Acute Compartment Syndrome of the Extremities
October 21, 2020
In a retrospective study of 1,184 patients investigating the use of continuous intra-compartmental pressure monitoring for the diagnosis of acute compartment syndrome reported an estimated sensitivity of 94%, specificity of 98%, and a negative predictive value of 99%, using the intraoperative clinical findings as the gold standard.
Acute compartment syndrome most often develops soon after significant trauma, particularly involving long bone fractures of the lower leg or forearm. Moreover, acute compartment syndrome can occur without a fracture (or a crush injury). The lower leg and the forearm are common sites for acute compartment syndrome. The leg is made up of four compartments (anterior, lateral, deep posterior, and superficial posterior). The anterior compartment of the leg is the most common location for acute compartment syndrome. The anterior compartment contains the four extensor muscles of the foot, the lateral tibial artery, and the deep peroneal nerve.
Brief Case Description
If there is suspicion of compartment syndrome within a patient, the surgeon will commonly measure the compartment pressure to immediately eliminate the potential of a missed diagnosis. When measuring compartment pressures, the surgeons commonly use the difference between the diastolic blood pressure and the intra-compartmental blood pressure (delta pressure). Experts believe that if the difference between the diastolic or mean arterial pressure and the compartment pressure falls below a specific value, perfusion pressure becomes compromised and acute compartment syndrome can develop. Many believe the use of absolute measurements leads to unnecessary fasciotomies, or in some cases failure to perform needed fasciotomies.
Intervention and Outcome Summary
Three different methods have been used most frequently to measure compartment pressures: a handheld manometer (STIC Intra-Compartmental Pressure Monitor), a simple needle manometer system, and the wick or slit catheter technique. The [C2Dx] STIC intra-compartmental pressure monitor is used most frequently used because it is portable, simple, and accurate. The early diagnosis of acute compartment syndrome is very important and continuous monitoring is advocated. The wick or slit catheter allows for continuous monitoring for up to 24 hours.
Andrea Stracciolini, MDE. Mark Hammerberg, MD