Glossary of 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?
- 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)
- 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
- What are some causes of fractures?
- pathologic (spontaneous)
- 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 _____.
- Blood supply to and within the bone usually _____ because of an injury, which causes an area of bone ____.
- 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
- As a result of _____ and _____ proliferation, the fracture site is surrounded by new vascular tissue known as a _____. Takes 2 to 6 weeks.
- Callus formation is the beginning of a _______ union.
- 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
- In young, healthy adult bone, healing takes about ___
- An older person has reduced bone mass, so healing takes about ___ to ____ months.
- Besides age, what are other factors that affect healing?
- severity of trauma
type of bone injured
severity of trauma
type of bone injured
infections at the fracture
ischemic or avascular
- What elements are necessary for new bone production?
- The loss of ____ during menopause is detrimental to new bone formation
- 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?
extensive insect bites
massive infiltration of IV
(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
3 plasma proteins
- 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?
persistent motor weakness in
myoglobinuric renal failure
extreme cases may require
- Infection from necrotic tissue may become severe enough that _____ of the limb is warranted.
- ____ _____ 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 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)
(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
- Since bone is very vascular, trauma to can sever adjacent arteries and cause ______ which may result in ______ shock
- Clinical finding for increased compartment pressure is?
- Clinical finding for increased capillary permeability is?
- Clinical finding for release of histamines is?
- increased edema
- Clinical finding for increased blood flow to area is?
- pulses present
- Clinical finding for pressure on nerve endings is?
- Clinical finding for increased tissue pressure is?
- Clinical finding for decreased tissue perfusion is?
- increased edema
- Clinical finding for decreased oxygen to tissues is?
- Clinical finding for increased production of lactic acid is?
- unequal pulses
- Clinical finding for anaerobic metabolism?
- Clinical finding for vasodilation is?
- increased edema
- Clinical finding for increased blood flow is?
- tense muscle swelling
- Clinical finding for increased edema is?
- Clinical finding for muscle ischemia is?
- severe pain unrelieved by medication
- Clinical finding for tissue necrosis is?
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