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Extremity Fracture, Long Bone Open Fracture — Neurovascular Assessment — Clinical Pathway: Emergency

Extremity Fracture, Long Bone Open Fracture — Neurovascular Assessment — Clinical Pathway: Emergency

Assessing for Neurovascular Emergencies Including
Compartment Syndrome

Injuries at Risk for
NV Emergencies
  • Displaced tibia or forearm fracture (before and after reduction)
  • Displaced supracondylar humerus fractures, especially with an associated distal radius fracture/compromised pulses
  • Soft tissue crush injuries
  • Re-vascularized limbs
  • Following orthopedic surgery for the above injuries or osteotomies
  • Subfascial IV infiltrates (such as with intraosseous lines)
  • Limb gunshot wounds
Upper Extremity
NV Exam
Lower Extremity
NV Exam
Compartment Syndrome
  • Symptoms
    • Pain out of proportion to injury; early and common finding
    • Persistent deep ache or burning pain
    • Paresthesia, onset within 30 min-2 hrs; suggests ischemic nerve dysfunction
  • Examination findings
    • Pain with passive stretch of muscles in the affected compartment; early finding
    • Tense compartment with firm "wood-like" feeling
    • Pallor from vascular insufficiency
    • Diminished sensation
    • Muscle weakness; onset within 2-4 hrs
    • Paralysis; late finding
Assess
  • Concern for NV injury or compartment syndrome
    • RN: q1hr
    • Ortho: q2hr

 

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