A 25-year-old male presents after a motorbike accident with a closed midshaft tibial fracture. Six hours later, he complains of severe pain disproportionate to the injury, worsened by passive dorsiflexion. Distal pulses are palpable, but there is loss of sensation in the first web space. What is the most appropriate next step in management?

Question

The following is affected in Kienbock disease-

Answer 1

Step 1: Understanding the Question:
The scenario describes a patient with a tibial fracture developing acute compartment syndrome, which is a limb-threatening surgical emergency.
Step 2: Detailed Explanation:

Clinical Recognition: The classic "6 Ps" of compartment syndrome are Pain (out of proportion), Pressure, Paresthesia, Pallor, Paralysis, and Pulselessness.

Critical Findings: "Pain disproportionate to injury" and "Pain with passive stretch/dorsiflexion" are the earliest and most reliable clinical signs.

Nerve Involvement: Loss of sensation in the first web space indicates compression of the Deep Peroneal Nerve within the anterior compartment of the leg.

The Pulse Myth: Distal pulses are usually palpable in early compartment syndrome because the intracompartmental pressure rarely exceeds systolic arterial pressure. A palpable pulse does NOT rule out this diagnosis.

Treatment Strategy: Once the diagnosis is suspected clinically, the treatment is surgical. Conservative measures like elevation (which decreases arterial inflow) or casting (which increases external pressure) are strictly contraindicated.

Fasciotomy: A double-incision, four-compartment fasciotomy must be performed immediately to decompress the muscle and prevent irreversible myonecrosis and nerve damage.

Step 3: Final Answer:
Immediate fasciotomy is the only appropriate intervention for acute compartment syndrome to save the limb.

Show Hint

The Correct Option is B

Solution and Explanation

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