Muscle Viability and Nerve Dysfunction Quiz

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Questions and Answers

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?

Core decompression (correct)

Stitch removal

Chemotherapy

Physical therapy

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?

Respiratory distress Signup and view all the answers

What laboratory value indicated indices of rhabdomyolysis in the patient?

Platelet count of 222 (×10 /ml) Signup and view all the answers

What was the objective sensory deficit noted in the patient?

Hypoesthetic dorsal foot Signup and view all the answers

What is the most common cause of compartment syndrome according to the text?

Fracture of the tibia Signup and view all the answers

What is the main consequence of increased compartment pressures?

Nerve and muscle ischemia Signup and view all the answers

How is compartment syndrome diagnosed according to the text?

Compartment pressure measurement Signup and view all the answers

Which physical sign is NOT associated with compartment syndrome according to the text?

Pruritus Signup and view all the answers

What is the effect of elevated compartment pressures on nerve and muscle tissues?

Decreased tissue perfusion Signup and view all the answers

In which situation might compartment syndrome not occur according to the text?

Painless fractures Signup and view all the answers

What is considered a late sign of Acute Compartment Syndrome (ACS)?

Paralysis Signup and view all the answers

What is the main purpose of a fasciotomy in the treatment of ACS?

To provide full and adequate decompression Signup and view all the answers

What is one of the potential consequences of myoglobinemia in ACS?

Renal failure Signup and view all the answers

What is recommended within 5-7 days if all muscle groups are viable in wound care for ACS?

Delayed closure Signup and view all the answers

Which diagnostic approach is still considered the cornerstone for diagnosing ACS?

Clinical assessment Signup and view all the answers

What potential complication is NOT mentioned as a consequence of missed compartment syndromes in ACS?

Pulmonary embolism Signup and view all the answers

Which symptom is out of keeping with nerve dysfunction?

Swelling Signup and view all the answers

What may signal the loss of muscle viability?

Resolution of pain without recovery of nerve function Signup and view all the answers

When is compartment pressure monitoring considered?

In an obtunded patient with tight compartments Signup and view all the answers

What is the primary event associated with raised tissue pressure?

Raised intra-compartmental pressures Signup and view all the answers

Which method can be used for compartment pressure measurement?

Needle manometer method Signup and view all the answers

Which condition warrants compartment pressure monitoring according to the text?

Persistent pain despite analgesia Signup and view all the answers

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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Description

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.