Tibial Anterior Compartment Syndrome


Article Author:
John Kiel


Article Editor:
Kimberly Kaiser


Editors In Chief:
Donald Kushner
Annabelle Dookie


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Trevor Nezwek
Radia Jamil
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Steve Bhimji
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Nazia Sadiq
Hajira Basit
Phillip Hynes
Tehmina Warsi


Updated:
4/2/2019 1:07:01 AM

Introduction

Compartment syndrome occurs when the tissue pressure within a given compartment exceeds the perfusion pressure of the arterial supply resulting in ischemia to the muscles and nerves of the compartment. The etiology is varied; however, most commonly it is related to acute trauma or overuse syndrome. In the leg, this can occur in any of the four compartments: anterior, lateral, superficial posterior, or deep posterior. Compartment syndrome can occur in other places in the body as well including the thigh, forearm, hand, and wrist.

The muscles of the anterior compartment of the leg contain the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and fibularis tertius. In general, the muscles are responsible for dorsiflexion and participate in eversion and inversion of the foot and ankle. Specifically, the tibialis anterior dorsiflexes and inverts the foot. The extensor digitorum longus extends digits 2 to 5 and dorsiflexes the ankle while the extensor hallucis longus is responsible for extension of the 1st digit and also dorsiflexes the ankle. The fibularis tertius aids in dorsiflexion and eversion. The leg's anterior compartment is supplied by the deep fibular nerve (L4, L5, S1), which is a branch of the common fibular nerve. Blood flow is supplied by the anterior tibial artery which is a branch of the popliteal artery and transitions to the dorsalis pedis artery as it crosses into the foot. The borders of the anterior compartment are the anterior tibia, anteromedial fibula, interosseous membrane, and the anterior intermuscular septum.

Etiology

Trauma is the most common etiology of compartment syndrome. Other causes of anterior leg compartment syndrome can vary wildly. Some examples include trauma (blunt or penetrating trauma, fracture, hemorrhage, burns), infectious (tetany, myositis), neurogenic (seizures), toxicology (envenomation, drug or alcohol abuse resulting in coma, androgenic steroid abuse), renal (decreased serum osmolarity), musculoskeletal (tear of the muscles of the anterior compartment, everyday activity, muscle hypertrophy, vigorous exercise, chronic repetitive exercise), autoimmune (vasculitis), vascular (deep vein thrombosis, hemorrhage), rhabdomyolysis, and postischemic swelling[1].

Compartment syndrome can occur during routine medical or surgical care. Causes include dressings, splints or casts which are too tight; lying in the lithotomy position; malfunctioning sequential compression devices; intramuscular or intracompartmental injections; intraosseous line or infusion of hypertonic intravenous (IV) fluid or contrast agent; bleeding into compartments from attempted cannulation of vein or artery; intraoperative use of pressurized pulsatile irrigation; and military antishock trousers. Compartment syndrome can occur as the sequelae of orthopedic procedures and may be the result of post-operative bleeding, muscle edema, or tight closure of fascial layers.

Epidemiology

Tibial fracture is the most common cause of compartment syndrome accounting for up to 12% of all compartment syndrome cases. Open tibial fractures are more likely to cause compartment syndrome (6%) than closed fractures (1.2%). In patients with tibial diaphyseal fractures, younger age is associated with increased risk of developing compartment syndrome[2]. Increased fracture length relative to the length of the tibia is associated with increased risk. Tibial plateau fracture increases risk, especially Schatzker VI, as compared to shaft or pilon fractures. Accompanying fibular fracture also increases a patient's risk.

Traumatic compartment syndrome may be more common in men. Use of intramedullary rod is not associated. The frequency of compartment syndrome is much higher in patients with associated vascular insults. One study suggested 19% of patients with vascular injuries required a fasciotomy.

The incidence of chronic exertional compartment syndrome is a relatively common cause of leg pain in athletes ranging from 27% to 33%. Risk factors include running athletes. Also, fascia defects occur in up to 40% of athletes compared to 5% in asymptomatic athletes. Symptoms are frequently bilateral. Males and females are affected equally.

Compartment syndrome in children without a fracture is rare and not well understood. The leg is also the most common location of compartment syndrome in children. In one study of 39 cases of compartment syndrome in kids, vascular was the most common etiology (28%), followed by trauma (26%), postoperative (21%), exertion (15%), and infection (10%).

