Flashcards in Compartment Syndrome Deck (24):
What is compartment syndrome?
- compartmental hypertension caused by edema, resulting in muscle necrosis of the lower extremity, often seen in the calf; patient may have a distal pulse.
What complication after prolonged ischemia to the lower extremity must be treated immediately?
- compartment syndrome
What is the treatment for compartment syndrome?
- opening compartments via bilateral calf-incision fasciotomies of all four compartments in the calf within 4 hours.
What must be looked for postoperatively after reperfusion of a limb?
- compartment syndrome, hyperkalemia, renal failure from myoglobinuria, MI
Why does tissue swelling from reperfusion to the leg cause compartment syndrome?
- because the leg is separated into compartments by unyielding fascia and the increased intracompartmental pressure results in decreased capillary flow, ischemia, and myonecrosis
At what intracompartmental pressure does myonecrosis occur?
- 30 mm Hg
What are the signs/symptoms of compartment syndrome?
- SYMPTOMS: pain out of proportion, especially after passive flexing/extension of the foot, paralysis, paresthesias
- SIGNS: cyanosis or pallor, hypoesthesia (decreased sensation to two-point discrimination), firm compartment
*PULSES ARE PRESENT in most cases because systolic pressure is much higher than the minimal 30 mm Hg needed for the syndrome!
Can a patient have a pulse and compartment syndrome?
How is the diagnosis of compartment syndrome made?
- history/suspicion, compartment pressure measurment
What is the chief concern following tibial fractures?
- compartment syndrome
What are the causes of compartment syndrome?
- fractures, vascular compromise, reperfursion injury, compressive dressings; can occur after any musculoskeletal injury.
What are the common causes of forearm compartment syndrome?
- supracondylar humerus fracture, brachial artery injury, radius/ulna fracture, crush injury.
What is Volkmann's contracture?
- final sequela of forearm compartment syndrome; CONTRACTURE of the forearm flexors from replacement of dead muscle with fibrous tissue.
What is the most common site of compartment syndrome?
- calf (four compartments: anterior, lateral, deep posterior, superficial, posterior compartments)
What 4 situations should immediately alert one to be on the lookout for a developing compartment syndrome?
1. supracondylar elbow fractures in children
2. proximal/midshaft tibial fractures
3. electrical burns
4. arterial/venous disruption
What are the 4 possible complications of compartment syndrome?
1. muscle necrosis
2. nerve damage
What is the initial treatment of the orthopedic patient developing compartment syndrome?
- bivalve and split casts, remove constricting clothes/dressings, place extremity at heart level.
What is ABDOMINAL compartment syndrome?
- increased intra-abdominal pressure usually seen after laparotomy or after massive IVF resuscitation (e.g. BURN patients).
What are the signs/symptoms of ABDOMINAL compartment syndrome?
- tight distended abdomen
- decreased urine output
- increased airway pressure
- INCREASED INTRA-ABDOMINAL PRESSURE
How do you measure intra-abdominal pressure?
- via intrabladder pressure (Foley catheter hooked up to manometry after instillation of 50-100 cc of water).
What is normal intra-abdominal pressure?
- less than 15 mm Hg
What intra-abdominal pressure indicates need for treatment?
- greater than 25 mm Hg, especially if signs of compromise
What is the treatment of ABDOMINAL compartment syndrome?
- release the pressure by placing drain and/or decrompressive laparotomy (leaving fascia open).