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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 25-year-old male sustains the injury depicted in Figure A. He is splinted in the field, but on arrival to the emergency room, he complains of painful "tightness" around the leg and severe uncontrolled pain despite maximum dose narcotics. His pain is exacerbated when the toes and ankle are passively stretched in flexion and extension. What is the most appropriate next step in treatment?
External fixation with serial doppler examinations
Open reduction internal fixation using plates and screws
Immediate 2-compartment fasciotomies and external fixation
Immediate 4-compartment fasciotomies and external fixation
Select Answer to see Preferred Response
A 24-year-old male is brought to the ED after an MVC. He is found to have a closed comminuted segmental fibula fracture after a prolonged extraction from the vehicle. Several hours after arrival, the patient reports increasing pain and is noted to have an exacerbation of his pain with passive stretching of the ankle. He has a heart rate of 103 and a blood pressure of 141/87. Compartment pressures are obtained and are 27 mmHg in the anterior compartment, 47 mmHg in the lateral compartment, 28 mmHg in the superficial posterior compartment, and 27 mmHg in the deep posterior compartment. Which of the following correctly describes the initial pathophysiology of compartment syndrome and the neurologic deficit that would likely occur in this patient if left untreated?
Decreased arterial inflow; decreased sensation on the dorsum of his foot involving the first webspace
Decreased arterial inflow; decreased sensation on the dorsum of his foot involving the hallux, 3rd, and 4th toes
Decreased arterial inflow; inability to dorsiflex his ankle
Decreased venous outflow; decreased sensation on the dorsum of his foot involving the first webspace
Decreased venous outflow; decreased sensation on the dorsum of his foot involving the hallux, 3rd, and 4th toes
You are called to evaluate a 45-year-old male in the ED who was in a motor vehicle accident prior to arrival. EMS reported a prolonged extrication and GCS of 6 on scene, which required a field intubation. He has obvious deformity and crepitus of his left leg, with radiographs seen in Figure A. The ED physician reports an increase in soft tissue swelling and firmness of the leg. You decide to measure the patient's compartments given clinical concern for compartment syndrome. Which of the following is true of intracompartmental pressure measurements?
Interobserver reliability is poor
Should be obtained remote to the zone of injury
Should always be obtained to objectively confirm clinical suspicion for compartment syndrome
Have high specificity for diagnosis of compartment syndrome when absolute pressures exceed 20 mmHg
Threshold for fasciotomy remains similar intraoperatively
An 8-year-old boy is involved in an ATV crash. Xrays were obtained in the trauma bay after being airlifted to your facility, shown in Figures A. On the day of presentation, you perform the treatment shown in the figure B. On postoperative day 1, the patient states his pain is controlled, however, you find that his calf is tense, his foot is cool and has diminished pulses compared to the contralateral extremity. What is the best next step of the options below?
Remove your fixation and perform repeat reduction
Measure leg compartment pressures
Request vascular consultation
Measure ankle-brachial index (ABI)
Duplex ultrasound evaluation
A 35-year-old male sustains a closed tibial shaft fracture after falling from 12 feet. Which of the following measurements would be concerning for an evolving compartment syndrome?
Intraoperative anterior compartment measurement of 29, with preoperative diastolic pressure 58
Preoperative anterior compartment measurement of 25, with preoperative diastolic pressure of 60
Intraoperative anterior compartment measurement of 25, with intraoperative diastolic pressure of 54
Intraoperative anterior compartment measurement of 28, with intraoperative diastolic pressure of 72
Preoperative anterior compartment measurement of 22, with mean arterial pressure of 70
A 28-year-old male sustains a midshaft fibula fracture after being kicked during a karate tournament and develops compartment syndrome isolated to the lateral compartment of his leg. If left untreated, which of the following sensory or motor deficits would be expected?
Decreased sensation on the dorsum of his foot involving the hallux, 3rd, and 4th toes
Inability to plantar flex the ankle
Decreased sensation on the dorsum of his foot involving the first webspace
Inability to dorsiflex the ankle
Inability to abduct his toes
During a dual incision fasciotomy of the leg, the soleus is elevated from the tibia to allow access to which of the following compartments?
A 35-year-old female presents to the emergency room after a motor vehicle collision where her leg was pinned under the car for over 30 minutes. A clinical photo and radiographs are shown. Which of the following is the most accurate way to diagnose compartment syndrome?
surgeon's palpation of the leg compartments
paresthesias in her foot
diastolic blood pressure minus intra-compartmental pressure is less than 30 mmHg
diastolic blood pressure minus intra-compartmental pressure is greater than 30 mmHg
intra-compartmental pressure measurement of 25 mmHg
A 32-year-old male sustains the injury seen in Figure A. His blood pressure preoperatively was 132/84. After closed reduction and placement of an intramedullary nail, his intraoperative leg compartment pressures are measured, with the highest being 28 mmHg. His blood pressure at this time is 84/57. What is the next appropriate step?
Immediate four compartment fasciotomy
Fasciotomy of the highest compartment(s)
Removal of the nail and placement of an external fixator
Repeat evaluation in recovery room
Addition of pressors to anesthesia
Which of the following structures is at risk during proximal dissection of a single lateral perifibular approach for compartment syndrome of the leg?
Common peroneal nerve
Superficial peroneal nerve
Deep peroneal nerve
Anterior tibial artery
Lateral inferior genicular artery
A 10-year-old girl is treated for a tibia/fibula fracture with a long leg cast. The on-call resident is called to evaluate the patient for increasing pain medicine requirements and tingling in her foot. Examination of the cast reveals that the ankle has been immobilized in 10 degrees of dorsiflexion. What ankle position results in the safest compartment pressures in a casted lower leg?
40-50 degrees of plantar flexion
10-20 degrees of ankle dorsiflexion
Neutral to 30 degrees of plantar flexion
Neutral to 10 degrees of dorsiflexion
Ankle position has no effect on calf compartment pressure
Increasing the oxygen gradient for diffusion is the primary mechanism of action for which of the following methods of treatment of lower extremity trauma?
Hyperbaric oxygen therapy
Negative pressure wound therapy
Which clinical sign is the most sensitive for the diagnosis of compartment syndrome in a child with a supracondylar humerus fracture?
increasing analgesia requirement
An 11-year-old child has a tibia-fibula fracture following a fall from a swing. The fracture is reduced and placed in a long leg splint in the emergency room. What is considered the earliest sign or symptom of a developing compartment syndrome of the leg?
pain out of proportion to injury
pale appearance of the foot
loss of the ability to move the toes
decreased sensation in the foot
decreased pulses in the foot
A 6-year-old boy with progressive bilateral genu varum undergoes the surgeries shown in Figure A. On postoperative rounds later that day, the patient appears sedated after several doses of pain medication. His toes are pink with brisk capillary refill however, passive motion of his toes causes pain. Among the answer choices listed, what is the best management strategy for this child?
Elevate his legs and reevaluate on morning rounds
Adjust his pain medication to accommodate for his increasing pain
Administer a muscle relaxant for leg spasms
Cast removal and measurement of compartment pressures with a standard device
Examine the cast for areas of constriction and reevaluate in the morning
All of the following are true statements regarding compartment syndrome in the pediatric patient EXCEPT:
Increasing analgesic requirement is an important indicator for the diagnosis of compartment syndrome in children
Duration of compartment syndrome prior to treatment is the most important variable in determining the outcome
Mechanism of injury is the best predictor of compartment syndrome development
Traditional hallmarks of adult compartment syndrome may be more challenging to detect in pediatric compartment syndrome
Careful patient positioning and the use of prophylactic fasciotomy are methods of preventing compartment syndrome