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***Must inform registrar and/or consultant on-call***
introduction (1,2)
introduction (1,2)
- Limb-threatening and potentially life-threatening condition
- Perfusion pressure falls below tissue pressure/compartment pressure leading to tissue necrosis, renal failure and death if untreated.
- Commonly affects lower limb, abdomen, buttocks and upper limb.
- Mechanism of injury
- Crush injuries with multiple fractures which can lead to vascular injury and swelling of soft tissue.
- Prolonged extrinsic compression.
- Combination of injuries.
Image reference: Orthobullet's "Hand & Forearm Compartment Syndrome" (2019)
assessment (3,4)
assessment (3,4)
- Symptoms ‘five Ps of ischaemia’:
- Pain – persistent, progressive, severe (out of proportion to clinical findings)
- Passive – stretching of muscles is exquisitely tender
- Paraesthesia
- Paralysis
- Pallor
- Pulselessness – not always present and should not be a discriminating factor.
- These are not always reliable; therefore, clinical impression is important.
management (1)
management (1)
- Discuss with senior immediately
- Keep NBM
- Manage injury appropriately while awaiting review
- Splint in a position of function with strict elevation in Bradford sling.
- Urgent decompression/fasciotomy required in theatre.
- TAnticipate rhabdomyolysis/myoglobinuria and treat it appropriately (IV hydration and/or mannitol)
references
references
1. Chiu TW. Stone’s Plastic Surgery Facts: A Revision Guide, Fourth Edition. CRC Press; 2018. 2. Green DP, Wolfe SW. Green’s operative hand surgery. Elsevier/Churchill Livingstone; 2011. 3. Torlincasi AM, Lopez RA, Waseem M. Acute Compartment Syndrome. StatPearls. StatPearls Publishing; 2020. 4. Reichman EF. Compartment Syndrome of the Hand: A Little Thought about Diagnosis. Case Rep Emerg Med. 2016;2016:2907067.
Useful resource:Henderson R. Compartment Syndrom. patient.co.uk 2015 Jan 23 (v23)
Image References:Header Image Reference: Licensed by Adobe Stock (2019)Compartment Syndrome Image Reference: Orthobullet's "Hand & Forearm Compartment Syndrome" (2019)
Useful resource:Henderson R. Compartment Syndrom. patient.co.uk 2015 Jan 23 (v23)
Image References:Header Image Reference: Licensed by Adobe Stock (2019)Compartment Syndrome Image Reference: Orthobullet's "Hand & Forearm Compartment Syndrome" (2019)
This subpage has been reviewed by:
1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (09/02/2020)
1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (09/02/2020)
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