TEOT Ortopedia Practice Questions - TEOT - Título De Especialista Em Ortopedia E Traumatologia (Sociedade Brasileira De Ortopedia E Traumatologia AMB) Exam

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A 34-year-old man who underwent closed reduction and cast immobilization for a closed comminuted tibial shaft fracture 12 hours ago reports unremitting, escalating pain in his calf that is completely refractory to intravenous morphine. Physical examination demonstrates a tense, non-compressible calf and severe exacerbation of pain upon passive dorsiflexion of the great toe. His blood pressure is 115/75 mmHg and intracompartmental catheter measurement of the deep posterior compartment records a pressure of 48 mmHg. What is the definitive management?

Immediate bivalving of the cast and elevation of the lower extremity above the level of the heart. Immediate emergent two-incision, four-compartment fasciotomy of the leg. Urgent CT angiography of the lower extremity to rule out popliteal artery pseudoaneurysm before surgical intervention. Administration of intravenous mannitol and high-dose dexamethasone with compartment pressure re-evaluation in 4 hours.

Correct Answer:

Immediate emergent two-incision, four-compartment fasciotomy of the leg.

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