Diagnosis Of Acute Compartment Syndrome Research Articles

A rare case report: compartment syndrome after brachiocephalic arteriovenous fistula formation in a hemodialysis patient

Introduction: Acute compartment syndrome is a condition in which increased pressure in the tight fascia space reduces capillary perfusion below the level required for tissue viability. Very few cases of acute compartment syndrome associated with dialysis have been reported. It can lead to severe damage to the tissues of the arm. Case Illustration: A 47-year-old woman with end-stage renal failure presented to the emergency room with swelling and pain in the right upper extremity and has lasted for a day. Three days before admission, the patient underwent right brachiocephalic arteriovenous (AV) fistula surgery. Physical Examination showed a blackish bruise at the fossa cubiti, radial and ulnar artery were not palpable, but there is trill at AV fistula. Decreased motoric strength, reduced hand sensation and decreased capillary return in fingers. Oxygen blood saturation of the right fingers could not be read. Diagnosis of acute compartment syndrome was made. The patient was immediately taken to the operating room for decompression surgery. Emergency compartment fasciotomy was performed. After fasciotomy, necrotomy was performed. Furthermore, brachiocephalic AV fistula was ligated. Postoperative evaluation obtained good radial and ulnar artery. Six months after the surgery, the wound was fully healed and no sign of neuromuscular or vascular deficit. Conclusion: Compartment syndrome is a possible complication after AV fistula formation that can have disastrous consequences. However, it can be effectively treated if detected and treated early. Prognosis of compartment syndrome after fasciotomy depends on how quickly the condition is diagnosed and treated.

Risk Factors for Surgical Site Infections Following Fasciotomy in Patients With Acute Compartment Syndrome: A Study on the February 2023 Kahramanmaraş Earthquake.

Surgical site infections (SSIs) developing after fasciotomy are difficult to treat, costly, and an important source of mortality and morbidity. This study aimed to determine the risk factors affecting the development of SSI in patients who underwent fasciotomy with the diagnosis of acute compartment syndrome (ACS) within 72 hours after two consecutive earthquakes of 7.7 and 7.6 magnitude that occurred in Kahramanmaraş on February 6, 2023. A total of 116 patients were retrospectively analyzed. Patients were divided into two groups: those who developed SSI and those who did not. In this study, variables such as basic demographic characteristics, time of fasciotomy, center performing fasciotomy, type of wound closure, affected extremity, concomitant renal failure, hyperbaric oxygen (HBO) therapy, blood creatine kinase (CK) level were examined. Of 116 patients, 58 (50%) had SSI. It was statistically observed that patients who underwent treatment with vacuum-assisted closure (VAC), those who underwent primary closure with the shoelace method, those who went into renal failure, and those whose fasciotomy was performed in an earthquake zone had a higher incidence of SSI (p<0.001). Blood CK level above 17.839 seemed to be a risk factor according to receiver operating characteristic (ROC) analysis (P<0.01). Age (p=0.193), gender (p=0.125), fasciotomy time (p=0.843), lower extremity (p=0.234), upper extremity (p=0.806), and HBO treatment (p=0.56) were not associated with SSI. Infection was found to be a significant risk factor for amputation (p<0.001). The use of VAC as a wound closure technique for SSI after fasciotomy in patients who developed ACSdue to the earthquake, the presence of renal failure in the patients, and performing fasciotomy in the earthquake zone were independent risk factors. A blood CK level above 17.839 was also determined as a risk factor, but the confidence interval was found to be low.

Incidence of acute compartment syndrome with routine use of regional anesthesia for patients with long bone fractures: a large single-center retrospective review from a level I trauma tertiary academic institution

IntroductionTraditionally, using peripheral nerve blocks (PNBs) in patients with long bone fractures has been limited due to concerns that it may interfere with the timely diagnosis of acute compartment syndrome...

Early assessment of extremity compartment syndrome by biochemical markers in a rat model.

