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Compartment Syndrome: Diagnostic Dilemma for the Orthopedic Surgeon

A missed or delayed diagnosis of compartment syndrome can have devastating outcomes for both the patient and the physician.  A patient can suffer severe muscle and nerve damage, which can lead to the potential loss of a limb, while the physician can suffer large legal claims. The time to diagnosis is critical!

Abstract
The diagnosis and management of compartment syndrome represents a serious dilemma for clinicians and patients. A major concern for clinicians is the importance of time to diagnosis. If the diagnosis is missed or delayed, there can be a potentially devastating outcome for the patient. The sequelae of missed compartment syndrome can result in serious long-term morbidity, limb deformity, and painful neuropathies. These severe results can cause detrimental issues for the patient and can create medicolegal claims for the physician.

Brief Case Description
The prognosis in cases of missed compartment syndrome can result in severe repercussions for a diagnosis delayed within just a matter of hours. A patient can lose muscle or nerve damage within eight hours. If the surgeon attempts a late release of the fascia within a compartment, the patient can be subject to a high risk of infection and life-threatening complications. Sheridan and Matsen reported an infection rate of 46%, and an amputation rate of 21% after fasciotomy was delayed by 12 hours. Given that nerve and muscle damage can occur within hours, compartment syndrome is stressful for both the patient and the clinician. It is crucial that the physician tests the patient’s compartment pressures to have data to support their clinical decision.

As compartment syndrome is one of the true orthopedic emergencies, orthopedic surgeons are at high risk of encountering medicolegal claims. Given the high morbidity patients can suffer, awards for plaintiffs or settlements may be large. A national database reported a review of multiple lawsuits involving compartment syndrome and the average time commitment to resolve a claim to be over five years.

Intervention and Outcome Summary
The severity of compartment syndrome and the time to diagnosis for the patient is crucial. Measuring intra-compartmental pressures (using the delta pressure) and understating the patient’s medical history are key for a proper diagnosis. The (C2Dx) side-ported needle has proven to be the most accurate measurement of compartment pressures. In any incompetent or obtunded patient, the measurement of intra-compartmental pressures should be measured immediately. Focusing on the time to diagnosis, and the measurement of the intra-compartmental pressure can reduce a late or missed diagnosis.

Original Publication:
Compartment Syndrome. A Guide to Diagnosis and Management
Authors:
Michael Maher and Cyril Mauffrey