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Compartment Syndrome of the Foot

Compartment Syndrome of the Foot. N. Craig Stone M.D. F.R.C.S.(C) Discipline of Orthopaedic Surgery. Introduction. Definition Pathophysiology Etiology Clinical Presentation Treatment Long term sequelae. Definition. Increased pressure within a closed fascial compartment

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Compartment Syndrome of the Foot

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  1. Compartment Syndrome of the Foot N. Craig Stone M.D. F.R.C.S.(C) Discipline of Orthopaedic Surgery U of T Foot and Ankle Symposium 2002

  2. Introduction • Definition • Pathophysiology • Etiology • Clinical Presentation • Treatment • Long term sequelae U of T Foot and Ankle Symposium 2002

  3. Definition • Increased pressure within a closed fascial compartment • Sufficient magnitude to impede vascular inflow U of T Foot and Ankle Symposium 2002

  4. Pathophysiology • Insult to muscle within a closed compartment • Intracellular swelling/Hematoma • Pressure rises and capillary perfusion drops • Vicious circle U of T Foot and Ankle Symposium 2002

  5. Pathophysiology • Tissues vary in susceptibility to damage • Nerve < 4 hours • Muscle < 8 hours • After 8 hours irreversible damage U of T Foot and Ankle Symposium 2002

  6. Pathophysiology • ? Critical pressure • Proportional to systemic blood pressure • Not a fixed number • Experimentally • Within 10mmHg of diastolic pressure • Injured tissue 20 mmHg U of T Foot and Ankle Symposium 2002

  7. Fascial Anatomy of the Foot • At least 9 separate compartments • 4 are clinically relevant • Medial, central, lateral, interosseous U of T Foot and Ankle Symposium 2002

  8. Etiology • Crush injuries / trauma • +/- fracture U of T Foot and Ankle Symposium 2002

  9. Etiology • Temporary vascular occlusion • Trauma, thrombus • Altered consciousness • CNS • Drugs, alcohol U of T Foot and Ankle Symposium 2002

  10. Clinical Presentation • History of injury / energy absorbed • Swelling • Pain • Passive stretch • Pallor, paresthesia, pulselessness, paralysis U of T Foot and Ankle Symposium 2002

  11. Investigations • Compartmental pressure measurements • Whiteside technique • Arterial line setup • Commercially available monitors U of T Foot and Ankle Symposium 2002

  12. Investigations • 1 sample vs continuous monitoring • Measure all four compartments • Don’t delay getting measurements if diagnosis is obvious U of T Foot and Ankle Symposium 2002

  13. What number to we use? Fixed number (30 mmHg) VS. Variable (20 mmHG less than diastolic) U of T Foot and Ankle Symposium 2002

  14. Treatment • Remove dressings • Do not excessively elevate the foot • Level of the heart • Analgesia • Have low threshold to proceed surgically U of T Foot and Ankle Symposium 2002

  15. Treatment • Emergency fascial release • 3 incisions • 1 medial 2 Dorsal • Blunt and finger dissection • Divide fascia • Delayed closure • +/- skin grafting • Prophylactic releases U of T Foot and Ankle Symposium 2002

  16. Missed Compartment Syndromes • Early • Myonecrosis • Renal concerns • Late • Deformities from contracture of necrotic muscle • Nerve Injury • Ulcerations U of T Foot and Ankle Symposium 2002

  17. Summary • High index of suspicion • Careful with altered consciousness • Be aggressive to prevent long term sequelae U of T Foot and Ankle Symposium 2002

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