Podcast
Questions and Answers
What symptom did the patient experience 3 months after discharge from the hospital?
What symptom did the patient experience 3 months after discharge from the hospital?
- Right buttock swelling
- Respiratory distress
- Severe left groin pain (correct)
- Fever and chills
What was the decision made regarding the femur neck osteonecrosis?
What was the decision made regarding the femur neck osteonecrosis?
- Core decompression (correct)
- Stitch removal
- Chemotherapy
- Physical therapy
What was the patient's position during the complicated surgery?
What was the patient's position during the complicated surgery?
- Prone
- Sitting on a chair
- Standing upright
- Right tilted supine (correct)
Which symptom did NOT present in the patient after the surgery?
Which symptom did NOT present in the patient after the surgery?
What laboratory value indicated indices of rhabdomyolysis in the patient?
What laboratory value indicated indices of rhabdomyolysis in the patient?
What was the objective sensory deficit noted in the patient?
What was the objective sensory deficit noted in the patient?
What is the most common cause of compartment syndrome according to the text?
What is the most common cause of compartment syndrome according to the text?
What is the main consequence of increased compartment pressures?
What is the main consequence of increased compartment pressures?
How is compartment syndrome diagnosed according to the text?
How is compartment syndrome diagnosed according to the text?
Which physical sign is NOT associated with compartment syndrome according to the text?
Which physical sign is NOT associated with compartment syndrome according to the text?
What is the effect of elevated compartment pressures on nerve and muscle tissues?
What is the effect of elevated compartment pressures on nerve and muscle tissues?
In which situation might compartment syndrome not occur according to the text?
In which situation might compartment syndrome not occur according to the text?
What is considered a late sign of Acute Compartment Syndrome (ACS)?
What is considered a late sign of Acute Compartment Syndrome (ACS)?
What is the main purpose of a fasciotomy in the treatment of ACS?
What is the main purpose of a fasciotomy in the treatment of ACS?
What is one of the potential consequences of myoglobinemia in ACS?
What is one of the potential consequences of myoglobinemia in ACS?
What is recommended within 5-7 days if all muscle groups are viable in wound care for ACS?
What is recommended within 5-7 days if all muscle groups are viable in wound care for ACS?
Which diagnostic approach is still considered the cornerstone for diagnosing ACS?
Which diagnostic approach is still considered the cornerstone for diagnosing ACS?
What potential complication is NOT mentioned as a consequence of missed compartment syndromes in ACS?
What potential complication is NOT mentioned as a consequence of missed compartment syndromes in ACS?
Which symptom is out of keeping with nerve dysfunction?
Which symptom is out of keeping with nerve dysfunction?
What may signal the loss of muscle viability?
What may signal the loss of muscle viability?
When is compartment pressure monitoring considered?
When is compartment pressure monitoring considered?
What is the primary event associated with raised tissue pressure?
What is the primary event associated with raised tissue pressure?
Which method can be used for compartment pressure measurement?
Which method can be used for compartment pressure measurement?
Which condition warrants compartment pressure monitoring according to the text?
Which condition warrants compartment pressure monitoring according to the text?
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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.
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