Current thinking about acute compartment syndrome
Acute compartment syndrome (ACS) is a clinical condition that, although uncommon, is seen fairly regularly in modern orthopedic practice and is an emergency requiring immediate surgical decompression. It can be defined as a condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space. ACS occurs most frequently among young people. The purpose of this study was to bring awareness of acute exertional compartment syndrome and the incidence of co-morbidities related to delayed diagnosis.
In accordance with institutional review board approval, a retrospective chart review evaluated patient data from 1997-2013 who underwent emergency fasciotomy for acute exertional compartment syndrome (AECS). For comparison, male patients were identified with sports-related closed fractures of the tibia. All cases of AECS had occurred in the leg.
In AECS group, mean time from symptom onset to diagnosis was 97 hours. Four patients initially had a missed diagnosis. On presentation, 6 of 7 patients experienced neurologic symptoms although none had perfusion deficits. The mean compartment pressure was 91 mm Hg. They all underwent isolated anterior and lateral compartment releases and required a mean of 4 surgeries. The mean follow-up was 270 days. Of the 4 patients with missed diagnoses, 2 had significant neurologic and functional deficits at final follow-up. The other 5 patients had a maximum recovery. Fracture-related ACS patients were younger with quicker time from symptom onset to surgery and required more compartments to be decompressed at surgery.
Although pathophysiology of the disorder is well known to physicians who care for patients with musculoskeletal injuries, the diagnosis is often difficult to make and should maintain a high index of suspicion for compartment syndrome. A delay in diagnosis that leads to a delay in treatment can result in permanent disability. Delayed or missed diagnosis can be devastating to both patients and members of the health care team. Because it can progress rapidly, urgent diagnosis and treatment are necessary to prevent subsequent tissue ischemia and necrosis Thus, early diagnosis is essential and requires a high degree of vigilance by the care team.