Foot compartment syndrome [Malpractice Case]

[bbc586]

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Has anyone here after 1. diagnosed compartment syndrome of the foot or 2. checked a compartment pressure on the foot?

Interesting case of a guy who got his foot run over, seen at an occupational health clinic, sent home.

3 days later sent to ED, gets fasciotomies of the foot. Permanently disabled.

A few orthos are saying that doing the fasciotomies of the foot is often worse than the compartment syndrome, standard may be switching to just splint, pain meds, then release contractures once they happen months - years later.

 

[BoardingDoc]

Has anyone here after 1. diagnosed compartment syndrome of the foot or 2. checked a compartment pressure on the foot?

Interesting case of a guy who got his foot run over, seen at an occupational health clinic, sent home.

3 days later sent to ED, gets fasciotomies of the foot. Permanently disabled.

A few orthos are saying that doing the fasciotomies of the foot is often worse than the compartment syndrome, standard may be switching to just splint, pain meds, then release contractures once they happen months - years later.

Yep. I diagnosed one a few months ago. Young guy. Healthy. No trauma. Foot pain. Very uncomfortable. Seemed like a reasonable guy and not drug seeking. Worked out earlier that day but nothing crazy. Xrs neg. Foot looked fine but he was just in too much pain. Medial compartment seemed firm so I strykered it as I'd never heard of compartment syndrome in a foot, but I had no idea what else this could be. Pressure was 60. I assumed I just screwed up how I zeroed the needle so I redid everything. 65. Transferred.

Ortho notes were sorta like "ED doc reports elevated pressure so we are obligated to go to the OR"
OR note describes "dusky appearing muscle tissue bursting from the compartment once the fascia was incised"

I felt pretty good about that catch.

 

[Apollyon]

Ortho notes were sorta like "ED doc reports elevated pressure so we are obligated to go to the OR"
OR note describes "dusky appearing muscle tissue bursting from the compartment once the fascia was incised"

I felt pretty good about that catch.

That sounds like black letter academic passive/aggressive BS. If they were so dismissing, why didn't they just Stryker it themselves?

 

[southerndoc]

I'm going to show my ignorance here, but I never thought a foot compartment syndrome could exist.

 

[RustedFox]

I would have reservations about where to introduce the stryker needle in the foot.
I mean: "in the compartment", yeah - but... approach?

 

[BoardingDoc]

I would have reservations about where to introduce the stryker needle in the foot.
I mean: "in the compartment", yeah - but... approach?

My guy was tender and tense over the medial compartment, so I just stuck the needle in, medial approach at the apex of the arch about halfway between dorsal/ventral, right in the middle of the meat. I was definitely making it up as I went along, but it seemed like the obvious choice.

 

[bbc586]

Yep. I diagnosed one a few months ago. Young guy. Healthy. No trauma. Foot pain. Very uncomfortable. Seemed like a reasonable guy and not drug seeking. Worked out earlier that day but nothing crazy. Xrs neg. Foot looked fine but he was just in too much pain. Medial compartment seemed firm so I strykered it as I'd never heard of compartment syndrome in a foot, but I had no idea what else this could be. Pressure was 60. I assumed I just screwed up how I zeroed the needle so I redid everything. 65. Transferred.

Ortho notes were sorta like "ED doc reports elevated pressure so we are obligated to go to the OR"
OR note describes "dusky appearing muscle tissue bursting from the compartment once the fascia was incised"

I felt pretty good about that catch.

So just spontaneous compartment syndrome? No clear cause? Thats kind of terrifying.

 

[bbc586]

I would have reservations about where to introduce the stryker needle in the foot.
I mean: "in the compartment", yeah - but... approach?

Ortho bullets lists 9 compartments of the foot... Are we going to Stryker every one? That seems ridiculous.

 

[Jabbed]

Never a foot, but multiple hands. The weirdest one to me, but which is apparently common, was from IV infiltration in a peds patient.

 

[southerndoc]

So just spontaneous compartment syndrome? No clear cause? Thats kind of terrifying.

As terrifying as the thoracic aortic dissections without chest pain.

 

[thegenius]

Yep. I diagnosed one a few months ago. Young guy. Healthy. No trauma. Foot pain. Very uncomfortable. Seemed like a reasonable guy and not drug seeking. Worked out earlier that day but nothing crazy. Xrs neg. Foot looked fine but he was just in too much pain. Medial compartment seemed firm so I strykered it as I'd never heard of compartment syndrome in a foot, but I had no idea what else this could be. Pressure was 60. I assumed I just screwed up how I zeroed the needle so I redid everything. 65. Transferred.

Ortho notes were sorta like "ED doc reports elevated pressure so we are obligated to go to the OR"
OR note describes "dusky appearing muscle tissue bursting from the compartment once the fascia was incised"

I felt pretty good about that catch.

good catch. I don't even have a stryker. I would have called Ortho and they would have laughed at me

 

[AlmostAnMD]

I had a case in residency. Same as previous story, it was laughed off by ortho until they actually forcibly came to see the patient.

Dunno why they don't care about it?

 

[Mount Asclepius]

Dunno why they don't care about it?

They always look like they care more about their muscles than their bones. When it comes to patients though they like the bones more than the muscle, and the hardware more than the bones.

 

[turkeyjerky]

Never a foot, but multiple hands. The weirdest one to me, but which is apparently common, was from IV infiltration in a peds patient.

I've been told by hand surgeons multiple times that this doesn't exist. I've never really believed them. It's really weird the stuff you hear from people sometimes...

 

[lucid_leprechaun]

I've been told by hand surgeons multiple times that this doesn't exist. I've never really believed them. It's really weird the stuff you hear from people sometimes...

“That doesn’t exist“ equals I’ve never seen that and I’m a specialist

 

[RustedFox]

I had a case in residency. Same as previous story, it was laughed off by ortho until they actually forcibly came to see the patient.

Dunno why they don't care about it?

They always look like they care more about their muscles than their bones. When it comes to patients though they like the bones more than the muscle, and the hardware more than the bones.

"Orthopedic surgery" is what happens when a kid who likes playing with his erector set a little too much grows up and goes to medical school.

 

[Vandalia]

I had a case in residency. Same as previous story, it was laughed off by ortho until they actually forcibly came to see the patient.

Dunno why they don't care about it?

Forcibly?

As in they broke down the doors to see the patient?

Or they were forced by their attending after an attending-to-attending conversation?

Or forcibly as in you made up signs with arrows "New Hospital Gym This Way" put up from the OR locker room to the patient's room and then locked the door behind them?

 

[Apollyon]

“That doesn’t exist“ equals I’ve never seen that and I’m a specialist

I call that the "fallacy of anecdote" - "I've never seen it, therefore, it doesn't exist".

 

[Neopolymath]

I call that the "fallacy of anecdote" - "I've never seen it, therefore, it doesn't exist".

Pairs nicely with "sometimes wrong, never in doubt"

 

[Angry Birds]

Just don’t be the last one holding the potato

 

[MechEDoc]

Ortho bullets lists 9 compartments of the foot... Are we going to Stryker every one? That seems ridiculous.

Each one, twice.

 

[bravotwozero]

Just don’t be the last one holding the potato

Would you have transferred this from your critical access hospital ED?

 

[Angry Birds]

Would you have transferred this from your critical access hospital ED?

Most definitely