This experimental study aimed to define a biochemical marker that will enable early diagnosis of acute compartment syndrome (ACS) of extremities, a mortal condition that occurs due to trauma. A total of 15 Wistar rats were included in the study in which saline infusion technique, a clinically compatible ACS model, was applied. After the rats were anesthetized with ketamine-xylazine, the in-compartment pressure of the hind limb was slowly increased with saline delivered through the angiocatheter, and after reaching the target compartment pressure, the pressure level was kept with a rubber tourniquet. The in-compartment pressure level was continuously monitored with a pressure transducer. The rats were divided into three groups. No intervention was applied to the control group (CG) (n = 3). In study group 1 (SG1) (n = 6), ACS was created using the saline infusion technique, keeping the in-compartment pressure between 30 and 40 mmHg for 45 min. In study group 2 (SG2) (n = 6), ACS was created using the saline infusion technique, keeping the in-compartment pressure between 30 and 40 mmHg for 90 min. Fasciotomy was performed on all rats. Tissue samples were obtained for histopathological examination and blood samples for biochemical analysis. Total oxidant status (TOS) (p = 0.004), ischemia-modified albumin (IMA) (p = 0.030), aspartate transferase (AST) (p = 0.003) and neopterin (p = 0.012) levels differed significantly between groups in the early period of muscle ischemia. In fact, TOS levels differed significantly between the groups even in the cellular phase where signs of ischemia were not observed (p = 0.048, p = 0.024). According to histopathological evaluation, there was no significant difference between the groups. TOS can be detected in the early reversible stage of ischemia, when the histopathological findings of ACS do not occur.

Is the Presence of a Psychiatric Disorder Associated With More Aggressive Management of Compartment Syndrome?

To determine whether pre-existing psychiatric disorder is associated with potentially unnecessary fasciotomy. Retrospective cohort study. Academic Level-1 trauma center. All the patients with orthopaedic trauma undergoing leg fasciotomy at an academic Level I trauma center from 2006 to 2020. Pre-existing diagnosis of psychiatric disorder. Early primary wound closure and delayed primary wound closure. In total, 116 patients were included. Twenty-seven patients (23%) had a pre-existing diagnosis of psychiatric disorder with 13 having anxiety, 14 depression, 5 bipolar disorder, and 2 ADHD. Several patients had multiple diagnoses. Fifty-one patients (44%) had early primary closure (EPC), and 65 patients (56%) had delayed primary closure. Of patients with a psychiatric disorder, 52% received EPC compared with 42% of patients without a disorder, P = 0.38. This lack of a strong association did not seem to vary across specific psychiatric conditions. After adjusting for sex, age, injury type, and substance abuse, there was still no significant association between a psychiatric disorder and EPC with an odds ratio of 1.08 (95% CI, 0.43-2.75). Among patients with orthopaedic trauma undergoing emergent fasciotomy for acute compartment syndrome, a psychiatric disorder was not associated with a significantly increased rate of possibly unnecessary fasciotomy. Given the potential for a psychiatric condition to complicate the diagnosis of acute compartment syndrome, this data is somewhat reassuring; however, there remains a need for continued vigilance in treating patients with psychiatric conditions and research in this area. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

BioFACTS: biomarkers of rhabdomyolysis in the diagnosis of acute compartment syndrome – protocol for a prospective multinational, multicentre study involving patients with tibial fractures

IntroductionThe ischaemic pain of acute compartment syndrome (ACS) can be difficult to discriminate from the pain linked to an associated fracture. Lacking objective measures, the decision to perform fasciotomy is...

