Diagnosing acute compartment syndrome—where have we got to?

Abstract

PurposeAcute compartment syndrome is a condition whereby tissue ischaemia occurs due to increased pressure in a closed myofascial compartment. It is a surgical emergency, with rapid recognition and treatment—the keys to good outcomes.MethodsThe available literature on diagnostic aids was reviewed by one of the senior authors 15 years ago. Now, we have further reviewed the literature, to aim to ascertain what progress has been made.ResultsIn this review, we present the evidence around a variety of available diagnostic options when investigating a potential case of acute compartment syndrome, including those looking at pressure changes, localised oxygenation, perfusion, metabolic changes and available blood serum biomarkers.ConclusionsA significant amount of work has been put into developing modalities of diagnosis for acute compartment syndrome in the last 15 years. There is a lot of promising outcomes being reported; however, there is yet to be any conclusive evidence to suggest that they should be used over intracompartmental pressure measurement, which remains the gold standard. However, clinicians should be cognizant that compartment pressure monitoring lacks diagnostic specificity, and could lead to unnecessary fasciotomy when used as the sole criterion for diagnosis. Therefore, pressure monitoring is ideally used in situations where clinical suspicion is raised.

An Early Detection of Acute Compartment Syndrome in Fastened Zip-Tie Rat Model Using Dynamic Phosphorous-31 Magnetic Resonance Spectroscopy at 9.4 Tesla

“…However, detecting the early ischemic muscular damage in ACS remains a di cult task. While there are several different diagnostic methods, including pressure levels, biomarkers, and imaging techniques, the conventional diagnosis techniques provide insu cient evidence to diagnose a patient's condition is most cases [6]. It is currently in the stage of research and development.…”

“…It is currently in the stage of research and development. For early diagnosis and early treatment of ACS, it is necessary to evaluate muscle bioenergetics and metabolism in vivo non-invasively [6][7][8].…”

Utilizing Dynamic Phosphorous-31 Magnetic Resonance Spectroscopy for the Early Detection of Acute Compartment Syndrome: A Pilot Study on Rats

“…Current non-invasive ACS detection techniques are near-infrared spectroscopy (NIRS), ultrasound, laser Doppler flowmetry, and conventional magnetic resonance imaging (MRI). However, as these are used to monitor changes occurring to the body structures in real-time, they are also incapable of detecting early signs of ACS [ 16 ]. Thus, early ACS detection remains a difficult task, as conventional diagnostic techniques often provide insufficient evidence to diagnose a patient’s condition [ 16 ].…”

“…Selecting the most appropriate diagnostic technique requires a good understanding of ACS’s pathophysiology [ 17 ]. For the early diagnosis and treatment of ACS, it is necessary to evaluate muscle bioenergetics and metabolism non-invasively [ 7 , 16 , 18 , 19 , 20 , 21 , 22 ]. Magnetic resonance spectroscopy (MRS) is a unique technique for assessing tissue metabolic properties through the quantification of essential metabolites such as inorganic phosphate (Pi), phosphocreatine (PCr), and adenosine triphosphate (ATP) [ 22 , 23 ].…”

Increased morphine requirements are predictive of acute compartment syndrome in adults with tibia fractures

“…In addition to the patient morbidities associated with ACS, orthopedic surgeons face great indemnity payments for this complication of low incidence [9,10]. Surgeons require sensitive indicators to make a timely diagnosis and must have a high index of suspicion for patients at risk of ACS [10,11].…”