Compartmentsyndrome Treatment: Difference between revisions

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{{CMG}}; {{AE}}[[User:DrMars|Mohammadmain Rezazadehsaatlou[2]]] ;
= Overview =
= Overview =
[[Compartment syndrome|CS]] is a medical emergency requiring immediate surgical treatment known as a [[fasciotomy]] to allow the pressure to return to normal.


= Treatment =
= Treatment =
Acute compartment syndrome is a medical emergency requiring immediate surgical treatment known as a [[fasciotomy]] to allow the pressure to return to normal.
Immediate management of suspected [[Compartment syndrome|CS]] include<ref name="pmid9813693">{{cite journal |vauthors=Mars M, Hadley GP |title=Raised intracompartmental pressure and compartment syndromes |journal=Injury |volume=29 |issue=6 |pages=403–11 |date=July 1998 |pmid=9813693 |doi= |url=}}</ref><ref name="pmid19472025">{{cite journal |vauthors=Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S |title=Compartment syndrome of the lower leg and foot |journal=Clin. Orthop. Relat. Res. |volume=468 |issue=4 |pages=940–50 |date=April 2010 |pmid=19472025 |pmc=2835588 |doi=10.1007/s11999-009-0891-x |url=}}</ref><ref name="pmid20486031">{{cite journal |vauthors=McDonald S, Bearcroft P |title=Compartment syndromes |journal=Semin Musculoskelet Radiol |volume=14 |issue=2 |pages=236–44 |date=June 2010 |pmid=20486031 |doi=10.1055/s-0030-1253164 |url=}}</ref><ref name="pmid21651657">{{cite journal |vauthors=Johnston-Walker E, Hardcastle J |title=Neurovascular assessment in the critically ill patient |journal=Nurs Crit Care |volume=16 |issue=4 |pages=170–7 |date=2011 |pmid=21651657 |doi=10.1111/j.1478-5153.2011.00431.x |url=}}</ref><ref name="pmid15589934">{{cite journal |vauthors=Suzuki T, Moirmura N, Kawai K, Sugiyama M |title=Arterial injury associated with acute compartment syndrome of the thigh following blunt trauma |journal=Injury |volume=36 |issue=1 |pages=151–9 |date=January 2005 |pmid=15589934 |doi=10.1016/j.injury.2004.03.022 |url=}}</ref><ref name="pmid29316189">{{cite journal |vauthors=Alexander W, Low N, Pratt G |title=Acute lumbar paraspinal compartment syndrome: a systematic review |journal=ANZ J Surg |volume= |issue= |pages= |date=January 2018 |pmid=29316189 |doi=10.1111/ans.14342 |url=}}</ref><ref name="pmid18457774">{{cite journal |vauthors=Thati S, Carlson C, Maskill JD, Anderson JG, Bohay DR |title=Tibial compartment syndrome and the cavovarus foot |journal=Foot Ankle Clin |volume=13 |issue=2 |pages=275–305, vii |date=June 2008 |pmid=18457774 |doi=10.1016/j.fcl.2008.02.001 |url=}}</ref>:


Subacute compartment syndrome, while not quite as much of an emergency, usually requires urgent surgical treatment similar to acute compartment syndrome.
Any dressing, splint, cast, or other restrictive covering should be removed and relieving all external pressure on the compartment should be considered as a primary step. The limb should neither be elevated nor placed in a dependent position. Placing the limb level with the heart is helpful to avoid reductions in arterial inflow and increases in compartment pressures from dependent swelling, both of which can exacerbate limb ischemia. Supplementary oxygen, Analgesics, and intravenous isotonic saline (Hypotension reduces perfusion, exacerbating tissue injury) should be provided. [[Fasciotomy]] to fully decompress all involved compartments is the definitive treatment for [[Compartment syndrome|CS]]<nowiki/>in the great majority of cases. Delayed fasciotomy increase morbidity, including the need for amputation.


Chronic compartment syndrome in the lower leg can be treated conservatively or surgically. Conservative treatment includes rest, anti-inflammatories, and stretching. In cases where symptoms persist the condition should be treated by a surgical procedure, subcutaneous fasciotomy or open fasciectomy <ref>Leversedge FJ, Casey PJ, Seiler 3rd JG, et al. Endoscopically assisted fasciotomy: description of technique and in vitro assessment of lower-leg compartment decompression. Am J Sports Med 2002;30(2):272-8.</ref>. Without treatment chronic compartment syndrome can develop into the acute syndrome <ref>Mubarak SJ, Owen CA, Garfin S, et al. Acute exertional superficial posterior compartment syndrome. Am J Sports Med 1978;6(5):287-90.</ref>. A possible complication of surgical intervention for chronic compartment syndrome can be chronic venous insufficiency.
= References =
= References =
<references />

Latest revision as of 07:16, 6 July 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2] ;


Overview

CS is a medical emergency requiring immediate surgical treatment known as a fasciotomy to allow the pressure to return to normal.

Treatment

Immediate management of suspected CS include[1][2][3][4][5][6][7]:

Any dressing, splint, cast, or other restrictive covering should be removed and relieving all external pressure on the compartment should be considered as a primary step. The limb should neither be elevated nor placed in a dependent position. Placing the limb level with the heart is helpful to avoid reductions in arterial inflow and increases in compartment pressures from dependent swelling, both of which can exacerbate limb ischemia. Supplementary oxygen, Analgesics, and intravenous isotonic saline (Hypotension reduces perfusion, exacerbating tissue injury) should be provided. Fasciotomy to fully decompress all involved compartments is the definitive treatment for CSin the great majority of cases. Delayed fasciotomy increase morbidity, including the need for amputation.

References

  1. ↑ Mars M, Hadley GP (July 1998). "Raised intracompartmental pressure and compartment syndromes". Injury. 29 (6): 403–11. PMID 9813693.
  2. ↑ Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S (April 2010). "Compartment syndrome of the lower leg and foot". Clin. Orthop. Relat. Res. 468 (4): 940–50. doi:10.1007/s11999-009-0891-x. PMC 2835588. PMID 19472025.
  3. ↑ McDonald S, Bearcroft P (June 2010). "Compartment syndromes". Semin Musculoskelet Radiol. 14 (2): 236–44. doi:10.1055/s-0030-1253164. PMID 20486031.
  4. ↑ Johnston-Walker E, Hardcastle J (2011). "Neurovascular assessment in the critically ill patient". Nurs Crit Care. 16 (4): 170–7. doi:10.1111/j.1478-5153.2011.00431.x. PMID 21651657.
  5. ↑ Suzuki T, Moirmura N, Kawai K, Sugiyama M (January 2005). "Arterial injury associated with acute compartment syndrome of the thigh following blunt trauma". Injury. 36 (1): 151–9. doi:10.1016/j.injury.2004.03.022. PMID 15589934.
  6. ↑ Alexander W, Low N, Pratt G (January 2018). "Acute lumbar paraspinal compartment syndrome: a systematic review". ANZ J Surg. doi:10.1111/ans.14342. PMID 29316189.
  7. ↑ Thati S, Carlson C, Maskill JD, Anderson JG, Bohay DR (June 2008). "Tibial compartment syndrome and the cavovarus foot". Foot Ankle Clin. 13 (2): 275–305, vii. doi:10.1016/j.fcl.2008.02.001. PMID 18457774.
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