Medical 9-MS55-Acute Compartment Syndrome (ACS)

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Define fracture?: a break or disruption in the continuity of a bone
What are 2 classifications of fractures?: complete
incomplete
Define complete fracture?: the break is across the entire width of the bone in such a way that the bone is divided into two distinct sections
Define incomplete fracture?: the fracture does not divide the bone into two portions because the break is through only part of the bone
A fracture is described by the extent of associated soft-tissue damage as?: open (compound)
closed (simple)
What is an open or compound fracture?: skin surface broken causing an external wound...
Grade 1 is the least severe injury...
Grade II open fracture is accompanied by skin and muscle contusions...
Grade III there is damage to skin, muscle, nerve tissue, and blood vessels; the wound is more than 2.4 to 3.2 inches in diameter
What is a closed (simple) wound?: does not extend through the skin and therefore has no visible wound
What are common types of fractures (8)?: closed, nondisplaced
open, compound
comminuted, fragmented
displaced
oblique
spiral
impacted
greenstick
What are some causes of fractures?: pathologic (spontaneous)
fatigue (stress)
compression
What causes pathologic or spontaneous fractures?: minimal trauma to a bone that has been weakened by disease...may be a result of bone cancer or osteoporosis
What causes fatigue or stress fractures?: excessive strain and stress on the bone
What causes compression fractures?: produced by a loading force applied to the long axis of cancellous bone...commonly occur in vertebrae of clients with osteoporosis
Within 48 to 72 hours after an injury, a _______ forms at the site of the fracture because bone is extremely _____.: hematoma
vascular
Blood supply to and within the bone usually _____ because of an injury, which causes an area of bone ____.: diminishes
necrosis
After a bone injury, cells start to die which prompts the migration of 1_____ and 2_____ as part of the inflammatory process. This then prompts the formation of 3_____, providing the foundation for bone healing. This can take anywhere from 4____ days to: 1 fibroblasts
2 osteoblasts
3 fibrocartilage
4 three
5 two
As a result of _____ and _____ proliferation, the fracture site is surrounded by new vascular tissue known as a _____. Takes 2 to 6 weeks.: vascular
cellular
callus
Callus formation is the beginning of a _______ union.: nonbony.
As healing continues, it is transformed from a loose, fibrous tissue into bone. How long does this take?: within 3 weeks to 6 months
What happens to callus before the final phase of bone healing begins?: excess callus is resorbed
During the final phase of healing, consolidation, and remodeling, bone continues to be ______ and deposited in response to stress, reshaping to meet mechanical demands. This process may start as early as ___ weeks after fracture and can continue for up t: resorbed
six
one
In young, healthy adult bone, healing takes about ___ weeks.: six
An older person has reduced bone mass, so healing takes about ___ to ____ months.: three
six
Besides age, what are other factors that affect healing?: severity of trauma
type of bone injured
severity of trauma
type of bone injured
inadequate immobilization
infections at the fracture
site
ischemic or avascular
necrosis (AVN)
What elements are necessary for new bone production?: calcium
phosphorus
vitamin D
protein
The loss of ____ during menopause is detrimental to new bone formation: estrogen
How does peripheral vascular diseases (arteriosclerosis) affect bones?: reduces arterial circulation
to bone...bone receives
less oxygen and lesser
amounts of nutrients
What are compartments?: sheaths of inelastic fascia that support and partition muscles, blood vessels, and nerves in the body
What is acute compartment syndrome (ACS)?: a serious condition in which increased pressure (can be from internal or external source) within one or more compartments causes massive compromise of circulation to the area
What are the most common sites for ACS in clients experiencing musculoskeletal trauma?: compartments in the lower leg....
dorsal and volar compartments of the forearm
What are examples of external compartment pressure?: tight, bulky dressings and casts