Pathophysiology

Compartment syndrome results from increased compartment pressure. When the systemic blood pressure is inadequate to overcome the pressure within a compartment, ischemia of its contents occur[3]. This disease state can be acute or chronic depending on the mechanism.

When there is increased fluid in a fixed volume compartment, such as with bleeding or soft tissue swelling, tissue and venous pressure rises. When the interstitial pressure exceeds the capillary perfusion pressure (CPP), capillary collapse can occur[4]. This leads to decreased blood flow, anoxia, and eventually soft tissue ischemia. Muscle response to this is to release histamine-like substances which increase vascular permeability and fluid in the compartment thereby worsening the ischemia. As cells begin to lyse, their osmotic activity can also attract water from the vascular supply[5].

Tissue perfusion is proportional to the difference between systolic blood pressure and compartment pressure. Stated differently, it is the difference between the interstitial fluid pressure and capillary perfusion pressure. One equation to measure this is local blood flow (LBF) = [local arterial (LA) pressure - venous pressure (PV)] / local vascular resistance. Under normal conditions, the difference between diastolic blood pressure and compartmental pressure should be more than 30 mm Hg although controversy exists over the precise cutoff. As the compartmental pressure increases, this difference will decrease. Compartment pressures greater than 30 mm Hg should raise suspicion for compartment syndrome.

Chronic exertional compartment syndrome is reversible ischemia caused by repetitive physical activity and resolves with cessation of the offending activity. In rare cases where the athlete continues to exercise, irreversible acute compartment syndrome can develop. Normal physiologic response to activity can lead to a 20% increase in muscle volume. Intramuscular pressure can remain elevated even after fasciotomy suggesting other pathophysiology contributing to CECS. The pathogenesis is not well understood but may include a lower capillary density, lower number of capillaries and abnormal arteriolar regulation.

History and Physical

History is critical in establishing the etiology and likelihood of compartment syndrome. Past medical and surgical history must be reviewed. In the trauma setting, it is important to distinguish the mechanism. Both high-velocity blunt trauma and penetrating trauma can lead to compartment syndrome. Clarify if the patient is on any antiplatelet or anticoagulant medications. In the non-trauma setting, the clinician should obtain a further history to evaluate for other possible etiologies including but not limited to toxicologic, iatrogenic, infectious, vascular, among others. The ability to gather history in children or patients with other injuries may be limited.

Compartment syndrome classically presents with pain out of proportion to the exam. He or she may describe it as deep, burning or aching or a fullness, swelling or tense feeling. He or she may endorse pins and needle sensation, numbness, or tingling. The patient may report an inability to dorsiflex the leg or describe it as feeling “dead” or “weak.”

On exam, the provider should evaluate for any breaks in the skin, swelling, erythema, discoloration or other signs of trauma. Palpation of the anterior compartment will reveal a swollen, tender muscle belly, typically at the middle and distal one-third of the leg. Pain is classically worsened with passive stretching of the affected muscles. In the case of anterior compartment syndrome, passive plantar flexion should worsen the patient's pain. The patient may have decreased sensation, especially to two-point discrimination. Vibration sense may also be diminished. He or she may have limited dorsiflexion, inversion and/or eversion. Both the dorsalis pedis and posterior tibial pulses should be documented.

Examining patients with symptoms concerning for chronic exertional compartment syndrome requires a unique approach. They will typically report pain that worsens with a specific activity and resolves with rest. These individuals can reliably predict when the symptoms will start and end. They are likely to have a normal exam at the time of evaluation. They should participate in an exercise challenge, for example, run on a treadmill or outside, and be re-evaluated after they become symptomatic.  Once symptomatic, their exam should be abnormal; the clinician may observe swelling, muscle herniation, tenderness along the anterior compartment, pain with passive plantar flexion, and foot drop.

Evaluation

The history and physical examination should drive the evaluation and workup of a patient with suspected anterior tibial compartment syndrome, and the diagnosis is largely clinical. For example, evaluating for acute trauma, chronic exertional compartment syndrome, and snake envenomation all have a very different clinical context. Evaluation should be directed at the primary etiology of the patient’s symptoms. In patients with classic symptoms of compartment syndrome associated with a tibial fracture, further workup is often unnecessary. Lab work early in the course of the disease is likely to be within a normal distribution.

