Acute compartment syndrome: obtaining diagnosis, providing treatment, and minimizing medicolegal risk
Data shows 6% of all malpractice claims against orthopaedic surgeons are ACS related with 50% ruled in favor of the patient versus 25% of overall claims against the same group. It also showed a linear relationship between the number of cardinal signs and the time from presentation to fasciotomy and payment size. Late or missed diagnosis of acute compartment syndrome can be catastrophic; hence there should be a low threshold for decompressive fasciotomy.
McQueen and Court-Brown reported a prospective clinical series with continuous compartment monitoring using the difference between the diastolic blood pressure and the intra-compartmental pressure. Acute compartment syndrome commonly develops in traumatized patients with distracting of neurologically inhibiting injuries. Acute compartment syndrome is one of only a handful of true orthopedic emergencies where a delayed diagnosis often will result in limb, and life-threatening consequences.
Intervention and Outcome Summary
Time to diagnosis is the most important prognostic factor for patients with increased compartment pressures. An insufficient understanding of the natural history and limited evaluation of signs and symptoms primarily account for delays in diagnosis. Late or missed diagnosis of acute compartment syndrome can be catastrophic, hence there should be a low threshold for decompressive fasciotomy.