Compartment Syndrome Evaluation (Orthopaedics)

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Suspected compartment syndrome
  • Abnormal tissue pressures
  • A history that suggests possible compartment syndrome
  • Abnormal physical exam that suggests compartment syndrome
  • Long bone fracture in intubated patient
  • Table 1 lists the signs and symptoms of the respective compartments when compartment syndromeis suspected.
CONTRAINDICATIONS
  • There are no absolute contraindications to performing compartment pressure measurements or continuous pressure monitoring. Use caution in patients with platelet dysfunction or other coagulation disorders.
  • If possible, needle insertion should be avoided in areas of cellulitis, infection, or burns.
EQUIPMENT
  • Stryker 295-2 Quick Pressure Monitor Set (disposable pouch)
  • Stryker handheld pressure monitoring unit (included in the Stryker Set)
  • 1 3-mL syringe prefilled with saline (included in the Stryker Set)
  • 1 side-port needle (included in the Stryker Set)
  • 1 diaphragm chamber (included in the Stryker Set)
  • Sterile gauze
  • Skin antiseptic
  • Supplies for anesthetic administration
    • 1% lidocaine
    • 5-mL syringe
    • 25-gauge needle
ANATOMY
  • Forearm compartments
    • The volar forearm compartment
    • Dorsal forearm compartment
    • The “mobile wad” compartment
  • Hand compartments
    • Dorsal interossei compartments
    • Volar interossei compartments
    • Thenar compartment
    • Hypothenar compartment
  • Lower leg compartments
    • Anterior lower leg compartment
    • Lateral lower leg compartment
    • The deep posterior lower leg compartment
    • Superficial posterior lower leg compartment
  • Foot compartments
    • There are nine compartments, separated into four groups: the central/calcaneal, intrinsic/interosseous, medial, and lateral groups.
  • Gluteal region
    • The fascia divides the musculature into three distinct compartments: maximus, tensor, and medius/minimus.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Fasciotomy
    • Details of the procedure are beyond the scope of this chapter.
  • In addition to surgical intervention (fasciotomy), physiologic support is paramount.
    • Support blood pressures.
    • Remove sources of external pressure, if appropriate.
COMPLICATIONS
  • Infection
  • Pain
RESULT ANALYSIS
  • There is no consensus on the threshold at which a fasciotomy should be performed. Some authors argue an absolute compartment pressure of ≥30 mm Hg as the threshold. But others have reported patients with pressures <45 mm Hg with no signs or symptoms consistent with compartment syndrome, whereas those with pressures >60 mm Hg were symptomatic.
  • Some authors relate the pressure threshold to blood pressure.
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