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Compartment Syndrome

Severe pain caused due to the inflammation of an enclosed area (compartment) thereby giving no room for the muscles, blood vessels, nerves and bones within the compartment to expand is called compartment syndrome. Veins, nerves and arteries undergo tremendous pressure thereby resulting in pain and slow circulation to the muscles and nerves. It can cause permanent damage to the tissues. Symptoms include severe pain, weakness and paresthesia. Symptoms of compartment syndrome involve 5 Ps - Pain , Pallor, Paresthesia (tingling or burning sensation on the skin), Pulselessness, and Poikilothermia (problem maintaining constant core temperature independent of ambient temperature). Common causes for compartment syndrome:

  • Trauma caused due to elevated-force during a road accident. Compartment Syndrome is mostly noticed in long bone fracture, crush injury and circumferential burns to the extremities.

  • Tightly wound bandages or casts.

  • Repetitive forceful activity focusing on a particular compartment alone.

  • Compartment syndrome is likely to occur more often in the lower legs, forearm and less likely in the upper arm, thigh, hand and foot.

Even after holding the affected part in an elevated position, if the pain does not reduce it is a typical symptom of compartment syndrome. Other symptoms of compartment syndrome are severe weakness and paleness. In case pain is caused by tight bandage or splint then it has to be loosened. The patient must be kept hydrated and hypotension must be avoided. Surgery is often resorted to for cases of compartment syndrome. Fasciotomy surgery is performed on those suffering acute compartment syndrome to minimize tissue damage. Thus the contents of the compartment are allowed to swell without increasing the pressure. After some days the incision is closed. Skin grafting might be required in the affected region.

Lisfranc fracture

Lisfranc fracture is almost always accompanied by dislocation of the Lisfranc joints or the tarsometatarsal joints that are located in the middle of the foot. A twisting fall or a heavy blow can cause this fracture. Connective tissues or ligaments hold the bones in place. The first and second metatarsals are not held by any connective tissue. Hence when a twisting fall occurs, dislocation of these bones takes place. Due to this injury the tarsal bones are dislocated, but (MT) does not occur always. Generally, the fracture and the dislocation are treated independently with stabilization devices. One or more of the tarsometatarsal joints are dislocated when Lisfranc dislocation occurs.

Many times, mistaken for sprains, Lisfranc fractures are associated with swelling of the top of the foot which is also very painful. It is very difficult to put any weight on the foot if the injury is very severe. Often X-rays do not reveal Lisfranc injuries. Serious complications like joint degeneration and compartment syndrome will follow when Lisfranc injuries go unrecognized. If the pain or swelling does not reduce in spite of normal treatment for a sprain, it is better to take the advice of an orthopaedic specialist.

By examining the foot for signs of injury, an orthopedist will move the foot in a circular motion holding the heel steady. A CT scan or MRI scan will show the exact nature of the injury. Open Reduction Internal Fixation (OR IF) is advised for dislocation.

Femur fracture

The word 'femur' is taken from Latin meaning 'thigh'. The femur is the thigh bone and it is the largest and strongest bone in the human body. The femur bone extends from the hip to the knee joint. A femur fracture can be life threatening. Since the inside of the thigh is a place of major blood vessels, broken femur means break in the artery. Femur fracture is also called femoral shaft fracture, femur injury, femur stress fracture, fractured femur, femur trauma and femoral diaphyseal fracture. Femur is a tremendously strong bone. It usually requires a great deal of force to break the femur bone. The most common causes for femur fractures include:

  • Falls from a great height
  • Blows that are strong in force
  • Car accidents and Collisions
  • Severe twists
  • Bones weakened by osteoporosis, tumor or infection leading to a condition called pathologic femur fracture.

Proximal femur fracture: This involves fracture in the uppermost portion of the thighbone adjacent to the hip joint. are further sub divided into different types.

Femoral shaft fracture: The femoral shaft fracture is a severe injury that occurs during high-speed motor vehicle collisions and significant falls. Injuries caused by femoral shaft fractures are usually severe. Treatment of femoral shaft fracture is always with surgery. The common procedure is to insert a metal rod bone, called 'intramedullary rod' down the center of the thigh. The two ends of the bone are connected by the rod. This intramedullary rod usually remains in the bone for the life of the patient but can be removed if it causes pain and other problems.

Supracondylar femur fracture: In this kind of fracture, the injury occurs just above the knee joint. Cartilage surface of the knee joint is usually involved in this fracture. Patients who sustain supracondylar femur fracture are at high risk of developing knee arthritis later. Supracondylar femur fracture is common in patients with severe osteoporosis. Patients who have undergone total knee replacement surgery also run the risk of this fracture. Treatment for supracondylar femur fracture is highly variable. A cast or brace, external fixator, plate, screws or intramedullary rod are used for treatment.

Symptoms of femur fracture include swelling, bruising and severe pain. There may be numbness or paralysis in the leg below the femur fracture. Femur fractures are apparent and visible in many cases. Apart from clinical examination by the orthopaedic, for non-apparent fractures, a bone scan is required. Treatment for fractures of femur depends upon various factors such as the patient's age, type of fracture, location of the break, bone stability in the injured, mechanism of injury, direction of the blow, factors of twisting, existence of internal bleeding and extent of soft tissue damage. Some of the methods of treatment are:

  • Reduction or re-alignment
  • Immobilization whereby the movement is restricted
  • Insertion of an intramedullary fixation
  • A cast
  • External fixation such as a frame on the outside of the leg anchored into the bone using pins.

Potential complications from fracture of femur
  • Pain or arthritis
  • Rotational deformity due to misalignment
  • Infections in open fractures
  • Uneven leg length
  • Injury of blood vessels
  • Nerve damage
  • Compartment syndrome
  • Amputation
  • Failure to heal - 'non-union' is also a possibility

Intra articular sepsis, arthritis and knee stiffness are some of the permanent complications that can occur among persons who have undergone femur fracture and treatment. Sometimes femur fracture is bound to cause permanent disability in injured persons. This is due to the thigh muscle pull and incorrect reunion of fragments when they overlap. Femur fracture patients should be careful not to put weight on the leg as this can delay the healing process.

Tags: #Compartment Syndrome #Lisfranc fracture #Femur fracture
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Collection of Pages - Last revised Date: July 23, 2024