Acute Compartment Syndrome - Royal Orthopaedic ... Acute Compartment Syndrome Osseo-fascial compartment

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  • Acute Compartment Syndrome Mr Usman Ahmed MBBS PhD FRCS(Orth)

    Trauma & Orthopaedic Registrar Birmingham Orthopaedic Training Programme

  • Acute Compartment Syndrome Osseo-fascial compartment pressure raises leading to decreased perfusion and irreversible muscle &

    nerve damage -

    Compartment pressure higher than 30mmHg or within 30mmHg of diastolic blood pressure

    - Needs rapid assessment & management

    - Surgical Emergency

  • Causes & Areas Affected •  Acute fractures •  Crush injuries •  DislocaNons •  Following limb surgical procedures

    •  There is also chronic compartment syndrome

    •  Arm •  Hand •  Thigh •  Leg - Most common •  Foot

    •  Cranium •  Abdomen

  • Signs & Symptoms

    •  Pain out of proporNon to clinical situaNon •  Pain with passive stretch is most sensiNve finding prior to onset of ischemia

    •  Palpable tense swelling •  More Pain •  Late signs –  Paraesthesia and hypoesthesia indicaNve of nerve ischemia in affected compartment

    –  Paralysis & absent pulses

  • Diagnosis

    •  Diagnosis is clinical •  Compartment pressures measurements – Availability of measuring kits – Depends on user familiarity

    •  High CK may indicate muscle necrosis – But this demonstrates that Compartment Syndrome has been missed.

  • Management •  High index of suspicion – early diagnosis is criNcal

    •  Inform registrar immediately •  Release compression bandages/cast •  Rest •  Analgesia – record carefully – Excessive analgesia use is a sign of potenNal CS

    •  Prepare paNent for surgery •  PaNent will need fasciotomies.

  • Leg Compartment Syndrome

  • Fasciotomies •  Plan fasciotomy with

    plasNc surgeons •  Long incisions to

    ensure complete release

    •  Once release, cover the wounds

    •  Return to theatre for wound review & closure

    •  PlasNc surgery for graYing if needed

  • Fasciotomy of Thigh & Leg

  • Forearm Fasciotomies

    Prep & Drape the limb – Mark the full extent of the incisions

  • Summary

    •  Compartment syndrome is a surgical emergency

    •  PAIN – is the criNcal symptom – Define the extent and characterisNcs – The cause & Nmeline of symptoms

    •  Call registrar early even to update as part of ongoing evaluaNon

  • Thank you!

    PresentaNon available on h[ps://www.bon.ac.uk