Compartment syndrome

Question 1

What is compartment syndrome?

Answer 1

Complication following fractures or ischaemic reperfusion injury

• Increased pressure within a muscle compartment
• Decreased tissue perfusion
• Necrosis; nerve damage

Question 2

Give three presenting features of acute compartment syndrome

Answer 2

Usually occurs within 48hr of injury:

• Increased pain despite fracture immobilisation
  
  • Excessive pain on passive movement
• Parasthesia in distribution within compartment
• Muscle tenderness and swelling
• Tissue ischaemia (late)
  
  • Pallor
  • May have pulses due to microvascular compromise

Question 3

Name two differential diagnoses for acute compartment syndrome

Answer 3

• Peripheral oedema
• Infection
• DVT

Question 4

Request two investigations for acute compartment syndrome

Answer 4

Measure intracompartmental pressure:

• ^e.g Wick catheter; needle manometry; side-ported needles
• >20mmHg is abnormal
• >40mmHg is diagnositic

Question 5

Outline the management of acute compartment syndrome

Answer 5

• Urgent extensive fasciotomies
• Continuous pressure monitoring
• Debridement of necrosis; consider amputation
  
  • Muscle death occurs within 4-6h
• Aggressive IV fluids
  
  • Risk of AKI due to myoglobinuria

Question 6

Name two complications of acute compartment syndrome

Answer 6

• Amputation
• AKI
• Ischaemic contracture

Question 7

What clinical sign is often seen with compartment syndrome of the lower limb?

Answer 7

Foot drop

Damage to the common fibular nerve