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European Journal of Trauma and Emergency Surgery

, Volume 40, Issue 5, pp 521–528 | Cite as

The diagnosis of acute compartment syndrome: a review

  • M. M. McQueen
  • A. D. DuckworthEmail author
Review Article

Abstract

Delay in the diagnosis of acute compartment syndrome (ACS) has serious and sometimes catastrophic consequences for the outcome of injury, and has been recognised as one of the primary causes of a poor outcome. This article reviews the evidence for the use of clinical findings and intra-compartmental pressure (ICP) monitoring in making a prompt diagnosis of ACS. Clinical findings have poor sensitivities (13–64 %) compared to ICP monitoring (94 %) using a differential pressure threshold of less than 30 mmHg for more than 2 h. The specificities of clinical findings range from 63 to 98 % compared to a value of 98 % for ICP monitoring. Patients at risk of ACS or at risk of a delayed diagnosis are defined, and it is recommended that these patients undergo ICP monitoring. It is recommended that decompression is carried out primarily on the basis of the differential pressure being less than 30 mmHg for more than 2 h as this results in a reduced time to definitive treatment when compared to waiting for the development of clinical symptoms and signs.

Keywords

Acute compartment syndrome Diagnosis Compartmental pressure monitoring Threshold for decompression Risk factors 

Notes

Conflict of interest

Margaret McQueen declares that she has no conflict of interest. Andrew Duckworth declares that he has no conflict of interest.

Ethical Standards

The manuscript does not contain clinical studies or patient data.

