Clinical Presentation/RF
What are the different grades of pulses? [400 pts]
0 = Absent/nonpalpable pulses
1+ = barely detectable
2+ = slightly diminished intensity
3+ = Normal and easily palpable
4+ = bounding pulse stronger than expected
A rancher is kicked on the front of his leg while walking behind a horse, and a large bruise develops. A hematoma deep to the fascia developed within the anterior compartment of the leg. The most likely finding resulting from this anterior compartment syndrome is? [400 pts]
Foot drop
Why is imaging important when diagnosing compartment syndrome? [300 pts]
To visualize bone fractures, displacement, and other injuries.
List at least 3 members of a rehab team that can help with post-op care for patients recovering from compartment syndrome and explain their roles. [400 pts]
Physical Therapist - regain function and strength and prevent contractures and stiffness.
Occupational therapist - help teach the patient how to perform daily living activities
Nutritionist/dieticians - regain fluids and electrolytes
Psychiatrist - seek care after a traumatic injury
Pharmacist - for meds
What are the common signs of acute compartment syndrome? [300 pts]
"The Five P's": pain, pulselessness, paresthesia, paralysis, and pallor.
(6th P = Passive stretch)
What imaging modality, view, and body part are depicted? What abnormalities do you see? Would you want to swap legs with this patient? [400 pts]
lateral radiograph of the knee
Transverse patellar fracture with associated soft tissue swelling.
From the serum lab results in this case, which components were elevated? Explain why. [500 pts!!!]
Potassium, myoglobin, creatine phosphokinase
Rhabdomyolysis - when muscle tissue breaks down, releasing substances into the bloodstream
What is an emergency fasciotomy? What is the ideal timeframe to perform this procedure? [400 pts]
surgical procedure to cut through the fascia surrounding a group of muscles to relieve pressure and prevent tissue death that could lead to life-threatening infection or limb amputation.
The ideal timeframe for fasciotomy is within six hours of injury, and fasciotomy is not recommended after 36 hours following injury.
What causes chronic compartment syndrome? [300 pts]
builds up over time; mostly due to frequent, intense exercise that puts repeated stress on the same muscles and causes pressure build-up
A patient presents to the emergency room following a crushing injury. The physical exam reveals that the patient has pain on her inner thigh and has notable difficulty in thigh adduction. Which nerve is most likely injured? [400 pts]
Obturator nerve
Why were the calcium levels low in the serum lab results from this case? [300 pts]
damaged muscle cells to take up calcium from the bloodstream, lowering the systemic level.
List at least 3 potential complications following compartment syndrome. [400 pts]
(Bonus if you discussed with an OMS-4 🙂)
Rhabdomyolysis, Pain, Contractures, Nerve damage and associated numbness and/or weakness, Infection, Renal failure, Death/necrosis
List some of the common physical exam findings of compartment syndrome. What causes them? [400 pts]
Crepitus - cracking or popping sounds; can be due to fracture
Pale skin - Paler skin color that is cold on the touch due to lack of blood
Tachypnea - from pain, shock, or anxiety from the traumatic incident
loss of sensation - possible nerve damage or compression
change in pulse strength - pressure restricts or reduces the flow of blood
What imaging modality, view, and body part are depicted? What abnormalities do you see? Would you want to swap legs with this patient? [500 pts!!!]
lateral radiograph of the left femur
Heavily comminuted distal femoral shaft fracture with medial displacement distally. Multiple metallic foreign bodies are adjacent to the fracture. Soft tissue gas noted.
What is the normal pressure found in normal body compartments? What pressure is seen in acute compartment syndrome? [400 pts]
Normal = less than 10 mmHg
Acute compartment syndrome = 30 mmHg or greater
Why is aggressive hydration given instead of normal hydration? [500 pts!!!]
Adequate hydration supports optimal bone mineral density, bone remodeling, and calcium absorption.
It plays a vital role in the absorption and distribution of calcium, which is necessary for building and maintaining strong bones.
List at least 3 of the causes of acute compartment syndrome, excluding fractures. [400 pts]
car accidents, falls, crushing injuries, severe muscle contusions, sports injuries, complications after surgery or from wearing a cast or splint that’s too tight, prolonged pressure after not moving for several hours, bleeding disorders, infections, penetrating trauma, intense athletic activity
What imaging modality, view, and body part are depicted? What abnormalities do you see? Would you want to swap legs with this patient? [500 pts!!!]
2 views: AP and lateral radiograph of the left lower extremity
Comminuted fracture: The tibia is broken into multiple fragments.
Displaced fracture: The bone fragments are not aligned properly.
Mid-diaphyseal fibular fracture: The fibula is fractured in the middle shaft.
Why was a CMP ordered in this case? [400 pts]
crucial in managing rhabdomyolysis as it monitors key indicators of muscle breakdown, electrolyte balance, and acute kidney injury
Why is it important to splint the leg following acute compartment syndrome? [400 pts]
initial stabilization to prevent further damage, reduce pain, and control swelling.
It immobilizes the broken bone, protecting soft tissues, aligning the fracture site, and allowing the healing process to begin.