The Dreaded Acute Compartment Syndrome
July 21, 2020
Pain is one of the earliest findings in patients who have acute compartment syndrome, but findings on history and exam cannot rule out the diagnosis. The measurement of intra-compartmental pressures using a [STIC Intra-Compartmental] pressure monitor is the most reliable test.
Acute compartment syndrome, otherwise known as a surgical emergency, is most common in patients 35 years or older and males are ten times more likely to be diagnosed with compartment syndrome, in comparison to females. Elderly have an increased risk of compartment syndrome as they have reduced muscle mass and hypertension. This commonly results in increased perfusion pressures. Fractures are also the most common cause of compartment syndrome, particularly tibial fractures.
Brief Case Description
This case discusses a 24-year-old male which presents with severe right lower pain in result of a motorcycle accident. The patient suffered right comminuted tibia and fibula fractures, and fortunately, his only other injuries included some extremity abrasions and road rash. The pain in his right leg, continued to elevate. After many doses of a hydromorphone IV, the pain was significantly out of proportion and the patient was tested for compartment syndrome using a STIC pressure monitor.
Intervention and Outcome Summary
Failure to treat acute compartment syndrome can cause long-term neurovascular deficits and is associated with significant medicolegal risk. In fact, a total of 23% of medicolegal cases are due to a misdiagnosis of compartment syndrome, and 32% of cases are due to a delay in treatment. Once acute compartment syndrome is suspected in a patient, an immediate diagnosis involves obtaining the intra-compartmental pressure. This is commonly assessed with direct, invasive monitoring of the compartment. The most common method used to measure the pressure is with a STIC device such as the [C2Dx] STIC Intra-compartmental Pressure Monitor. The STIC monitor, well known as the Gold Standard, is accurate with a sensitivity rating of 94% and a specificity rate of 98%, commonly noted as the most reliable test.
Brit Long, MD, Michael Gottlieb, MD