
Q

Treatment of myoglobinuria

A

1) crystalloid 2) Mannitol 3) bicarb

29
Q

Treatment goals of myoglobinuria

A

pH > 6.5

30
Q

Role of HD in treatment myoglobinuria

A

minimal molecule too big for HD

31
Q

Contraindication to fasciotomy

A

1) non-viable tissue 2) crush injury

32
Q

Most common nerve injury in fasciotomies

A

superficial peroneal

33
Q

Course of the superficial peroneal nerve

A

Branch from common at proximal fibular head descend in lateral compartment in intermuscular septum

34
Q

Failure rate of subcutaneous fasciotomy with minimal skin incision

A

12%

35
Q

Full fasciotomy length of incision

A

12-20 cm

36
Q

Two incision technique fo LE fasciotomy

A

Ant/lat 1) between figular shaft and tibial crest 2) 4 cm lateral to crest is septum 3) raise skin flap 4) terminate fasciotomy 5cm from fibular head Post 1) skin incision 2 cm posterior to tibia 2) avoid saphenus nerve 3) cut gastroc fascia 4) cut soleus attach to tibia 5) cut fascia over flexor and posterior tibialis

37
Q

Single incision technique

A

Start with typical ant/lateral incision 2) develop posterior subcutaneous flap 3) accss fascia to superficial posterior 4) dissect flexor hallucis longus off fibula 5) mobilize peroneal neurovascular bundle posteriorly 6) incise into deep posterior compartment

38
Q

Thigh compartments

A

1) anterior 2) posterior 3) medial

39
Q

Contents of the anterior thigh compartment

A

1) sartorius 2) quadriceps 3) innervate by femoral nerve

40
Q

Contents of the posterior thigh compartment

A

1) biceps femoris 2) semimembranosis 3) semitendonosis 4) innervate by sciatic nerve

41
Q

Contents of the medial thigh compartment

A

1) Pectineus 2) obturator externus 3) Gracilis 4) adductors 5) innervate by obturator nerve

42
Q

Decompressing thigh compartments

A

1) lateral thigh intertrochanteric line down to lateral epicondyle 2) cut IT band 3) reflect vastus lateralis medially 4) enter intermuscular septum Incision on adductor muscle group to decompress medial compartment

43
Q

Gluteal compartment decompression

A

Each of the 3 muscles have own fascial compartment so incise into each

44
Q

Foot compartments

A

1) Medial 2) lateral 3) superficial 4) calcaneal 5) interosseous muscles each have one

45
Q

Foot decompression

A

1) longitudinal dorsal incision along medial part of 2nd metatarsal 2) longitudinal dorsal incision along lateral 4th metatarsal

46
Q

Upper extremity forearm compartments

A

1) Volar 2) lateral 3) extensor

47
Q

Henry’s Volar fasciotomy

A

1) Single curvilineal incision proximal to ACF medial to bicep tendon 2) cross ACF crease 3) extend to radial side of forearm 4) incise each muscle of deep flexor 5) extend from lateral epicondyle to wrist between extensor carpi radialis brevis and extensor digitorium communis

48
Q

Compartments of the hand

A

total 10 1) hypothenar 2) thenar 3) adductor pollicis 4) 4 dorsal interosseous 5) 3 volar interosseous

49
Q

Releasing hand compartments

A

Longitudinal incision to release carpal tunnel +/- some interosseous

50
Q

Post-fasciotomy mortality

A

11-15%

51
Q

Post-fasciotomy major amputation

A

5-21%

52
Q

Post-fasciotomy wound complication

A

4-38%

53
Q

Post-fasciotomy neuro deficit

A

7-36% especially in forearm

54
Q

Late complications of fasciotomies

A

1) impaired sensation 77% 2) tethered tendon 7% 3) recurrent ulceration 13% 4) venous insufficiency due to lack fo calf pump 47% 5) late amputation 7.5%

55
Q

Consequence of delaying treatment in compartment syndrome > 12 hours

A

93% neuropathy 50% amputation

56
Q

Voklmann contracture define

A

ischemic muscles fibrosis Treat with contracture and joint release

57
Q

Chronic exertional compartment syndrome (CECS) classic signs

A

1) exercise-induced 2) young 20-30’s 3) athlete/runner 4) 20-30 min onset 5) 15-30 min resolve after resting

58
Q

Chances of bilateral exertional compartment syndrome

A

82%

59
Q

Differential of chronic exertional compartment syndrome

A

1) fascial hernia 2) medial tibial syndrome 3) claudication with popliteal entrapment

60
Q

Pedowitz criteria for CECS ICP

A

Pain with exercise + 1 of: 1) rest ICP > 15 2) ICP > 30 post exercise in first 1-2 min 3) ICP > 20 even 5 min post exercise

61
Q

Treatment of CECS exertional compartment Different ways

A

1) Only treat anterolateral compartment 2) transverse incision 3) fasciectomy

62
Q

Outcome of CECS treatment (exertional compartment)

A

83% success at 2 years with symptom resolution

63
Q

Indications for treatment compartment syndrome with fasciotomy

A

R9 (200 decks)

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