Measurement of intracompartmental pressure remains the gold standard for diagnosis of compartment syndrome. Measurement is typically performed using a needle manometer. However other techniques include slit catheter, microtip pressure, wick catheter, and microcapillary infusion are available. Ultrasound does not increase the diagnostic accuracy of needle placement[6]. Controversy exists about absolute cutoffs for acute compartment syndrome. In acute compartment syndrome, an absolute pressure greater than 30 mm Hg or a systolic blood pressure minus compartment pressure measuring less than 30 degrees is worrisome[7].

In chronic exertional compartment syndrome, compartment pressures are measured at rest. Then the patient exercises until symptomatic, and compartment pressures are measured again and compared to the baseline. The modified Pedowitz criteria are generally accepted for the diagnosis of CECS. Patients are considered positive with one or more of the following findings: (1) pre-exercise pressure greater than or equal to 15 mm Hg, (2) 1-minute post-exercise pressure greater than or equal to 30 mm Hg, or (3) 5-minute post-exercise pressure greater than or equal to 25 mm Hg[8].

In general, imaging studies do not have a role in the diagnosis of compartment syndrome. They are likely to help exclude other causes of the patient's symptoms. Radiographs are the initial imaging study of choice in a patient with suspicion for anterior tibial pain[9]. Infrared spectroscopy and MRI may have a future role in diagnosing compartment syndrome; however, their role in current management is not established in the literature.

Treatment / Management

Definitive management of acute anterior leg compartment syndrome is a subcutaneous fasciotomy. Several techniques are described in the literature including single and double incision[10]. Care is taken to avoid the anterior tibial artery and deep peroneal nerve. The clinician should also direct management towards the primary etiology of the compartment syndrome. For example, in the setting of trauma, open reduction and internal fixation of the tibial fracture is the treatment of choice.

Treatment of CECS can initially be conservative. This includes activity modification including discontinuing the offending activities, NSAIDS, stretching, foot orthotics, physical therapy and an alternative exercise program for 6 to 12 weeks. In patients unwilling to modify their athletic activity or refractory to conservative management, fasciotomy is indicated. This can be successful in relieving symptoms in up to 90% of patients.

Differential Diagnosis

The differential diagnosis of anterior compartment syndrome is broad and includes infection (cellulitis, necrotizing fasciitis, osteomyelitis), neurologic (deep peroneal nerve entrapment), toxicology (snake envenomation), vascular (deep vein thrombosis, ischemic necrosis or gangrene, popliteal artery entrapment), trauma (vascular, nerve, muscle, or fascia soft tissue injuries, tibia or fibula fracture), musculoskeletal (chronic exertional compartment syndrome, stress fracture, medial tibial stress syndrome) and rhabdomyolysis.

Staging

There is currently no widely accepted staging criteria for acute or chronic compartment syndrome.

Prognosis

The prognosis for compartment syndrome depends on the etiology, diagnosis, and time from injury to intervention. If acute compartment syndrome is treated with fasciotomy within 6 hours, complete recovery of limb function is anticipated. After 6 hours of ischemia, necrosis occurs, and thus, 6 hours is the accepted upper limit of tissue viability. Fasciotomies of the anterior compartment tend to do better than those of the posterior compartment.

Late diagnosis of compartment syndrome leads to irreversible necrosis and subsequently permanent muscle and nerve damage. Patients may develop chronic pain and in the anterior compartment, deep peroneal nerve palsy and foot drop. Volkmann’s contracture occurs with myonecrosis and formation of new fibrous tissue leading to myotendinous adhesions. This results in a residual deformity and loss of function and can occur in up to 10% of patients with compartment syndrome. Calcific myonecrosis can occur.

In chronic exertional compartment syndrome, fasciotomy is associated with high levels of pain relief and patient satisfaction with successful outcomes reported between 80% and 100%.

Complications

Infection is a serious complication of compartment syndrome and fasciotomy. In one study, 11 out of 24 patients with surgical decompression developed infections. Infection can become chronic. Other complications include hematomas and seromas, peripheral nerve injury, and deep vein thrombosis.

Recurrence of symptoms ranges from 2% to 17% in published studies. This may be due to incomplete release of the fascial layers, failure to release all or the appropriate compartments, or fascial scarring. Thus, some patients may require revision.

