Compartment Syndrome Fundamentals and Management Flashcards
(30 cards)
What is the primary management approach for chronic exertional compartment syndrome (CECS)?
Conservative management is the first-line approach.
This includes activity modification, physical therapy with stretching/strengthening exercises, appropriate footwear, gait retraining, and anti-inflammatory medications.
Approximately 60% of patients improve with these measures before surgical fasciotomy becomes necessary.
What differentiates chronic exertional compartment syndrome from acute compartment syndrome?
CECS presents with predictable, recurrent pain during exercise that resolves with rest, while acute compartment syndrome presents as a surgical emergency with continuous, progressive pain.
What is the success rate of surgical fasciotomy for chronic exertional compartment syndrome?
Surgical fasciotomy has a success rate exceeding 80% for chronic exertional compartment syndrome. This procedure is typically reserved for patients who fail conservative management or athletes seeking to maintain high-level performance.
What is the earliest and most reliable clinical indicator of acute compartment syndrome?
Pain out of proportion to injury is the earliest and most reliable indicator. This pain is typically severe, progressive, and exacerbated by passive stretching of muscles in the affected compartment.
What are the ‘5 Ps’ in compartment syndrome assessment, and which ones represent late findings?
- Pain,
- Pallor,
- Paresthesia,
- Paralysis, and
- Pulselessness.
Paralysis and pulselessness are late findings that suggest irreversible damage may have already occurred.
What is the significance of pain with passive stretching in compartment syndrome diagnosis?
Pain with passive stretching of the muscles in the affected compartment is a particularly sensitive early indicator of developing compartment syndrome.
What compartment pressure thresholds are suggested as diagnostic for acute compartment syndrome?
Diagnostic thresholds include absolute pressures of 30-45 mmHg or
differential pressures (diastolic pressure minus compartment pressure) ≤30 mmHg.
Why is relying primarily on compartment pressure measurements problematic in diagnosing acute compartment syndrome?
Relying primarily on pressure measurements can lead to delayed diagnosis because clinical signs often precede pressure elevations.
How does compartment syndrome present in neonates?
In neonates, compartment syndrome presents with excessive crying, irritability when the affected extremity is palpated, decreased spontaneous movement of the limb, and edema.
What is the most common location for compartment syndrome in neonates?
The forearm is the most common location for compartment syndrome in neonates.
What are the primary etiologies of compartment syndrome in neonates?
Primary etiologies include birth trauma, fractures, extravasation of intravenous fluids, tight casts or bandages, positioning during delivery, and vascular catheterization or infiltration injuries.
What is the relationship between crush injury and renal failure?
Crush injuries can lead to renal failure through rhabdomyolysis—the breakdown of damaged skeletal muscle with release of myoglobin into circulation.
What mechanisms contribute to myoglobin-induced nephrotoxicity following crush injury?
Myoglobin causes nephrotoxicity through three primary mechanisms:
- Direct tubular cell toxicity,
- Tubular obstruction via precipitation with Tamm-Horsfall protein
- Renal vasoconstriction leading to decreased perfusion.
What are the key prevention strategies for renal failure following crush injury with compartment syndrome?
- aggressive intravenous fluid resuscitation,
- urinary alkalinization,
- early fasciotomy, and
- in severe cases, renal replacement therapy.
What laboratory parameters should be monitored to assess risk of renal failure in crush injuries?
Serum creatinine kinase (CK) levels,
Serum creatinine,
Blood urea nitrogen (BUN),
Urine myoglobin, and
Urine output.
Does serum creatinine kinase (CK) reliably predict functional outcomes in compartment syndrome?
No, CK levels indicate muscle damage has occurred but do not reliably correlate with severity of functional impairment or recovery potential.
What is the most critical predictor of functional outcomes in acute compartment syndrome?
Time to decompression is the most critical predictor. Fasciotomy performed within 6 hours of symptom onset yields substantially better functional outcomes.
What are the diagnostic challenges specific to compartment syndrome in unconscious patients?
In unconscious patients, the inability to report pain removes the most sensitive indicator, making diagnosis more difficult.
What is the ‘delta P’ criterion for diagnosing compartment syndrome?
The ‘delta P’ criterion defines acute compartment syndrome as a differential pressure (diastolic blood pressure minus compartment pressure) of ≤30 mmHg.
What is Volkmann’s ischemic contracture and how does it relate to compartment syndrome?
Volkmann’s ischemic contracture is a permanent flexion deformity resulting from muscle and nerve ischemia due to untreated or delayed treatment of compartment syndrome.
What specific anatomical factors make the volar forearm particularly susceptible to compartment syndrome?
The volar forearm’s susceptibility stems from its confined fascial compartments, relatively poor collateral circulation, and high muscle content.
How does fasciotomy technique differ between acute compartment syndrome and chronic exertional compartment syndrome?
In acute compartment syndrome, fasciotomy requires extensive incisions to decompress all involved compartments, while for CECS, minimally invasive approaches may be utilized.
What is the two-incision fasciotomy technique for forearm compartment syndrome?
The two-incision technique involves a volar approach and a dorsal approach. Each incision must extend the full length of the forearm to ensure complete decompression.
What are the indicators for immediate amputation rather than limb salvage in severe compartment syndrome?
- completely nonviable muscle throughout all compartments,
- severe irreversible neurovascular injury
- extensive tissue necrosis.
