Orthopaedics

Question 1

Abnormal intracompartmental pressure

Answer 1

> 20mmHg abnormal

>40mmHg diagnostic of compartment syndrome

Question 2

How long before muscle death occurs in compartment syndrome?

Answer 2

4-6 hours

Question 3

Treatment options for compartment syndrome

Answer 3

Fasciotomy

Debridement and amputation

Aggressive IV fluids if myoglobinuria to prevent AKI

Question 4

5 Ps of compartment syndrome

Answer 4

Pain (out of proportion, and on passive movement)
Paraesthesiae
Pallor
Pulseless (although pulse may be present)
Paralysis

Question 5

Grading of open fractures (GUSTILO AND ANDERSON)

Answer 5

1. Low energy wound <1cm
2. > 1cm wound with moderate tissue damage
3. High energy wound >1cm with extensive tissue damage
   3a adequate soft tissue coverage
   3b inadequate soft tissue coverage
   3c arterial injury

Question 6

Initial management of open fractures

Answer 6

Control haemorrhages 
Dressing
ABX
Distal neurovascular status 
Debridement, keep open, irrigate with 6L of saline 
Stabilise with external fixator