Postoperative and Rehabilitation Care

Postoperative care is initially directed at pain management and infection and swelling prevention. Patients will use crutches and be weaned off them as weight-bearing increases. The active and passive range of motion will progress at the hip, knee, and ankle with the strengthening of plantar and dorsiflexion. Normal walking can begin around 4 to 6 weeks while running takes about 6 weeks on average. Most patients should anticipate full recovery by 16 weeks.

Consultations

Patients with acute compartment syndrome require consultation with an orthopedic surgeon in the emergency department for immediate surgical fasciotomy. Patients with chronic exertional compartment syndrome can be managed as an outpatient by a sports medicine physician or orthopedic surgeon.

Deterrence and Patient Education

There are no accepted guidelines for the avoidance of acute or chronic compartment syndrome.

Pearls and Other Issues

  • Compartment syndrome represents a mismatch between compartment pressure and arterial blood flow resulting in tissue ischemia.

  • Traumatic tibial fracture most commonly causes acute compartment syndrome of the anterior leg although many causes exist.

  • Acute compartment syndrome is a surgical emergency; definitive management is a fasciotomy.

  • Chronic exertional compartment syndrome is an exercise-induced compartment syndrome.

  • CECS can be initially managed conservatively although cases may require an elective fasciotomy.

Enhancing Healthcare Team Outcomes

The diagnosis and management of acute compartment syndrome is complex and is best managed with a team that includes an orthopedic surgeon, emergency department physician, radiologist and nurses. While the actual management of the condition is done by an orthopedic surgeon, the monitoring is usually done by the nurses. The patient's leg has to be continuously monitored for change in color, pain, paresthesias, and loss of pulses.

Patients with acute compartment syndrome require consultation with an orthopedic surgeon in the emergency department for immediate surgical fasciotomy. Patients with chronic exertional compartment syndrome can be managed as an outpatient by a sports medicine physician or orthopedic surgeon.

Patients who are managed promptly have a good outcome, but delays in diagnosis can lead to amputation. Even those managed acutely often have a prolonged recovery course. Wound infections, muscle atrophy, and disability are not uncommon complications. [11][12](Level V)


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Tibial Anterior Compartment Syndrome - Questions

Take a quiz of the questions on this article.

Take Quiz
What percentage of patients with chronic exertional compartment syndrome of the anterior tibial compartment present with bilateral symptoms?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient is involved in a motor vehicle accident from which he was thrown through the windshield and landed flush on the pavement. He suffered multiple injuries and requires intubation at the scene. His vitals are labile, and he is rushed to the hospital. Because of poor IV access, an intraosseous line is inserted in the right lower leg. A surgeon is called to perform a cutdown on a neck vein at the same time. The patient is resuscitated and stabilized. A CT scan reveals a fracture of the pelvis and four ribs in the left chest. Radiographs of the lower extremity show a comminuted tibial shaft fracture. After application of an external fixator, the patient is taken to the intensive care unit. Late in the night, the nurse notes no pulses in the right leg which is now tense, ecchymotic, and he is unable to dorsiflex his toes and ankle. Which of the following muscles is not involved in his pathology?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Without adequate training, a 38-year-old man runs in a 26-mile race. A few hours thereafter he notes pain over the anterior tibia. The next morning the area is swollen, warm, and erythematous. He is unable to extend the great toe on the involved side. If this patient has surgical decompression, which compartment of the leg will have the lowest response?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An 18-year-old runner presents for right leg pain. The patient runs track for the local university and states that over the last few months she’s had progressively worsening pain with running to the point where she gets tingling in her foot. She states sometimes she feels like she can't lift it normally. When she stops running, it completely resolves. She denies systemic symptoms. She has a normal exam today. What initial management will provide the most useful diagnostic information?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 17-year-old high school athlete presents with a history of worsening leg pain with running and foot drop that resolves when she stops running. She has a normal exam, but the likely diagnosis is chronic exertional compartment syndrome and requires compartment testing. She asks for an explaination as to what compartment syndrome is. What should she be told?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 49-year-old male presents after a motor vehicle collision with several injuries including an open tibial shaft fracture with intact pulses. He is in the emergency department for several hours during his workup and reports progressive pain and swelling of that fractured leg. He states he can not wiggle his toes anymore, and his analgesia requirements are increasing. What is the concern in this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 17-year-old boy presents to the emergency department with a snake bite to his anterior right leg. He reports he was hiking through some tall grass when a snake lunged at him, biting him. He doesn't know what type of snake it was. He was able to continue hiking. Today he is in the emergency department because of worsening pain and swelling and now states he can not lift his right foot off the ground. Based on his exam and history he has acute compartment syndrome of the anterior compartment of his leg. What are the anatomical contents of this compartment?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 44-year-old female presents after a motor vehicle collision with an isolated tibial fracture of her right leg. She has swelling and bruising at the site of trauma. She has increasing pain medication requirements in the emergency department, and her pain is worse when her leg is passively stretched. She now reports tingling and numbness. On re-examination, the dorsalis pedis pulse is not palpable, and she cannot feel light touch to her foot. Which history or exam finding in acute compartment syndrome is most likely to present first?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient presents to the emergency department with severe pain in his right leg after a crush injury from getting his leg trapped between two car bumpers. The emergency department physician makes the diagnosis of anterior compartment syndrome. Besides pain, what are the other classic features of this disorder? Select all that apply.

