acute compartment syndrome - royal orthopaedic …...acute compartment syndrome osseo-fascial...
TRANSCRIPT
AcuteCompartmentSyndromeMrUsmanAhmedMBBSPhDFRCS(Orth)
Trauma&OrthopaedicRegistrarBirminghamOrthopaedicTrainingProgramme
AcuteCompartmentSyndromeOsseo-fascialcompartmentpressureraisesleadingtodecreasedperfusionandirreversiblemuscle&
nervedamage-
Compartmentpressurehigherthan30mmHgorwithin30mmHgofdiastolicbloodpressure
-Needsrapidassessment&management
-SurgicalEmergency
Causes&AreasAffected• Acutefractures• Crushinjuries• DislocaNons• Followinglimbsurgicalprocedures
• Thereisalsochroniccompartmentsyndrome
• Arm• Hand• Thigh• Leg-Mostcommon• Foot
• Cranium• Abdomen
Signs&Symptoms
• PainoutofproporNontoclinicalsituaNon• PainwithpassivestretchismostsensiNvefindingpriortoonsetofischemia
• Palpabletenseswelling• MorePain• Latesigns– ParaesthesiaandhypoesthesiaindicaNveofnerveischemiainaffectedcompartment
– Paralysis&absentpulses
Diagnosis
• Diagnosisisclinical• Compartmentpressuresmeasurements– Availabilityofmeasuringkits– Dependsonuserfamiliarity
• HighCKmayindicatemusclenecrosis– ButthisdemonstratesthatCompartmentSyndromehasbeenmissed.
Management• Highindexofsuspicion–earlydiagnosisiscriNcal
• Informregistrarimmediately• Releasecompressionbandages/cast• Rest• Analgesia–recordcarefully– ExcessiveanalgesiauseisasignofpotenNalCS
• PreparepaNentforsurgery• PaNentwillneedfasciotomies.
LegCompartmentSyndrome
Fasciotomies• Planfasciotomywith
plasNcsurgeons• Longincisionsto
ensurecompleterelease
• Oncerelease,coverthewounds
• Returntotheatreforwoundreview&closure
• PlasNcsurgeryforgraYingifneeded
FasciotomyofThigh&Leg
ForearmFasciotomies
Prep&Drapethelimb–Markthefullextentoftheincisions
Summary
• Compartmentsyndromeisasurgicalemergency
• PAIN–isthecriNcalsymptom– DefinetheextentandcharacterisNcs– Thecause&Nmelineofsymptoms
• CallregistrarearlyeventoupdateaspartofongoingevaluaNon
Thankyou!
PresentaNonavailableonh[ps://www.bon.ac.uk