References

  1. 1.
    Mithoefer K, Lhowe DW, Vrahas MS, Altman DT, Erens V, Altman GT. Functional outcome after acute compartment syndrome of the thigh. J Bone Joint Surg Am. 2006;88:729–37.PubMedCrossRefGoogle Scholar
  2. 2.
    Davis ET, Harris A, Keene D, Porter K, Manji M. The use of regional anaesthesia in patients at risk of acute compartment syndrome. Injury. 2006;37:128–33.PubMedCrossRefGoogle Scholar
  3. 3.
    Harrington P, Bunola J, Jennings AJ, Bush DJ, Smith RM. Acute compartment syndrome masked by intravenous morphine from a patient-controlled analgesia pump. Injury. 2000;31:387–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Mar GJ, Barrington MJ, McGuirk BR. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. Br J Anaesth. 2009;102:3–11.PubMedCrossRefGoogle Scholar
  5. 5.
    Mullett H, Al-Abed K, Prasad CV, O’Sullivan M. Outcome of compartment syndrome following intramedullary nailing of tibial diaphyseal fractures. Injury. 2001;32:411–3.PubMedCrossRefGoogle Scholar
  6. 6.
    Prasarn ML, Ouellette EA, Livingstone A, Giuffrida AY. Acute pediatric upper extremity compartment syndrome in the absence of fracture. J Pediatr Orthop. 2009;29:263–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Rorabeck CH, Macnab L. Anterior tibial-compartment syndrome complicating fractures of the shaft of the tibia. J Bone Joint Surg Am. 1976;58:549–50.PubMedGoogle Scholar
  8. 8.
    McQuillan WM, Nolan B. Ischaemia complicating injury. A report of thirty-seven cases. J Bone Joint Surg Br. 1968;50:482–92.PubMedGoogle Scholar
  9. 9.
    Bhattacharyya T, Vrahas MS. The medical-legal aspects of compartment syndrome. J Bone Joint Surg Am. 2004;86-A:864–8.PubMedGoogle Scholar
  10. 10.
    Matsen FA III, Stephens L, Jette JL, Warme WJ, Posner KL. Lessons regarding the safety of orthopaedic patient care: an analysis of four hundred and sixty-four closed malpractice claims. J Bone Joint Surg Am. 2013;95:e201–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Atrey A, Gupte CM, Corbett SA. Review of successful litigation against English health trusts in the treatment of adults with orthopaedic pathology: clinical governance lessons learned. J Bone Joint Surg Am. 2010;92:e36.PubMedCrossRefGoogle Scholar
  12. 12.
    Vranceanu AM, Barsky A, Ring D. Psychosocial aspects of disabling musculoskeletal pain. J Bone Joint Surg Am. 2009;91:2014–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Eaton RG, Green WT. Volkmann’s ischemia. A volar compartment syndrome of the forearm. Clin Orthop Relat Res 1975;113:58–64.Google Scholar
  14. 14.
    Matsen FA III, Krugmire RB Jr. Compartmental syndromes. Surg Gynecol Obstet. 1978;147:943–9.PubMedGoogle Scholar
  15. 15.
    Holden CE. The pathology and prevention of Volkmann’s ischaemic contracture. J Bone Joint Surg Br. 1979;61-B:296–300.PubMedGoogle Scholar
  16. 16.
    Wright JG, Bogoch ER, Hastings DE. The ‘occult’ compartment syndrome. J Trauma. 1989;29:133–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Matsen FA III, Clawson DK. The deep posterior compartmental syndrome of the leg. J Bone Joint Surg Am. 1975;57:34–9.PubMedGoogle Scholar
  18. 18.
    Mubarak SJ, Wilton NC. Compartment syndromes and epidural analgesia. J Pediatr Orthop. 1997;17:282–4.PubMedGoogle Scholar
  19. 19.
    Bae DS, Kadiyala RK, Waters PM. Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome. J Pediatr Orthop. 2001;21:680–8.PubMedGoogle Scholar
  20. 20.
    Myerson MS. Management of compartment syndromes of the foot. Clin Orthop Relat Res 1991;271:239–48.Google Scholar
  21. 21.
    Ulmer T. The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder? J Orthop Trauma. 2002;16:572–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Duckworth AD, Mitchell SE, Molyneux SG, White TO, Court-Brown CM, McQueen MM. Acute compartment syndrome of the forearm. J Bone Joint Surg Am. 2012;94:e63.PubMedCrossRefGoogle Scholar
  23. 23.
    Bradley EL III. The anterior tibial compartment syndrome. Surg Gynecol Obstet. 1973;136:289–97.PubMedGoogle Scholar
  24. 24.
    DeLee JC, Stiehl JB. Open tibia fracture with compartment syndrome. Clin Orthop Relat Res 1981;160:175–84.Google Scholar
  25. 25.
    Rorabeck CH. The treatment of compartment syndromes of the leg. J Bone Joint Surg Br. 1984;66:93–7.PubMedGoogle Scholar
  26. 26.
    Schwartz JT Jr, Brumback RJ, Lakatos R, Poka A, Bathon GH, Burgess AR. Acute compartment syndrome of the thigh. A spectrum of injury. J Bone Joint Surg Am. 1989;71:392–400.PubMedGoogle Scholar
  27. 27.
    Willis RB, Rorabeck CH. Treatment of compartment syndrome in children. Orthop Clin North Am. 1990;21:401–12.PubMedGoogle Scholar
  28. 28.
    Shuler FD, Dietz MJ. Physicians’ ability to manually detect isolated elevations in leg intracompartmental pressure. J Bone Joint Surg Am. 2010;92:361–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Whitesides TE, Haney TC, Morimoto K, Harada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res 1975;113:43–51.Google Scholar
  30. 30.
    Matsen FA III, Mayo KA, Sheridan GW, Krugmire RB Jr. Monitoring of intramuscular pressure. Surgery. 1976;79:702–9.PubMedGoogle Scholar
  31. 31.
    Mubarak SJ, Hargens AR, Owen CA, Garetto LP, Akeson WH. The wick catheter technique for measurement of intramuscular pressure. A new research and clinical tool. J Bone Joint Surg Am. 1976;58:1016–20.PubMedGoogle Scholar
  32. 32.
    Rorabeck CH, Castle GS, Hardie R, Logan J. Compartmental pressure measurements: an experimental investigation using the slit catheter. J Trauma. 1981;21:446–9.PubMedGoogle Scholar
  33. 33.
    Moed BR, Thorderson PK. Measurement of intracompartmental pressure: a comparison of the slit catheter, side-ported needle, and simple needle. J Bone Joint Surg Am. 1993;75:231–5.PubMedGoogle Scholar
  34. 34.
    Shakespeare DT, Henderson NJ, Clough G. The slit catheter: a comparison with the wick catheter in the measurement of compartment pressure. Injury. 1982;13:404–8.PubMedCrossRefGoogle Scholar
  35. 35.
