Diagnosis was confirmed clinically or by needle measurement of compartment pressure. Muscle necrosis was determined using pathology reports and surgeons' operative protocols. We used descriptive statistics and estimated tissue survival probability using the Vertex exchange method for interval-censored data. He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health.
On Twitter, he is precordialthump. This site uses Akismet to reduce spam. Learn how your comment data is processed. Background Musculoskeletal compartment syndrome is a limb threatening condition resulting from increased pressure within a muscular compartment, which causes compression of the nerves, muscles and vessels within the compartment.
Pathophysiology Muscles are contained within inelastic fascial sheaths. Compartment syndrome can affect many regions of the body: the forearm volar compartment and leg the anterior compartment — the anatomical leg being the bit below the knee… are most commonly affected.
It occurs early, is persistent, tends to be disproportionate compared with the original injury and is not relieved by immobilisation. Examination Pain is exacerbated by passive stretching, which is the most sensitive sign. The extremity may be swollen and affected compartments may feel tense and tender on palpation. Assess loss of sensation by light touch and two-point discrimination, rather than just pinprick, which is less sensitive. Refer to a surgeon if compartment syndrome is suspected — do not rely on clinical signs — have a high index of suspicion!
Compartment pressure measurement Measurement of elevated compartment pressures are not essential for the diagnosis if the clinical picture is compelling.
At least with tibial fractures, measurements should be taken in both the anterior and deep posterior compartments at the level of the fracture as well as at proximal and distal locations to reliably determine the highest tissue pressure measurement. This measurement should be used to determine the need for fasciotomy. A commercial device like the Stryker STIC Device is probably the easiest and most accurate means of measuring compartment pressures.
Compartment pressures may also be obtained using an angiocath connected to a blood pressure transducer e. Other options for measuring compartment pressures include the needle technique, the wick catheter, and the slit catheter.
The needle technique according to Perron et al is described as follows: The needle technique has the advantage that it can be performed with items that are readily available in every ED. Imaging Imaging has no role in the diagnosis of compartment syndrome, but may show the presence of fractures and soft tissue injuries that are associated with the condition. His leg has become pale and cool, with absent pulses.
This textbook presentation of compartment syndrome seems easy. Real cases often are not. Not only can compartment syndrome cause major complications, but frighteningly, 23 percent of medicolegal cases involving compartment syndrome were due to misdiagnosis, while 32 percent of cases were due to delayed treatment.
Compartment syndrome is due to excessive pressure in a fascial compartment, either through increased volume in a fixed compartment edema, hematoma or reduced size of a compartment tight cast, wound dressings, poor body positioning, etc.
The most commonly affected region is the anterior compartment of the lower leg, and compartment syndrome can occur in up to 10 percent of patients with tibial fracture. However, the elderly are also at higher risk due to baseline hypertension and reduced compartment perfusion.
How useful are historical features? Unfortunately, early findings can be subtle or not detected in patients with altered mental status, major trauma, substance use, and extremes of age.
Patients typically describe this pain as a deep, severe pain that worsens with passive stretch. Is your bedside exam reliable? All muscle should be carefully inspected for viability, and any nonviable tissue should be debrided. Once the process triggering compartment syndrome begins, compartment syndrome tends to increase in severity. Consider compartment syndrome if pain appears to be out of proportion to the severity of injury and is increased by passive stretching of muscles within the compartment or if the compartment is tense.
Measure compartment pressure to confirm the diagnosis; a finding of more than about 30 mm Hg or within about 30 mm Hg of diastolic BP confirms it. Unless the disorder resolves rapidly after initial treatment, fasciotomy must be done as soon as possible. American Academy of Orthopaedic Surgeons' clinical practice guideline for the management of acute compartment syndrome. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.
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