The Association between Clinical Features and Measurements of Intra-Compartmental Pressure in Diagnosis of Acute Compartment Syndrome of Closed Leg Fractures

Objective: To find the clinical features of compartment syndrome and measurement of intra-compartmental pressure (ICP) in early diagnosis of the compartment syndrome of different types of closed leg bone fractures and their association with the severity of the fracture. Methodology: This prospective study included 20 patients with unilaterally closed fractures of the tibia and/or fibular fracture that presented to Shar Hospital, Sulaimaniyah City, Northern Iraq, from October 1st, 2018, to July 1st, 2020. Sociodemographic information with date and mechanism of injury, severity, side, and site of a fractured leg, and fracture's type according to Oestern and Tscherne classification of the close fracture were obtained. ICP was measured in the broken leg and normal leg at the time of admission to the emergency ward for patients using the needle-infusion technique (Whiteside's technique).Results: All patients were followed clinically by looking at features of the compartment for three days before the definitive treatment was established. We found that 8 out of 20 patients were complaining of severe, unusual pain (paresthesia) during follow-up. Acute compartment syndrome (ACS) was diagnosed in 1 (55-year-old man) out of 8 patients whose clinical features of compartment syndrome built up and with the differential pressure (∆p) of &lt;30 mmHg. The cause of his fracture was a road traffic accident (RTA), and he underwent a fasciotomy. At the same time, the rest of the patients had no features of the compartment.Conclusions: We revealed a significant clinical correlation between the measurement of ICP and early detection and diagnosis of the post-traumatic ACS of the leg, and the measurement of ICP was valuable in the diagnosis of ACS and as a criterion for decompression. Also, this study shows a positive correlation between the type of fracture according to the Oestern and Tscherne classification and the increase in the measurement of the ICP.

An exploratory study of two-dimensional shear-wave elastography in the diagnosis of acute compartment syndrome

BackgroundTwo-dimensional shear-wave elastography (2D-SWE) is an ultrasound elastography technique that uses shear waves to quantitatively measure tissue stiffness and it has recently been developed as a safe, real-time, and noninvasive imaging technique. The purpose of this study was to investigate the value of 2D-SWE in the diagnosis and treatment of acute compartment syndrome (ACS).Methods2D-SWE was used to measure the elasticity values of the main muscles in the superficial compartments of the calf in 212 healthy volunteers, and the difference in the muscle elasticity values between different gender and age groups were analyzed. Nine patients with clinical suspicion of ACS were included in this study and 2D-SWE was used to measure the elasticity values of the muscles on the affected and unaffected sides, and a comparative analysis was performed.ResultsThe mean elasticity values of the tibialis anterior (TA), peroneus longus (PL), and gastrocnemius medialis (GA) muscles in the relaxed state of the 212 healthy volunteers were 25.4 ± 3.2 kPa, 15.7 ± 1.5 kPa, and 12.1 ± 2.1 kPa, respectively. No statistically significant differences was observed in the elasticity values of the same muscle under the state of relaxation in different gender and age groups (p > 0.05). A statistically significant difference in the elasticity values of the muscle between the affected and unaffected sides in the fasciotomy group (p < 0.05, n = 5) was observed. In contrast, no difference in the elasticity values of the muscle between the affected and unaffected sides in the conservative group (p > 0.05, n = 4) was observed. There was a statistically significant difference in the elasticity values of the muscle on the affected side in the two treatment groups (p < 0.05).ConclusionsWhen the ACS occurs, the muscle elasticity of the affected limb increases significantly. 2D-SWE is expected to be a new noninvasive technique for the assessment of ACS and may provide a potential basis for clinical diagnosis and treatment.

Evaluation of Clinical and Venous Blood Parameters as Surrogate Indicators in Assessing the Need for Fasciotomy in Lower Limb Compartment Syndrome.

