A person comes with fracture tibia with swelling of lower leg pulse feeble but palpable. Intacompatmental pressure is raised. What is the next step in management?
Correct Answer: Fasciotomy
Description: CRUSH SYNDROME: Clinical features and treatment The compromised limb is pulseless and becomes red, swollen and blistered; sensation and muscle power may be lost. The most impoant measure is prevention. From an intensive care perspective a high urine f low is encouraged with alkalization of the urine with sodium bicarbonate, which prevents myoglobin precipitating in the renal tubules. If oliguria or renal failure occurs then renal haemofiltration will be needed. If a compament syndrome develops, and is conf irmed by pressure measurements, then a fasciotomy is indicated. Excision of dead muscle must be radical to avoid sepsis. Similarly, if there is an open wound then this should be managed aggressively. If there is no open wound and the compament pressures are not high, then the risk of infection is probably lower if early surgery is avoided. REF:Apley&;s system of ohopaedics- 9th edn - pg no 681.
Category:
Orthopaedics
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