Orthopaedic MD

Wheeless' Textbook of Orthopaedics compartment syndrome is elevation of interstitial pressure in closed fascial compartment that results in microvascular compromise; - as duration & magnitude of interstitial pressure increase, myoneural function is impaired & necrosis of soft tissues eventually develops;

Review of CRPS (Reflex Sympathetic Dystrophy) Journal of Postgraduate Medicine 50(4)2004

Summary: Antibiotics are effective in preventing early infection in open fractures of the limbs Wound and bone infections are common complications following open fractures of the limbs. For more than 20 years, in developed countries, the use of antibiotics has been a part of a standard management protocol that also includes irrigation, surgical debridement, and stabilisation when indicated. The review of trials found that antibiotics are effective in decreasing the incidence of wound infections, as compared to no antibiotics or placebo. No studies on bone infection or long-term morbidity were identified. (Cochrane Review)
Gosselin RA, Roberts I, Gillespie WJ. Antibiotics for preventing infection in open limb fractures. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD003764.

From Journal RCSE

BMJ editorial BMJ 2002;325:557-558 Acute limb compartment syndrome is a surgical emergency characterised by raised pressure in an unyielding osteofascial compartment. Sustained elevation of tissue pressure reduces capillary perfusion below a level necessary for tissue viability, and irreversible muscle and nerve damage may occur within hours. Causes include trauma, revascularisation procedures, burns, and exercise. Regardless of the cause, the increased intracompartmental pressure must be promptly decompressed by surgical fasciotomy. Missed diagnosis and late decompression are associated with significant morbidity due to irreversible ischaemic necrosis of the muscles and nerves in the compartment. Increased awareness of the syndrome and the advent of measurements of intracompartmental pressure have raised the possibility of early diagnosis and treatment. Recent publications have, however, highlighted some of the problems associated with measurements of intracompartmental pressure. 1 2 Furthermore, late or poorly performed fasciotomies may contribute to morbidity

Perioperative Prophylactic Antibiotics:
- it is essential that antibiotics be given prior to incision;
- in most cases, patients should receive 1-2 gm of IV Ancef 30 min prior to the incision
Wheeless' Textbook of Orthopaedics

Antithrombotic Therapy. SIGN Guideline. SIGN Publication No. 36 ISBN 1899893 76 8 Published March 1999

Wheeless Textbook of Orthopaedics. Notes on:
Anterior Compartment Syndrome:
Posterior Compartment Syndrome
Lateral Compartment Syndrome
Non Operative Treatment
Indications for Surgery
Technique: (chronic anterior compartment syndrome)

Medscape Journal Scan April 2004 Review of articles on missed diagnosis of compartment syndrome

Wheeless Textbook of Orthopaedics compartment syndromes can occur in the foot as in other parts of body; - mechanism of injury is severe local trauma, & assoc skeletal injury may be minimal; - classic symptoms & signs are progressive pain, numbness in toes, and decreased motion, however, these are the same symptoms that one would expect to find w/ concomitant foot fractures and injury; - tense tissue bulging may be the most reliable symptom; - compartmental pressures will be elevated; - note that compartment syndromes of the foot are associated w/ compartment syndromes of the deep posterior compartment;

Wheeless' Textbook of Orthopaedics - compartment syndrome is uncommon in thigh because of large-volume that the thigh requires to cause a pathological increase in interstitial pressure; - fascial compartments of thigh blend anatomically w/ muscles of hip,potentially allowing extravasation of blood outside compartment; - compartment syndrome may be caused by a decrease in compartmental volume, increase in compartmental contents, or externally pressure;

compartment syndrome following tibia fractures are most common in closed frx (upto 20% of frx) but may also occur following open frx; - cast immobilization may increase pressure; - it remains unclear whether IM nailing will increase or decrease compartment pressures, but on occassion the surgeon may find a significant decrease in pressure measurements following nailing; - references: - Compartment syndrome in open tibial fractures. - Compartment syndrome after intramedullary nailing of the tibia. - compartment pressures measurements: - most common finding is isolated elevation in the deep posterior compartment followed by isolated elevation in the anterior compartment; - be sure to measure pressure in the deep posterior compartment as well as anterior & superficial compartments; - associated factors: - cast immobilization may increase pressure; - intramedullary nailing: - it remains unclear whether IM nailing will increase or decrease compartment pressures, but on occassion the surgeon may find a significant decrease in pressure measurements following nailing; - compartment pressures measurements: - most common finding is isolated elevation in the deep posterior compartment followed by isolated elevation in the anterior compartment; - be sure to measure pressure in the deep posterior compartment as well as anterior & superficial compartments; - compartment pressure measurements should be taken as close to the frx site as possible (since these will give the highest readings); - peak compartment pressures will be located within 5 cm of frx; - measurements away from the frx site may underestimate compartment pressure; - sterile technique is a must when compartments are measured, otherwise the frx hematoma may become infected;

Wheeless Textbook of Orthopaedics

SOA - Orthopaedic Care.net Textbook The purpose of this chapter is to provide an overview of acute upper extremity compartment syndrome. It will review the causes, the pathophysiology, the diagnosis, and the treatment of this condition. Some discussion of chronic compartment syndrome is also presented.

Compartmental Syndromes
A compartmental syndrome is a condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space. This condition is a cause of major loss of function, limb and even life. It can result from trauma, prolonged recumbancy (in surgery or resulting from drugs or alcohol), or physical activity. It is common enough to affect thousands of individuals each year, yet rare enough that each physician may encounter it only once or twice during his or her career.