(Move Mouse on Image to Enlarge)
  • Image 106 Not availableImage 106 Not available
    Contributed Illustration by Beckie Palmer
Attributed To: Contributed Illustration by Beckie Palmer



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Tibial Anterior Compartment Syndrome - References

References

Shadgan B,Pereira G,Menon M,Jafari S,Darlene Reid W,O'Brien PJ, Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal fractures in adults. Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology. 2015 Sep;     [PubMed]
Allmon C,Greenwell P,Paryavi E,Dubina A,OʼToole RV, Radiographic Predictors of Compartment Syndrome Occurring After Tibial Fracture. Journal of orthopaedic trauma. 2016 Jul;     [PubMed]
Livingston K,Glotzbecker M,Miller PE,Hresko MT,Hedequist D,Shore BJ, Pediatric Nonfracture Acute Compartment Syndrome: A Review of 39 Cases. Journal of pediatric orthopedics. 2016 Oct-Nov;     [PubMed]
McQueen MM,Court-Brown CM, Compartment monitoring in tibial fractures. The pressure threshold for decompression. The Journal of bone and joint surgery. British volume. 1996 Jan;     [PubMed]
DeLee JC,Stiehl JB, Open tibia fracture with compartment syndrome. Clinical orthopaedics and related research. 1981 Oct;     [PubMed]
Feliciano DV,Cruse PA,Spjut-Patrinely V,Burch JM,Mattox KL, Fasciotomy after trauma to the extremities. American journal of surgery. 1988 Dec;     [PubMed]
Matsen FA 3rd,Winquist RA,Krugmire RB Jr, Diagnosis and management of compartmental syndromes. The Journal of bone and joint surgery. American volume. 1980 Mar;     [PubMed]
George CA,Hutchinson MR, Chronic exertional compartment syndrome. Clinics in sports medicine. 2012 Apr;     [PubMed]
Peck E,Finnoff JT,Smith J,Curtiss H,Muir J,Hollman JH, Accuracy of palpation-guided and ultrasound-guided needle tip placement into the deep and superficial posterior leg compartments. The American journal of sports medicine. 2011 Sep;     [PubMed]
Styf JR,Körner LM, Chronic anterior-compartment syndrome of the leg. Results of treatment by fasciotomy. The Journal of bone and joint surgery. American volume. 1986 Dec;     [PubMed]
Konda SR,Kester BS,Fisher N,Behery OA,Crespo AM,Egol KA, Acute Compartment Syndrome of the Leg. Journal of orthopaedic trauma. 2017 Aug;     [PubMed]
Pretell-Mazzini J,Kelly DM,Sawyer JR,Esteban EM,Spence DD,Warner WC Jr,Beaty JH, Outcomes and Complications of Tibial Tubercle Fractures in Pediatric Patients: A Systematic Review of the Literature. Journal of pediatric orthopedics. 2016 Jul-Aug;     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Surgery-Podiatry APMLE Part 3. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Surgery-Podiatry APMLE Part 3, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Surgery-Podiatry APMLE Part 3, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Surgery-Podiatry APMLE Part 3. When it is time for the Surgery-Podiatry APMLE Part 3 board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Surgery-Podiatry APMLE Part 3.