MCQ Orthopedics Answer 22

The Correct Answer is E

The patient has a history of symptoms very suggestive of a compartment syndrome of the anterior compartment of the left leg. A common cause of this serious problem is limb compression during prolonged recumbency related to drug or alcohol overdose. Early diagnosis and treatment are essential in order to avoid permanent, severe disability.

The five “P’s” of compartment syndrome are pain, pallor, paresthesias, pulselessness, and paralysis. If distal pulses are reduced, then muscle necrosis has occurred and immediate surgical consultation is necessary.

Rest, ice, and evaluation are inappropriate treatment modalities for compartment syndrome. Intravenous antibiotics would be appropriate for cellulites. This diagnosis is unlikely in this scenario given the absence of fever, erythema, and edema, and the presence of diminished pulse. Duplex Doppler ultrasonography and impedance plethysmography are used to evaluate for deep venous thrombosis. Given the decreased pulses, however, this diagnosis becomes much less likely and such testing may needlessly delay urgent surgical treatment.

Ref: Tintinalli JE, Kelen GD, Stapczynski JS (eds): Emergency Medicine: A Comprehensive Study Guide, ed 5. McGraw-Hill, 2000, pp 1838-1841. (ABFM 2002)

Category: Orthopedics MCQs