Lower Limb Anatomy And Compartment Syndrome

Lower Limb Anatomy Sofina Begum CT2 Surgery

Osteology    

Femur Tibia Fibula Bones of the foot- ( separate session)

Femur

Tibia and Fibula

Arterial Supply

Fascial CompartmentsThigh

Medial fascial compartment of thigh

Posterior fascial compartment of the thigh

Fascial CompartmentsLeg

Anterior compartment

Posterior compartment

Lateral Compartment

Compartment Syndrome A condition characterized by the elevation of the interstitial pressure in a closed facial space that results in microvascular compromise that has the potential to cause irreversible damage to the contents of that closed compartment.

Aetiology Fractures

GSW

/ stabbings Blunt trauma Tumour ( crush injury) Snake bites IV & A-lines Infection Tight Cast/dressing  Anticoagulation/co Arterial injury agDisorder Post-ischaemic re- Burns/electrical perfusion injuries

Mechanisms  

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Issue is venous return Initial problem is oedema, haemorrhage, or external compression This raises compartment pressure

Mechanisms 

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Raised compartment pressure causes compression of small venules Worsening edema and raised compartmental pressure Eventually arteriolar compression Muscle and nerve ischemia

Signs & Symptoms      

Pain out of proportion Pain on passive stretch Paraesthesia Paresis Pulselessness Firmness of compartment  

Investigations      

Needle manometer Wick catheter Slit catheter STIC catheter Arterial transducer Noninvasive techniques

Management  

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Serial exam Clinically obvious Call vascular surgeons Clinically equivocal  Measure CP Serial CP measurement 30 mmHg is the “standard” Low threshold

Treatment 

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Remove all tight dressings and casts including the cast padding Resuscitate Limb at heart level to maintain optimise mean arterial pressure Hyperbaric oxygen

Fasciotomy 

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Only effective way to decompress ACS Must decompress all compartments Skin, fat, and fascia must all be split and left open