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Trauma to the Leg

Trauma to the Leg. Gazi Rashid, M4 grashid@emory.edu Dec 12 th 2018 ASP Clinical Anatomy. Objectives. Use a common trauma injury case to… Understand the basic pathophysiology of compartment syndrome Focus on the neurovasculature of a single compartment

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Trauma to the Leg

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  1. Trauma to the Leg Gazi Rashid, M4 grashid@emory.edu Dec 12th 2018 ASP Clinical Anatomy

  2. Objectives Use a common trauma injury case to… • Understand the basic pathophysiology of compartment syndrome • Focus on the neurovasculature of a single compartment • Walk through the treatment guided by anatomical landmarks

  3. Compartments in the Lower Leg 1 3 2 4 Med Lat R

  4. A common trauma patient

  5. ABCDE

  6. Med Lat

  7. Whew… • Went through ABCDEs • Arteries and veins intact • Broken tibia • Called Ortho

  8. What now?

  9. Compartment Syndrome

  10. Compartment Syndrome

  11. Compartments in the Lower Leg Med Lat Med Lat R

  12. What’s the treatment?

  13. Fasciotomy

  14. Objectives Use a common trauma injury case to… • Understand the basic pathophysiology of compartment syndrome • Focus on the neurovasculature of the anterior compartment • Walk through the treatment guided by anatomical landmarks

  15. Review the Qs • What’s the major artery passing through the anterior compartment that eventually becomes the dorsalidpedis? • The Common Peroneal nerve gives off what branch in the Lateral compartment and what branch in the Anterior compartment? • CS of the anterior compartment presents as numbness or tingling where? • Foot drop occurs with damage to the deep peroneal because which muscle is affected?

  16. Links • Acute Compartment Syndrome of the Lower Leg: A Review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970751/ • Lower extremity compartment syndrome: https://tsaco.bmj.com/content/2/1/e000094 • Two Incision Four Compartment Fasciotomy: https://www.youtube.com/watch?v=-1NDJkFH1vM&ab_channel=operationgivingback

  17. Things to Know • Vasculature • Anterior tibial artery is the blood supply for this compartment…terminal branch of popliteal artery…passes anteriorly through gap in superior part of interosseous membrane, at malleoli  Becomes dorsal artery of foot • The posterior tibial artery and its biggest branch the fibular artery supply the posterior compartment. • Know nerves • Deep peroneal - Extends in to foot to supply extensor digitorum brevis and extensor hallicus brevis and skin b/ 1st and 2nd toes • Goes to tibialis anterior  dorsiflexes  foot drop

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