    McDermott AG, Marble AE, Yabsley RH. Monitoring acute compartment pressures with the S.T.I.C. catheter. Clin Orthop Relat Res 1984;190:192–8.Google Scholar
  36. 36.
    Willy C, Gerngross H, Sterk J. Measurement of intracompartmental pressure with use of a new electronic transducer-tipped catheter system. J Bone Joint Surg Am. 1999;81:158–68.PubMedGoogle Scholar
  37. 37.
    McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br. 1996;78:99–104.PubMedGoogle Scholar
  38. 38.
    Heckman MM, Whitesides TE Jr, Grewe SR, Rooks MD. Compartment pressure in association with closed tibial fractures. The relationship between tissue pressure, compartment, and the distance from the site of the fracture. J Bone Joint Surg Am. 1994;76:1285–92.PubMedGoogle Scholar
  39. 39.
    Arbabi S, Brundage SI, Gentilello LM. Near-infrared spectroscopy: a potential method for continuous, transcutaneous monitoring for compartmental syndrome in critically injured patients. J Trauma. 1999;47:829–33.PubMedCrossRefGoogle Scholar
  40. 40.
    Gentilello LM, Sanzone A, Wang L, Liu PY, Robinson L. Near-infrared spectroscopy versus compartment pressure for the diagnosis of lower extremity compartmental syndrome using electromyography-determined measurements of neuromuscular function. J Trauma 2001;51:1–8, discussion.Google Scholar
  41. 41.
    Shuler MS, Reisman WM, Kinsey TL, Whitesides TE Jr, Hammerberg EM, Davila MG, et al. Correlation between muscle oxygenation and compartment pressures in acute compartment syndrome of the leg. J Bone Joint Surg Am. 2010;92:863–70.PubMedCrossRefGoogle Scholar
  42. 42.
    Shuler MS, Reisman WM, Whitesides TE Jr, Kinsey TL, Hammerberg EM, Davila MG, et al. Near-infrared spectroscopy in lower extremity trauma. J Bone Joint Surg Am. 2009;91:1360–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Lynch JE, Lynch JK, Cole SL, Carter JA, Hargens AR. Noninvasive monitoring of elevated intramuscular pressure in a model compartment syndrome via quantitative fascial motion. J Orthop Res. 2009;27:489–94.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Hargens AR, Akeson WH, Mubarak SJ, Owen CA, Gershuni DH, Garfin SR, et al. Kappa Delta Award paper. Tissue fluid pressures: from basic research tools to clinical applications. J Orthop Res. 1989;7:902–9.PubMedCrossRefGoogle Scholar
  45. 45.
    Matsen FA, III, Wyss CR, Krugmire RB, Jr., Simmons CW, King RV. The effects of limb elevation and dependency on local arteriovenous gradients in normal human limbs with particular reference to limbs with increased tissue pressure. Clin Orthop Relat Res 1980;150:187–95.Google Scholar
  46. 46.
    Heckman MM, Whitesides TE Jr, Grewe SR, Judd RL, Miller M, Lawrence JH III. Histologic determination of the ischemic threshold of muscle in the canine compartment syndrome model. J Orthop Trauma. 1993;7:199–210.PubMedCrossRefGoogle Scholar
  47. 47.
    White TO, Howell GE, Will EM, Court-Brown CM, McQueen MM. Elevated intramuscular compartment pressures do not influence outcome after tibial fracture. J Trauma. 2003;55:1133–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Mars M, Hadley GP. Raised compartmental pressure in children: a basis for management. Injury. 1998;29:183–5.PubMedCrossRefGoogle Scholar
  49. 49.
    McQueen MM, Duckworth AD, Aitken SA, Court-Brown CM. The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome. J Bone Joint Surg Am. 2013;95:673–7.PubMedCrossRefGoogle Scholar
  50. 50.
    McQueen MM, Christie J, Court-Brown CM. Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg Br. 1996;78:95–8.PubMedGoogle Scholar
  51. 51.
    Harris IA, Kadir A, Donald G. Continuous compartment pressure monitoring for tibia fractures: does it influence outcome? J Trauma. 2006;60:1330–5.PubMedCrossRefGoogle Scholar
  52. 52.
    McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg Br. 2000;82:200–3.PubMedCrossRefGoogle Scholar
  53. 53.
    Shore BJ, Glotzbecker MP, Zurakowski D, Gelbard E, Hedequist DJ, Matheney TH. Acute compartment syndrome in children and teenagers with tibial shaft fractures: incidence and multivariable risk factors. J Orthop Trauma. 2013;27:616–21.PubMedCrossRefGoogle Scholar
  54. 54.
    Al-Dadah OQ, Darrah C, Cooper A, Donell ST, Patel AD. Continuous compartment pressure monitoring vs. clinical monitoring in tibial diaphyseal fractures. Injury. 2008;39:1204–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Blick SS, Brumback RJ, Poka A, Burgess AR, Ebraheim NA. Compartment syndrome in open tibial fractures. J Bone Joint Surg Am. 1986;68:1348–53.PubMedGoogle Scholar
  56. 56.
    Court-Brown CM, Byrnes T, McLaughlin G. Intramedullary nailing of tibial diaphyseal fractures in adolescents with open physes. Injury. 2003;34:781–5.PubMedCrossRefGoogle Scholar
  57. 57.
    Finkemeier CG, Schmidt AH, Kyle RF, Templeman DC, Varecka TF. A prospective, randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft. J Orthop Trauma. 2000;14:187–93.PubMedCrossRefGoogle Scholar
  58. 58.
    Williams J, Gibbons M, Trundle H, Murray D, Worlock P. Complications of nailing in closed tibial fractures. J Orthop Trauma. 1995;9:476–81.PubMedCrossRefGoogle Scholar
  59. 59.
    Hope MJ, McQueen MM. Acute compartment syndrome in the absence of fracture. J Orthop Trauma. 2004;18:220–4.PubMedCrossRefGoogle Scholar
  60. 60.
    Court-Brown CM, McBirnie J. The epidemiology of tibial fractures. J Bone Joint Surg Br. 1995;77:417–21.PubMedGoogle Scholar
  61. 61.
    Frink M, Klaus AK, Kuther G, Probst C, Gosling T, Kobbe P, et al. Long term results of compartment syndrome of the lower limb in polytraumatised patients. Injury. 2007;38:607–13.PubMedCrossRefGoogle Scholar
  62. 62.
    Kosir R, Moore FA, Selby JH, Cocanour CS, Kozar RA, Gonzalez EA, et al. Acute lower extremity compartment syndrome (ALECS) screening protocol in critically ill trauma patients. J Trauma. 2007;63:268–75.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Edinburgh Orthopaedic Trauma UnitRoyal Infirmary of EdinburghEdinburghUK

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