(loosen bandage or tape to relieve...request an order to have cast cut...sometimes order not needed depending on hospital protocol)
What is a common source of internal pressure?: blood or fluid accumulation
Acute compartment syndrome can be found in what kinds of cases?: musculoskeletal
severe burns
extensive insect bites
massive infiltration of IV
fluids

(edema increases pressure in one or more compartments)
What is the primary pathophysiologic changes of increased compartment pressure referred to as?: ischemia-edema cycle
Explain the pathophysiology of ACS? 1______ within viable muscle dilate, which raises capillary pressure. Capillaries then become more permeable because of the release of 2_____ by the ischemic muscle tissue. As a result, 3____ _____ leak into: 1 Capillaries
2 histamine
3 plasma proteins
4 nerve
5 ischemia
6 paresthesia
7 weaken
8 pain
9 cyanosis
tingling
numbness
paresis
severe pain
ACS is not common, but an emergency when it does occur. Neuromuscular damage is irreversible within how many hours? The limb can become useless within how many hours after onset?: four to six hours after onset

24 to 48 hours
For high-risk patients, what is monitored singly or continuously?: compartment pressures
What does continuous monitoring require placement of?: wick or slit-tip catheter connected to a transducer and is recommended for comatose or unresponsive high-risk clients
How is a fasciotomy performed to verify ACS?: an incision is made through the skin and subcutaneous tissues into the fascia of affected compartment
How does a fasciotomy relieve the pressure?: restores circulation to affected area
How is the open wound treated following fasciotomy?: open wound is packed and dressed on a regular basis until secondary closure occurs, usually in 4 to 5 days...then the surgeon usually debrides the wound and may apply a skin graft to promote healing
What are uncommon problems associated with compartment syndrome?: infection
persistent motor weakness in
affected extremity
contracture
myoglobinuric renal failure
extreme cases may require
amputation
Infection from necrotic tissue may become severe enough that _____ of the limb is warranted.: amputation
____ _____ from injured nerves is not reversible, and the client may require braces or other orthotic devices for assistance in movement.: Motor weakness
Which contractures of the forearm can begin within 12 hours or pressure increase?: Volkmann's
Volkmann's contractures of the forearm result from?: shortening of ischemic muscle and from nerve involvement.
What is rhabdomyolysis?: muscle tissue breakdown
Rhabdomyolysis can cause?: myoglobinuric renal failure which is potentially fatal...commonly occurs when large or multiple compartments are involved
Myoglobinuric renal failure occurs because injured muscle tissue releases _____ into circulation, where it can occlude distal convoluted tubule and precipitate acute _____ failure (exact mechanisms unknown): myoglobulin (muscle protein)
renal

(may have a direct toxic effect on kidneys)
With myoglobinuric renal failure, damaged muscle cells also release 1_____, which cannot be excreted because of renal failure...this may result in 2_____ which may cause dysrhythmias and cardiac arrest: 1 potassium
2 hyperkalemia
Since bone is very vascular, trauma to can sever adjacent arteries and cause ______ which may result in ______ shock: hemorrhage
hypovolemic
Clinical finding for increased compartment pressure is?: none
Clinical finding for increased capillary permeability is?: edema
Clinical finding for release of histamines is?: increased edema
Clinical finding for increased blood flow to area is?: pulses present
pink tissue
Clinical finding for pressure on nerve endings is?: pain
Clinical finding for increased tissue pressure is?: tingling
numbness
Clinical finding for decreased tissue perfusion is?: increased edema
Clinical finding for decreased oxygen to tissues is?: pallor
Clinical finding for increased production of lactic acid is?: unequal pulses
flexed posture
Clinical finding for anaerobic metabolism?: cyanosis
Clinical finding for vasodilation is?: increased edema
Clinical finding for increased blood flow is?: tense muscle swelling
Clinical finding for increased edema is?: paresthesia
Clinical finding for muscle ischemia is?: severe pain unrelieved by medication
Clinical finding for tissue necrosis is?: paresis/paralysis

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