Acute Lower-leg Compartment Syndrome

Abstract

Acute compartment syndrome remains a challenging problem for orthopedic surgeons because its diagnosis is not always straightforward and it has a high risk of associated limb morbidity if left undiagnosed or untreated. Failure to diagnose and treat acute compartment syndrome is one of the most common causes of successful medical liability claims. The authors review the current literature concerning the diagnosis of acute compartment syndrome and discuss new non-invasive technologies that may allow for earlier and more accurate diagnosis of impending acute compartment syndrome.

Acute Compartment Syndrome of the Lower Leg: A Review

“…2, 3, 9 However, a variety of other etiologies, including non-traumatic causes, can contribute to ACS and are listed in Table 1. There are atypical causes of ACS that nonorthopedic providers need to be cognizant of.…”

“…Male patients are ten times more impacted by ACS than females, and this may be explained by males having larger muscle mass within a fixed compartment. 3, 8, 12 Younger patients (≤ 35 years of age) are also at a greater risk to ACS due to having tighter fascia and larger muscle mass and as they are prone to injuries or accidents. 3, 8, 12 …”

“…Lower leg ACS is a condition in which increased pressure within a muscle compartment surrounded by a closed fascial space leads to a decline in tissue perfusion and compromises motor and sensory function. 1-3 In addition to muscle, key structures within the fascial compartment that are affected by increased compartment pressures include nerves and vasculature. 1 Importantly, delay in diagnosis or treatment can result in irreversible damage to these components with devastating and permanent complications such as contractures, paralysis, amputation, sepsis with multi-organ failure, and even death.…”

“…1, 3, 6 Fracture, caused by trauma, accounts for approximately 75% of ACS cases. 3 Early recognition of ACS is critical and requires a high index of clinical suspicion based on a thorough knowledge of risk factors, pathophysiology and clinical manisfestations.…”

“…1, 3, 6 Fracture, caused by trauma, accounts for approximately 75% of ACS cases. 3 Early recognition of ACS is critical and requires a high index of clinical suspicion based on a thorough knowledge of risk factors, pathophysiology and clinical manisfestations. 1, 7, 8 In addition, accurate intra-compartmental pressure (ICP) measurement and serial monitoring of changes in ICP levels within the muscle compartment is necessary to confirm ACS.…”