Characteristic features of the acute compament syndrome in the lower leg include all of the following except
C i.e. Normal sensation distally Compament Syndrome - Tibial diaphyseal fractures is the most common cause of compament syndromeQ (overall and in adults); in children the most common cause is fracture supracondylar humerusQ. In a recent study it has been repoed that 69% of compament syndromes are associated with fracturesQ and 36% of all compament syndrome are associated with tibial diaphyseal fractureQ. With the improved results associated with intramedullary nailing of tibial fractures, compament syndrome has become the commonest serious complication of closed tibial fractures. An open fracture does not protect the patient from compament syndrome. It mainly affects young male and is best detected by compament pressure monitoringQ. Most of the classical symptoms of compament syndrome only occur only after there has been irreversible soft tissue damageQ. If the surgeons wait for paresthesia, paralysis, or pulselessness, the patient is highly unlikely to recover full function and it is probable that myonecrosis will already have staed. If clinical suspicion is to be used for diagnosis, the diagnosis must be based on increased painQ (dispropoionate) and pain on passive muscle stretchQ, as these clinical signs usually occur at an earlier stage. It is extremely difficult to diagnose compament syndrome clinically, and this problem is exacerbated by the fact that a number of patients will be pain free, unconscious, on ventilators, or anesthetized when compament syndrome becomes clinically impoant. When monitoring it is only necessary to record the pressure in the anterior compament (as it is involved in all cases). The pressure is highest nearer the fracture site, it is there fore impoant to locate the tip of the catheter near to the fracture site to ensure that the muscle with the highest pressure is monitored. Continuous pressure monitoring is better than single reading. Surgeons use a single pressure level, usually 30 mm He, or a difference between intra compament pressure and diastolic blood pressure (diastolic BP - ICP) < 30 mmHgQ as an appropriate criteria to base the decision to undeake fasciotomy. Subtotal fasciotomy should never be undeaken. All four compaments should be decompressed. Compament decomression (fasciotomy) should be performed immideatelyQ as delay carries risk of permanent dysfunction.
Acute pain on employing the stretch test
Normal pulses
Normal sensation distally
Venous occlusion