Assessment and diagnosis of acute limb compartment syndrome: A literature review

Abstract

Background: Compartment syndrome is a collection of symptoms that signal increased pressure in the muscle compartment and results in compromised tissue perfusion. Failure to diagnose and treat the condition can result in permanent neurovascular deficit, tissue ischaemia, limb amputation and rhabdomyolysis. Aims:The aim of the review was to determine the strength of the evidence regarding risk reduction and early detection of ALCS and to identify the gaps in the evidence.Methods: Following a systematic search, literature about patient risk, risk reduction, clinical observation and compartment monitoring was identified and the methodological quality of studies was considered.Findings: Diaphyseal fractures of the tibia are the most significant risk factor for compartment syndrome followed by fracture of the distal radius. The anterior compartment of the leg and the flexor compartment of the forearm are most affected. Other factors include calcaneal fractures, male gender, age <35 years, high energy trauma, soft tissue injuries (especially in patients with bleeding disorders), open fracture, limb compression due to traction, padding and casts and surgical management of fractures. Males aged below 35 years who sustain a fracture of the lower leg or forearm should be monitored most carefully.Clinical observations, together with compartment pressure monitoring, in patients at risk appears to be the best method of diagnosing the condition. Pain out of proportion to the injury and pain on passive muscle stretch are the most effective clinical observation in conscious patients. Paresis/paralysis, parasthesia and pallor may help in diagnosis but are late signs. The sensitivity and specificity of these symptoms in diagnosing ALCS is unclear and the approach to pain assessment is not considered in detail.

Fasciotomy through multiple small skin incisions for the treatment of early acute osteofascial compartment syndrome in children

“…In other clinical retrospective studies, it has been found that 100% of the subjects suffered passive stretching pains in the limbs and 60% experienced paresthesia [14]. OCS can be diagnosed if the osteofascial compartment pressure is higher than 30 mmHg in patients with a history of trauma and a high degree of local swelling in the limbs [13,15]. However, pediatric patients often have poor descriptive capability, do not cooperate during physical examination, and cannot accurately express their sensation.…”

Fasciotomy through Multiple Small Skin Incisions for the treatment of early acute osteofascial compartment syndrome in children

“…[14] OCS can be diagnosed if the osteofascial compartment pressure is higher than 30 mmHg in the patients with a history of trauma and a high degree of local swelling in the limbs. [13,15] However, pediatric patients often have poor descriptive capability, do not cooperate during physical examination, and cannot accurately express their sensation. In addition, pressure measuring devices are not equipped in the hospitals in underdeveloped areas, and pressure measurement is inaccurate in some cases, leading to limited application of pressure measure in the diagnosis of OCS.…”

Acute compartment syndrome of the lower limb following childbirth: a case report

“…Rhabdomyolysis, a serious condition caused by muscle injury, may occur if the diagnosis of ACS is not made in time for urgent fasciotomy. The presence of high CK levels in the blood may indicate severe muscle damage or ischemia and may cause acute renal failure [ 3 , 5 , 9 ]. In the absence of clinical signs, raised CK levels could indicate an unsuspected ACS [ 6 ]; however, because rhabdomyolysis can lead to acute renal failure, and can be life-threatening [ 9 ], elevated CK levels should not be relied on for an early diagnosis of ACS [ 2 – 4 , 6 , 7 ], and creatinine clearance and plasma creatinine are late-stage markers of kidney damage that has already occurred [ 29 ].…”

“…ACS most frequently occurs after a traumatic event; however, up to 30% of cases develop without evidence of fracture [ 2 ]. Other factors that have been associated with ACS include ischemia-reperfusion injury; hemorrhage; phlegmasia cerulea dolens; vascular puncture in patients with bleeding disorders; intravenous/arterial drug injection; and soft tissue injury resulting from prolonged limb compression due to lithotomy positioning during surgery, constricting casts or wraps, crush injury, or burns [ 2 , 3 ]. ACS has also been associated with nephrotic syndrome, rhabdomyolysis, bleeding disorders, iatrogenic factors, and infections such as Streptococcus spp.…”