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AcuteCompartmentSyndrome（骨筋膜室綜合癥）AcuteCompartmentSyndrome（骨筋膜Whatiscompartmentsyndrome?Whatiscompartmentsyndrome?COMPARTMENTSCOMPARTMENTSDefinition: Anincreasedpressurewithinenclosedosteofascialspacethatreducescapillaryper-fusionbelowlevelnecessaryfortissueViabilityleadtoischemiaandnecrosis

Definition:DemographicsIncidence:Men 7.3/100,000Women 0.7/100,00069%duetotrauma36%fxtibia9.8%distalradius23%softtissueinjurywithoutfxHighenergy=lowenergyincidenceDemographicsIncidence:EtiologyFractures-closedandopensofttissueinjurywithoutfxTempvascularocclusionCast/dressingClosureoffascialdefectsBurns/electricalSurgicalpositioningEtiologyFractures-closedandoPathophysiology:

Pathophysiology:CompartmentSyndrome

TissueSurvivalMuscle3-4hours-reversiblechanges6hours-variabledamage8hours-irreversiblechangesNerve0.5hours-Nervedysfunction12-24hours-irreversiblechangesCompartmentSyndrome

TissueSuCLINICALPRESENTATIONPntc/oseverepainoutofproportiontoinjuryPainaggravatedbypassivemusclestretchLoss（dysfunction）ofsensationmaybeusefulsignDorsalispedispulsemayormaynotbeaffectedCLINICALPRESENTATIONPntc/osDiagnosisHistoryClinicalexam: thePsCompartmentpressuresLaboratorytestsCPKUrinemyoglobinDiagnosisHistoryClinicalDiagnosisThesix‘Ps’:PressurePainParesthesiaParalysis PallorPulselessness ClinicalDiagnosisThesix‘Ps’swellingswellingPressureEarlyfindingOnlyobjectivefindingto

ConfirmclinicalexamTechniqueWhitesideinfusionWickcatheterSlitcatheterPressureEarlyfindingWhitesideTechniqueWhitesideTechnique骨筋膜室綜合癥修改后課件骨筋膜室綜合癥修改后課件骨筋膜室綜合癥修改后課件TreatmentOrthopaedicEmergency!Lowerlegtoleveloftheheart(《practicalorthopedic》P323liftthewoundedlimbs?)RemovecastSplitalldressingsdowntoskinFasciotomyifcontinuedclinicalfindingsand/orelevatedcompartmentpressureTreatmentOrthopaeFasciotomyPrinciplesMakeearlydiagnosisLongextensileincisionstoReleaseallfascialcompartmentsPreserveneurovascularstructuresDebridenecrotictissuesCoveragewithin7-10daysFasciotomyPrinciplesMakeearlForearmForearmLegAnatomyLegAnatomyLegSingleIncisionTechniqueLegSingleIncisionTechniqueLegTwoIncisionTechniqueLegTwoIncisionTechniqueHandCompartmentsHandCompartmentsWoundCareSofttissuecoveragewith

abulkycompressiondressingby5-7daysSecondlookdebridementwithconsiderationforcoverageafter48-72hrsLimbshouldnotbeatriskforfurtherswellingPtshouldbeadequatelystabilizedDPC(Delayedprimaryclosure)possibleifresidualswellingisminimalUsuallyrequiresskingraft

Goalistoobtaindefinitivecoveragewithin7-10daysWoundCareSofttissuecoverage謝謝！謝謝！AcuteCompartmentSyndrome（骨筋膜室綜合癥）AcuteCompartmentSyndrome（骨筋膜Whatiscompartmentsyndrome?Whatiscompartmentsyndrome?COMPARTMENTSCOMPARTMENTSDefinition: Anincreasedpressurewithinenclosedosteofascialspacethatreducescapillaryper-fusionbelowlevelnecessaryfortissueViabilityleadtoischemiaandnecrosis

Definition:DemographicsIncidence:Men 7.3/100,000Women 0.7/100,00069%duetotrauma36%fxtibia9.8%distalradius23%softtissueinjurywithoutfxHighenergy=lowenergyincidenceDemographicsIncidence:EtiologyFractures-closedandopensofttissueinjurywithoutfxTempvascularocclusionCast/dressingClosureoffascialdefectsBurns/electricalSurgicalpositioningEtiologyFractures-closedandoPathophysiology:

Pathophysiology:CompartmentSyndrome

TissueSurvivalMuscle3-4hours-reversiblechanges6hours-variabledamage8hours-irreversiblechangesNerve0.5hours-Nervedysfunction12-24hours-irreversiblechangesCompartmentSyndrome

TissueSuCLINICALPRESENTATIONPntc/oseverepainoutofproportiontoinjuryPainaggravatedbypassivemusclestretchLoss（dysfunction）ofsensationmaybeusefulsignDorsalispedispulsemayormaynotbeaffectedCLINICALPRESENTATIONPntc/osDiagnosisHistoryClinicalexam: thePsCompartmentpressuresLaboratorytestsCPKUrinemyoglobinDiagnosisHistoryClinicalDiagnosisThesix‘Ps’:PressurePainParesthesiaParalysis PallorPulselessness ClinicalDiagnosisThesix‘Ps’swellingswellingPressureEarlyfindingOnlyobjectivefindingto

ConfirmclinicalexamTechniqueWhitesideinfusionWickcatheterSlitcatheterPressureEarlyfindingWhitesideTechniqueWhitesideTechnique骨筋膜室綜合癥修改后課件骨筋膜室綜合癥修改后課件骨筋膜室綜合癥修改后課件TreatmentOrthopaedicEmergency!Lowerlegtoleveloftheheart(《practicalorthopedic》P323liftthewoundedlimbs?)RemovecastSplitalldressingsdowntoskinFasciotomyifcontinuedclinicalfindingsand/orelevatedcompartmentpressureTreatmentOrthopaeFasciotomyPrinciplesMakeearlydiagnosisLongextensileincisionstoReleaseallfascialcompartmentsPreserveneurovascularstructuresDebridenecrotictissuesCoveragewithin7-10daysFasciotomyPrinciplesMakeearlForearmForearmLegAnatomyLegAnatomyLegSingleIncisionTechniqueLegSingleIncisionTechniqueLegTwoIncisionTechniqueLegTwoIncisionTechniqueHandCompartmentsHandCompartmentsWoundCareSofttissuecoveragewith

abulkycompressiondressingby5-7daysSecondlookdebridementwithconsiderationforcoverageafter

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