Acute compartment syndrome: obtaining diagnosis, providing treatment, and minimizing medicolegal risk

Abstract

Acute compartment syndrome (ACS) is a surgical emergency. Diagnosis depends on a high clinical suspicion and an understanding of risk factors, pathophysiology and subtle physical exam findings. The typical high risk scenario for ACS is a male patient younger than 35 years of age, involved in a high energy sport or roadway collision, resulting in a tibial shaft fracture. He will go on to develop acute compartment syndrome of the leg in less than 10 hours and require emergent fasciotomy. Diagnosis of ACS in this patient is primarily a clinical one but can be confirmed with invasive intracompartmental pressure monitoring or noninvasive near infrared spectroscopy (NIRS). Delaying the diagnosis will likely result in some degree of permanent disability and places the surgeon at high risk for litigation. This article reviews the salient features of acute compartment syndrome that should be understood by all orthopaedic residents and surgeons.

Profile of Hand Compartment Syndrome in Dr. Hasan Sadikin General Hospital, West Java, 2008−2012

“…Traumatic accident and working hazard injury can prolong and progress to range of mild to severe hand injury as explained by Chow et al 9 All the causal factors stated can explain the pathophysiology of the compartment syndrome as all the causes can either increase the compartment volume or decrease the compartment size. 10 This condition increases intracompartmental pressure.…”

“…In certain condition not all the findings will present, so it is important to study the characteristic of the syndrome before diagnosing the patient. 3,5,10 Measuring intracompartmental pressure is also an important diagnostic criteria for compartment syndrome as explained in study by Duckworth and Mcqueen. 5 Based on study, all seven cases did not use the measurement of intracompartment pressure, probably due to the emergency and serious disorder need a fast and prompt management.…”

“…Chandraprakasam and Kumar 4 also state that clinical findings are the most important part in diagnosing compartment syndrome and intracompartment pressure measurement can be done as the confirmation of disorder. 4,10 Fasciotomy is an invasive procedure to treat the compartment syndrome. The objective of this procedure is to open the involved tissue compartments to relieve the pressure before irreversible tissue damage occur.…”

Compartment syndrome suspected in domestic cat after radius and ulna fixation – Case report

“…O diagnóstico é principalmente clínico (Cortés & Castrejón, 2003;Granchi, 2008;Radke et al, 2006;Taylor;Sullivan;Mehta, 2012;Maki et al, 2014;Pinheiro et al, 2015). Mas adjunto aos sinais clínicos deve-se utilizar métodos de confirmação como a mensuração da pressão intracompartimental pela técnica de Whitesides (Whitesides Junior et al, 1975).…”

“…A fasciotomia é a medida de eleição para aliviar a tensão circunferencial e a pressão intracompartimental (Matsen;Winquist;Krugmire Junior, 1980;Taylor;Sullivan;Mehta, 2012).…”