Acute compartment syndrome in the lower limb, a surgical emergency, may cause ischemic damage to muscles and neurological deficits leading to loss of function of the limb which may even require amputation, thus drastically affecting the quality of life of a patient. Fasciotomy for decompression is suggested when the differential pressure in the compartment of the leg is ≤30 mm Hg. However, compartment pressure measurement is not always feasible. Surgeons often find themselves in a dilemma in deciding the right treatment option for the patient: fasciotomy or conservative management. Since there is no universally accepted reference standard for the diagnosis of acute compartment syndrome at present, there is a need for definitive diagnostic variables so as to not delay fasciotomy in patients who need it, as well as to avoid unnecessary fasciotomies, especially when compartment pressures cannot be measured. In this observational study including 71 patients, based on the compartment pressures of the affected limb, treatment was done either with fasciotomy or conservative approach, and various clinical and biochemical parameters were evaluated in between these two groups. Statistically significant difference was found in the venous blood gas parameters between patients managed conservatively and with fasciotomy (MANOVA, P = .001). The results revealed the association of lower venous blood bicarbonate levels (independent sample t test, P = .021) and the presence of paresthesia (Fisher exact test, P = .0016) with the fasciotomy group. Also, pain on passive stretching of the affected limb was found to be significantly associated with a delta pressure of ≤30 mm Hg in any compartment (Fisher exact test, P = .002). These variables may thus be used as an alternative to the measurement of compartment pressure to assess the requirement of fasciotomy.

Clinical versus Instrumented Reliability of Diagnosis of Acute Compartmental Syndrome in Tibial Fractures

Abstract Background: Acute compartment syndrome of the leg may be a devastating complication of a tibial fracture. Metic-ulous and repeated examinations of the patient who has such a fracture are needed to ensure the diagnosis of acute com-partment syndrome (ACS). A.C.S. remains challenging in many patients although the 5 Ps of compartment syndrome; pain, pallor, paralysis, pulselessness, and paresthesia. Aim of Study: To measure intra-compartmental pressure in different compartments in the lower leg in tibial fractures and to correlate it with common clinical findings found in acute compartment syndrome in trial to early detect acute compartment syndrome and to decrease its devastating com-plications and rate of fasciotomy. Patients and Methods: This study was conducted on 100 patients referred to the Emergency department having Tibial fracture predisposed to have acute compartment syndrome by measuring intra-compartmental pressure instrumentally using stryker intra-compartmental pressure monitoring system and correlated with clinical picture and detect the percentage of patients need fasciotomy. Results: The Stryker intra compartmental monitoring system (STIC catheter) has accuracy and easy to measure intra-compartmental pressure and helps us to early detect A.C.S. in the lower leg also to decrease rate of fasciotomy and complications but it is expensive and needs proper training to use it. Conclusion: The patient who undergoes fasciotomy re-quires a physical therapy program to regain function. Postop-erative care and rehabilitation are just as important as the procedure itself.

Portable Oxygen-Sensing Device for the Improved Assessment of Compartment Syndrome and other Hypoxia-Related Conditions.

Measurement of intramuscular oxygen could play a key role in the early diagnosis of acute compartment syndrome, a common condition occurring after severe trauma leading to ischemia and long-term consequences including rhabdomyolysis, limb loss, and death. However, to date, there is no existing oxygen sensor approved for such a purpose. To address the need to improve the assessment of compartment syndrome, a portable fiber-optic device for intramuscular oxygen measurements was developed. The device is based on phosphorescence quenching, where the tip of an optical fiber was coated with a poly(propyl methacrylate) (PPMA) matrix containing a brightly emitting Pt(II)-core porphyrin. The optoelectronic circuit is highly portable and is based on a microspectrometer and a microcontroller readout with a smartphone. Results from an in vivo tourniquet porcine model show that the sensor is sensitive across the physiological oxygen partial pressure range of 0-80 mmHg and exhibits an appropriate and reproducible response to changes in intramuscular oxygen. A commercial laboratory oxygen sensor based on a lifetime measurement did not respond as expected.

Utility of laboratory markers in evaluating for acute compartment syndrome in the emergency department.

