EM Vivas · Splinting and immobilisation
Compartment syndrome after backslab
Clinical viva on cast complications and the joint-above-and-below principle.
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ACEMFRCEMABEM
Prompt
A child returns 24 hours after a forearm backslab with severe pain, swollen fingers and pain on passive stretch. Discuss recognition, immediate action and counselling points for casted limbs.
Interpretation
Reveal interpretationShowHide
This is compartment syndrome until proven otherwise — pain out of proportion and pain on passive stretch are early; pulselessness is late. Immediate action: split the cast to skin including wool and spread, elevate, urgent orthopaedics for fasciotomy. Children may present with agitation alone (silent compartment). Prevention: backslab not circumferential cast in the acute swelling phase; cool dip water; pad prominences; recheck CSM after setting.[1]
References2ShowHide
- [1]McQueen MM, Court-Brown CM. Predictors of compartment syndrome after tibial fracture. J Orthop Trauma, 2015.PMID 25882967
- [2]Garfin SR, Mubarak SJ, Evans KL, et al. Quantification of intracompartmental pressure and volume under plaster casts. J Bone Joint Surg Am, 1981.PMID 7204445