24 Questions
What symptom did the patient experience 3 months after discharge from the hospital?
Severe left groin pain
What was the decision made regarding the femur neck osteonecrosis?
Core decompression
What was the patient's position during the complicated surgery?
Right tilted supine
Which symptom did NOT present in the patient after the surgery?
Respiratory distress
What laboratory value indicated indices of rhabdomyolysis in the patient?
Platelet count of 222 (×10 /ml)
What was the objective sensory deficit noted in the patient?
Hypoesthetic dorsal foot
What is the most common cause of compartment syndrome according to the text?
Fracture of the tibia
What is the main consequence of increased compartment pressures?
Nerve and muscle ischemia
How is compartment syndrome diagnosed according to the text?
Compartment pressure measurement
Which physical sign is NOT associated with compartment syndrome according to the text?
Pruritus
What is the effect of elevated compartment pressures on nerve and muscle tissues?
Decreased tissue perfusion
In which situation might compartment syndrome not occur according to the text?
Painless fractures
What is considered a late sign of Acute Compartment Syndrome (ACS)?
Paralysis
What is the main purpose of a fasciotomy in the treatment of ACS?
To provide full and adequate decompression
What is one of the potential consequences of myoglobinemia in ACS?
Renal failure
What is recommended within 5-7 days if all muscle groups are viable in wound care for ACS?
Delayed closure
Which diagnostic approach is still considered the cornerstone for diagnosing ACS?
Clinical assessment
What potential complication is NOT mentioned as a consequence of missed compartment syndromes in ACS?
Pulmonary embolism
Which symptom is out of keeping with nerve dysfunction?
Swelling
What may signal the loss of muscle viability?
Resolution of pain without recovery of nerve function
When is compartment pressure monitoring considered?
In an obtunded patient with tight compartments
What is the primary event associated with raised tissue pressure?
Raised intra-compartmental pressures
Which method can be used for compartment pressure measurement?
Needle manometer method
Which condition warrants compartment pressure monitoring according to the text?
Persistent pain despite analgesia
Study Notes
Gluteal Compartment Syndrome: Identification and Management
- 37-year-old man admitted to hospital with a gunshot wound to the buttock, transcervical fracture of the left hip, and fixation on day 6, discharged on the 4th post-op day, presented with severe left groin pain 3 months post-op.
- Diagnosed with osteonecrosis of the femur neck, and a vascularized fibular graft was planned.
Surgical Procedure and Post-Op Care
- Surgery was performed in a right-tilted supine position under general anesthesia, with core decompression, fibular strut, and post-op nursing in a supine to semi-Fowler's position.
- The patient experienced mild left buttock pain 8 hours post-op, but severe right buttock pain, paraesthesia, and swelling of the right buttock and leg.
- Clinical examination revealed active right hip motion, especially flexion, which worsened buttock pain.
Diagnosis and Management of Compartment Syndrome
- The patient was diagnosed with gluteal compartment syndrome, which was managed with emergency fasciotomy surgery 11 hours post-op in a prone position under general anesthesia.
- The surgery involved a Kocher-Langenbeck incision, gluteal fasciotomy, and skin closure.
- The patient's progress was monitored, and buttock pain, paraesthesia, and hypoaesthesia resolved within 48-72 hours post-op.
Definition and Pathophysiology of Compartment Syndrome
- Compartment syndrome is an increased pressure within an enclosed osteofascial space that reduces capillary perfusion below levels necessary for tissue viability.
- Elevated intracompartmental pressure leads to decreased space for contents, increased venous pressure, and decreased A-V gradient, resulting in nerve and muscle ischemia.
Epidemiology of Compartment Syndrome
- The incidence of compartment syndrome is higher in men (7.3/100,000) than women (0.7/100,000).
- The main causes include trauma (69%), fractures (36%), soft tissue injury (23%), and anticoagulation (10%).
- High-energy injuries have a higher incidence than low-energy injuries.
Diagnosis of Compartment Syndrome
- Diagnosis involves history, clinical exam, measurement of compartment pressure, and laboratory tests.
- Clinical findings include pain, swelling, pallor, paresthesia, pulselessness, and paralysis.
- Lab tests include CPK, urine myoglobin, and serum potassium levels.
Treatment of Compartment Syndrome
- Treatment involves removal of constrictive dressings, correction of hypotension, oxygen therapy, and fasciotomy.
- Delayed closure and skin grafting may be necessary.
- Wound care involves soft tissue coverage, debridement of necrotic muscle, and antibiotics.
Missed Compartment Syndrome and Complications
- Missed compartment syndrome can lead to myonecrosis, myoglobinemia, and renal failure.
- Late complications include deformities, muscle weakness, infection, non-unions, amputations, and nerve injury.
Conclusion
- Early diagnosis and management of compartment syndrome are crucial to prevent complications.
- Clinical assessment is the diagnostic cornerstone, and a vigilant examiner and cooperative patient are essential.
- Serum markers of muscle damage and compartment pressure monitoring are useful adjuncts to clinical examination.
Test your knowledge on muscle viability, nerve dysfunction, referred pain, and clinical criteria for diagnosis. Learn about resolving pain without recovery of muscle function indicating potential loss of muscle viability.
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