BackgroundAcute compartment syndrome is diagnosed by clinical examination with the aid of direct compartmental measurement. Previous work suggested using several laboratory markers that may suggest ongoing acute compartment syndrome in hospitalized patients. Serum creatinine kinase (CK) levels >4000 U/L, chloride (Cl) levels >104 mg/dL, and blood urea nitrogen (BUN) levels <10 mg/dL were found to have 100% association with the diagnosis of acute compartment syndrome. This strategy has not been studied in emergency department (ED) patients.MethodsA retrospective chart review of all patients diagnosed with acute compartment syndrome of the upper and lower extremity or tibia/fibula fracture was performed from 13 EDs between February 22, 2008 and October 1, 2018. Serum values were collected for each patient: CK, sodium (Na), potassium (K), Cl, bicarbonate (HCO3), glucose, BUN, creatinine (Cr), calcium, lactic acid (LA), and ionized calcium (iCa). A control group composed of patients without acute compartment syndrome who had tibia and/or fibula fractures was analyzed to compare with our cohort.ResultsWe identified 930 patients who meet inclusion criteria (389 acute compartment syndrome patients and 541 tibia/fibula fracture patients). Sex and ethnicity were similar in each population. A majority of the patients were evaluated at EDs without a trauma center designation. Using univariate modeling, HCO3, CK, iCa, Cr, BUN, and K values were found to be individual significant predictors of acute compartment syndrome (P < 0.05). Multivariate regression models found that HCO3 and Cr were significant predictors of acute compartment syndrome with a C‐statistic of 0.77. The Valdez model had a prediction accuracy of 0.52 and a specificity of 99.2% but had a sensitivity of only 2.9%.ConclusionOur model demonstrates that use of serum biomarkers in the ED does aid in the diagnosis of acute compartment syndrome in patients in the ED with 99.2% specificity but has a sensitivity of only 2.9%. Further research and prospective evaluation of serum markers are needed.

Perfusion Pressure Lacks Diagnostic Specificity for the Diagnosis of Acute Compartment Syndrome.

To evaluate the diagnostic performance of perfusion pressure (PP) thresholds for fasciotomy. Prospective observational study. Seven Level-1 trauma centers. One hundred fifty adults with severe leg injuries and ≥2 hours of continuous PP data who had been enrolled in a multicenter observational trial designed to develop a clinical prediction rule for acute compartment syndrome (ACS). For each patient, a given PP criterion was positive if it was below the specified threshold for at least 2 consecutive hours. The diagnostic performance of PP thresholds between 10 and 30 mm Hg was determined using 2 reference standards for comparison: (1) the likelihood of ACS as determined by an expert panel who reviewed each patient's data portfolio or (2) whether the patient underwent fasciotomy. Using the likelihood of ACS as the diagnostic standard (ACS considered present if median likelihood ≥70%, absent if <30%), a PP threshold of 30 mm Hg had diagnostic sensitivity 0.83, specificity 0.53, positive predictive value 0.07, and negative predictive value 0.99. Results were insensitive to more strict likelihood categorizations and were similar for other PP thresholds between 10- and 25-mm Hg. Using fasciotomy as the reference standard, the same PP threshold had diagnostic sensitivity 0.50, specificity 0.50, positive predictive value 0.04, negative predictive value 0.96. No value of PP from 10 to 30 mm Hg had acceptable diagnostic performance, regardless of which reference diagnostic standard was used. These data question current practice of diagnosing ACS based on PP and suggest the need for further research. Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Acute compartment syndrome in the limb.

Compartment syndrome of the limb is a true orthopaedic emergency that warrants prompt evaluation and treatment. Acute compartment syndrome of the limb is not uncommon and has the potential to cause devastating morbidity and mortality. Failure to provide urgent surgical intervention once established can lead to irreversible tissue damage within hours of onset. Compartment syndrome can occur across all limbs, the buttocks and even the abdomen, but this article focuses solely on the diagnosis of acute compartment syndrome of the limb. Acute compartment syndrome can have a wide range of causes, with trauma representing approximately 70% of cases.

