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Concomitant conditions do not prevent possibility of compartment syndrome
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WAIKOLOA, Hawaii — Orthopedists need to have heightened suspicion of compartment syndrome, especially in the forearm and tibia, according to presenter here at Orthopedics Today Hawaii 2016.
“You must recognize the signs of an emergency. Do not think that other concomitant conditions prevent the possibility of compartment syndrome, like a vascular Injury or an open fracture,” Frank A. Liporace, MD, said.
Liporace said difficulty in the treatment of open fractures is most often related to soft tissue injury and not the bone. The most common cause of compartment syndrome is muscle injury that leads to edema. A good soft tissue envelope is crucial to fracture healing and overall limb function, he said.
Frank A. Liporace
In the assessment of injuries, Liporace said it is important to consider the amount of energy that was imparted to the limb which is often reflected by the fracture pattern. The severity of soft tissue injury often parallels the severity of the fracture pattern.
Debridement is the most important factor in the prevention and treatment of late infection, he said. The timing of definitive fixation is an importation concern, and the presence of an open fracture does not rule out the presence of compartment syndrome.
Liporace said the only effective way to decompress acute compartment syndrome is by surgical fasciotomy. The affected limb should not be elevated, as elevation reduces mean arterial pressure and reduces blood flow into the compartment. He advised that the limb should be placed at the level of the heart. Liporace said fasciotomy does have risks of long-term complications, which can be up to 25%.
“But if it is necessary or you are suspicious, then do the fasciotomy. Save the limb and save your house,” he said. – by Kristine Houck, MA, ELS
Reference:
Liporace FA. Compartment syndrome. Presented at: Orthopedics Today Hawaii 2016; Jan. 10-14, 2016; Waikoloa, Hawaii.
Disclosure: Liporace reports he is on design teams and is an educational consultant for DePuy Synthes and Zimmer Biomet.