Acute Compartment Syndrome: A Literature Review and Updates

Abstract

BACKGROUNDA cute compartment syndrome (ACS) remains a diagnostic challenge today even with technological advances, where time to diagnosis is a determinant of the outcome. ACS occurs when the pressure within a closed muscle compartment exceeds the perfusion pressure resulting in ischemia and is most commonly seen after a traumatic event, especially involving fractures; hence, it is commonly encountered by orthopedic surgeons. [1,2] The consequences associated with delayed or missed diagnosis of ACS includes muscle necrosis which can potentially lead to rhabdomyolysis and renal failure in the short term and later on results in ischemic contractures, hence, being previously known as Volkmann contracture. [2][3][4] Volkmann et al. described the consequences of increased compartmental pressures as a result of ACS, which he subsequently noted nerve deficits of the involved compartment and the development of contractures. [4] Due to the devastating consequences associated with ACS, patients presenting with features highly suspicious for the syndrome have to be treated urgently with fasciotomy. This immediately releases the compartment pressures and restores myoneural perfusion. [2,5,6] The first reported fasciotomy for ACS was by Petersen Ueber, in 1888. [7] Later, in 1914, Murphy noted that the increased compartment pressures found in ACS could be due to the collection of necrotic debris and hemorrhage, whereas Peterson noted that it was due to inflammation and arterial occlusion back in 1888. However, both authors had similar viewpoint concerning the treatment of ACS that fasciotomy was necessary to prevent nerve injury and contracture development.

Digital droplet infusion

“…The clinical operation required the outlet pressure to be regulated not to exceed 0.58 psi (30 mmHg), above which it could lead to acute compartment syndrome (ACS). 23 Therefore, the outlet pressure was adjusted between 0 and 0.6 psi (31 mmHg) to simulate the pressure variations at the surgical site of a patient. A DDI device with a nozzle width of 515 μm and an input pressure of 10 psi was tested, and the valve was kept open during the testing.…”