Feasibility of ultrasound measurement in a human model of acute compartment syndrome

BackgroundEarly diagnosis of acute compartment syndrome (ACS) of the leg is essential to improve the outcome. Direct invasive measurement is currently recommended to measure intracompartmental pressure. A non-invasive and reproducible means of making the diagnosis would be a step forward. The purpose of this exploratory study was to investigate the feasibility of non-invasive ultrasound-guided angle measurement as a surrogate of increased pressure in a model of ACS.MethodsA model of ACS was generated by infusion of saline into the anterior compartment of the leg of human cadavers to incrementally increase the intracompartmental pressure from 10 to 100 mmHg. In 40 legs (20 cadavers), the angle (TFA, tibia-fascia angle) between the anterolateral cortex of the tibia and the fascia of the anterior compartment was measured at each 10 mmHg pressure increase using ultrasound in a standardized transversal plane. A multilevel linear regression model was used to estimate intracompartmental pressure from delta TFA (ΔTFA).ResultsTFA (mean [± SD]) increased from 61.0° (± 12.0°) at 10 mmHg up to 81.1° (± 11.1°) at 100 mmHg compartment pressure. Each increase ΔTFA by one degree was associated with an increase in pressure by 3.9 mmHg (95% CI, 3.8–4.0, p < 0.001).ConclusionsWe found that intracompartmental pressure of the anterior compartment of the calf can be well estimated by ultrasound-based ΔTFA in this post mortem experiment. Our findings indicate that non-invasive TFA measurement is feasible and it is reasonable that this will hold true in real life, but the findings are too preliminary to be used in clinical practice now.

Myofascial self-release law

Osteofascial compartment syndrome (OFCS) is clinically common and is well known to orthopedic surgeons. Clinicians attach great importance to OFCS because of its severe clinical consequences, and decompression of fascial compartment is often performed in emergency treatment. This article reviews the literature on the threshold of fascial compartment decompression proposed by many scholars in the past and discusses the problems in the clinical diagnosis of acute compartment syndrome, especially the inconsistent pressure thresholds as the indication for emergency decompression surgery. By observing calf fractures patients with tension blister, we found that the pressure of fascia decreased sharply upon the appearance of blisters. Meanwhile, the swelling gradually subsided as well as the clinical manifestations of pain and parasthsia. In view of the uncertainty of various thresholds of fascial decompression and self-decompression, the concepts of myofascial self-release law and muscle-swelling syndrome were first proposed. The author believes that when intracompartmental pressure rises to a point, some unknown mechanisms of fascia can achieve self-decompression. Therefore, no compartment syndrome will take place. We also emphasize that the 'muscle-swelling syndrome’ should be strictly distinguished from the soft tissue necrosis caused by crush syndrome and acute limb vascular injury, so as to provide more precise treatment. We believe that without external restrictions such as casts, splints and compression bandages, the muscle-swelling syndrome can achieve self decompression by releasing the pressure in the compartment through tension blisters, and there is no need for fasciotomy. Key words: Compartment syndromes; Blister; Myofascial self-release law

Low compartment pressure and myoglobin levels in tibial fractures with suspected acute compartment syndrome

BackgroundThe intense ischemic pain of acute compartment syndrome can be difficult to discriminate from the pain related to an associated fracture. Lacking objective measures, the decision to perform fasciotomy is often only based on clinical findings and performed at a low threshold. Biomarkers of muscle cell damage might help to identify and monitor patients at risk. In patients with fractures, however, markers of muscle cell damage could be elevated because of other reasons associated with the trauma, which would make interpretation difficult. In a review of all patients who underwent emergency fasciotomy in our health care district we aimed to investigate the decision-making process and specifically the use of biomarkers in patients with and without fractures.MethodsIn the southeast health care region of Sweden 79 patients (60 men) with fractures (median age 26 years) and 42 patients (34 men) without associated fractures (median age 44 years) were treated with emergency fasciotomy of the lower leg between 2007 and 2016. Differences in clinical findings, p-myoglobin and p-creatine phosphokinase as well as pressure measurements were investigated.ResultsP-myoglobin was analyzed preoperatively in 20% of all cases and p-creatine phosphokinase in 8%. Preoperative levels of p-myoglobin were lower in patients with fractures (median 1065 μg/L, range 200–3700 μg/L) compared with those without fractures (median 7450 μg/L, range 29–31,000 μg/L), p < 0.05. Preoperative intracompartmental pressure was lower in the fracture group (median 45 mmHg, range 25–90 mmHg) compared with those without fractures (median 83 mmHg, range 18–130 mmHg), p < 0.05.ConclusionsBiomarkers are seldom used in the context of acute fasciotomy of the lower leg. Contrary to our expectations, preoperative levels of p-myoglobin and intracompartmental pressures were lower in fracture patients. These findings support differences in the underlying pathomechanism between the groups and indicate that biomarkers of muscle cell necrosis might play a more important role in the diagnosis of acute compartment syndrome than previously thought.

Diagnosing acute compartment syndrome: are current textbooks misleading?

Background: Prompt diagnosis of acute compartment syndrome (ACS) is critical when trying to prevent irreversible limb damage. Pain out of proportion and pain on passive tendon stretching are sufficient clinical indicators of ACS. Primary care physicians may delay in making the diagnosis of ACS because they may rely on the classic “5 P” signs. However, paralysis and pulselessness will not appear until the later stages of ACS, at a time when irreversible damage has occurred. The aim of this study was to evaluate the guidelines for diagnosis of ACS as perceived by graduating medical students and primary care physicians and as published in textbooks. Methods: One hundred and seventeen medical students and primary care physicians were questioned as to the diagnostic criteria of ACS. Eleven medical textbooks were reviewed to evaluate the diagnostic approach to ACS. Results: Of the 117 participants, only 29 (24.8%) answered correctly. Of eleven textbooks, three specifically mentioned the classic “5 P” signs but still provided the correct diagnostic steps, including the essential elements of pain beyond proportion and pain upon passive tendon stretching. Disappointingly, seven textbooks made no mention of the potentially life and limb-threatening diagnosis of ACS, and only one textbook outlined the path to diagnosis of ACS with no mention of the “5 P” signs. Conclusions: The misguided diagnosis according to the “5 P” signs in nonorthopaedic medical textbooks that clinicians in multiple disciplines depend on may result in devastating consequences. Pulselessness, paresthesia, and paralysis are signs that appear too late in the course of the disease to serve as diagnostic signs and are not signs to be waited for, a point to be emphasized in teaching.

Acute postoperative compartment syndrome in a child receiving patient‐controlled analgesia and peripheral nerve block

SummaryPatient‐controlled analgesia and nerve blocks have been implicated in the delayed or missed diagnosis of acute compartment syndrome. We report a case of early successful diagnosis of acute compartment syndrome in a 15‐year‐old male, who received both morphine‐based patient‐controlled analgesia and a femoral nerve block following corrective surgery for patellofemoral instability. Our case demonstrates that multimodal analgesia, combining both patient‐controlled analgesia and a nerve block, does not necessarily prevent the early diagnosis of an evolving compartment syndrome. There must be a high level of clinical awareness amongst medical and nursing staff regarding the serious potential complication of postoperative compartment syndrome and ongoing vigilance to monitor for its symptoms and signs.

The Diagnosis of Acute Compartment Syndrome: A Critical Analysis Review.

* Delay in the diagnosis of acute compartment syndrome can have severe and potentially disastrous outcomes for the patient.* Factors associated with a delayed diagnosis are lack of experience of medical personnel, regional or general anesthesia, polytrauma cases, injuries to the soft tissue, and the use of clinical signs alone when making the diagnosis.* Youth has been identified as the key risk factor associated with confirmed cases of acute compartment syndrome, and over two-thirds of cases are associated with an underlying fracture.* Although pain is characteristically the index sign associated with the development of acute compartment syndrome, clinical findings in isolation have been proven to have inadequate diagnostic performance characteristics, with sensitivity ranging from 13% to 54%.* Intracompartmental pressure monitoring is recommended for patients at risk, given the documented high estimated sensitivity (94%) and specificity (98%) for the diagnosis of acute compartment syndrome when using a slit catheter technique and a differential pressure threshold of 30 mmHg for &gt;2 hours.