Diagnosing acute compartment syndrome-where have we got to?

Tristan E McMillan, William Timothy Gardner, Andrew H Schmidt, Alan J Johnstone, Tristan E McMillan, William Timothy Gardner, Andrew H Schmidt, Alan J Johnstone

Abstract

Purpose: Acute compartment syndrome is a condition whereby tissue ischaemia occurs due to increased pressure in a closed myofascial compartment. It is a surgical emergency, with rapid recognition and treatment-the keys to good outcomes.

Methods: The available literature on diagnostic aids was reviewed by one of the senior authors 15 years ago. Now, we have further reviewed the literature, to aim to ascertain what progress has been made.

Results: In this review, we present the evidence around a variety of available diagnostic options when investigating a potential case of acute compartment syndrome, including those looking at pressure changes, localised oxygenation, perfusion, metabolic changes and available blood serum biomarkers.

Conclusions: A significant amount of work has been put into developing modalities of diagnosis for acute compartment syndrome in the last 15 years. There is a lot of promising outcomes being reported; however, there is yet to be any conclusive evidence to suggest that they should be used over intracompartmental pressure measurement, which remains the gold standard. However, clinicians should be cognizant that compartment pressure monitoring lacks diagnostic specificity, and could lead to unnecessary fasciotomy when used as the sole criterion for diagnosis. Therefore, pressure monitoring is ideally used in situations where clinical suspicion is raised.

Keywords: Compartment syndrome; Diagnosis; Investigation; Ischaemia; Trauma.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Acute compartment syndrome: currently available investigations

References

    1. Elliott KG, Johnstone AJ. Diagnosing acute compartment syndrome. J Bone Joint Surg Br. 2003;85(5):625–632.
    1. Matsen FA. Compartmental syndromes: an unified concept. Clin Orthop Relat Res. 2018;113:8–14.
    1. Schmidt AH. Acute compartment syndrome. Injury. 2017;48(Suppl 1):S22–S25.
    1. Prasarn ML, Ouellette EA. Acute compartment syndrome of the upper extremity. J Am Acad Orthop Surg. 2011;19(1):49–58.
    1. Mehta V, Chowdhary V, Lin C, Jbara M, Hanna S. Compartment syndrome of the hand: a case report and review of literature. Radiol Case Rep. 2018;13(1):212–215.
    1. Smith RDJ, Rust-March H, Kluzek S (2015) Acute compartment syndrome of the thigh in a rugby player. BMJ Case Rep. 10.1136/bcr-2015-210856
    1. Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain M, De Keulenaer B, Duchesne J, Bjorck M, Leppaniemi A, Ejike JC, Sugrue M, Cheatham M, Ivatury R, Ball CG, Reintam Blaser A, Regli A, Balogh ZJ, D’Amours S, Debergh D, Kaplan M, Kimball E, Olvera C. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39(7):1190–1206.
    1. Sarwar U, Ting J (2017) Postoperative gluteal compartment syndrome following microsurgical free-flap hand reconstruction: the importance of early recognition and treatment. BMJ Case Rep. 10.1136/bcr-2017-220218
    1. DeLee JC, Stiehl JB. Open tibia fracture with compartment syndrome. Clin Orthop Relat Res. 1981;160:175–184.
    1. Blick SS, Brumback RJ, Poka A, Burgess AR, Ebraheim NA. Compartment syndrome in open tibial fractures. J Bone Joint Surg Am. 1986;68(9):1348–1353.
    1. Court-Brown C, McQueen M. Compartment syndrome delays tibial union. Acta Orthop Scand. 1987;58(3):249–252.
    1. Tischenko GJ, Goodman SB. Compartment syndrome after intramedullary nailing of the tibia. J Bone Joint Surg Am. 1990;72(1):41–44.
    1. Weinlein J, Schmidt A. Acute compartment syndrome in tibial plateau fractures--beware! J Knee Surg. 2010;23(1):9–16.
    1. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg Br. 2000;82(2):200–203.
    1. Shadgan B, Pereira G, Menon M, Jafari S, Darlene Reid W, O’Brien PJ. Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal fractures in adults. J Orthop Traumatol. 2015;16(3):185–192.
    1. Donaldson J, Haddad B, Khan WS. The pathophysiology, diagnosis and current management of acute compartment syndrome. Open Orthop J. 2014;8:185–193.
    1. Oman SA, Schwarz D, Muntz HG. Lower limb compartment syndrome as a complication of radical hysterectomy. Gynecol Oncol Rep. 2016;16:39–41.
    1. Meena S, Trikha V, Saini P, Kumar N, Kr S. Well-leg compartment syndrome after fracture fixation in hemilithotomy position: case report of a preventable condition. Med Princ Pract. 2014;23(3):275–278.
    1. Wijesuriya JD, Cowling PD, Izod C, Burton DJ. Deltoid compartment syndrome as a complication of lateral decubitus positioning for contralateral elbow surgery in an anabolic steroid abuser. Shoulder Elbow. 2014;6(3):200–203.
    1. DePasse JM, Palumbo MA, Haque M, Eberson CP, Daniels AH. Complications associated with prone positioning in elective spinal surgery. World J Orthop. 2015;6(3):351–359.
    1. Adrish M, Duncalf R, Diaz-Fuentes G, Venkatram S. Opioid overdose with gluteal compartment syndrome and acute peripheral neuropathy. Am J Case Rep. 2014;15:22–26.
    1. Weiner G, Styf J, Nakhostine M, Gershuni DH. Effect of ankle position and a plaster cast on intramuscular pressure in the human leg. J Bone Joint Surg Am. 1994;76(10):1476–1481.
    1. Lasanianos NG, Kanakaris NK, Roberts CS, Giannoudis PV. Compartment syndrome following lower limb arthroplasty: a review. Open Orthop J. 2011;5:181–192.
    1. Taylor BC, Dimitris C, Tancevski A, Tran JL. Gluteal compartment syndrome and superior gluteral artery injury as a result of simple hip dislocation: a case report. Iowa Orthop J. 2011;31:181–186.
    1. Smith A., Chitre V., Deo H. Acute gluteal compartment syndrome: superior gluteal artery rupture following a low energy injury. Case Reports. 2012;2012(dec17 1):bcr2012007710–bcr2012007710.
    1. Woon CY, Patel KR, Goldberg BA. Methicillin-resistant Staphylococcus aureus infected gluteal compartment syndrome with rhabdomyolysis in a bodybuilder. World J Orthop. 2016;7(5):338–342.
    1. Pechar J, Lyons MM. Acute compartment syndrome of the lower leg: a review. J Nurse Pract. 2016;12(4):265–270.
    1. Hargens AR, Romine JS, Sipe JC, Evans KL, Mubarak SJ, Akeson WH. Peripheral nerve-conduction block by high muscle-compartment pressure. J Bone Joint Surg Am. 1979;61(2):192–200.
    1. Vaillancourt C, Shrier I, Vandal A, Falk M, Rossignol M, Vernec A, Somogyi D. Acute compartment syndrome: how long before muscle necrosis occurs? CJEM. 2004;6(3):147–154.
    1. von Keudell AG, Weaver MJ, Appleton PT, Bae DS, Dyer GSM, Heng M, Jupiter JB, Vrahas MS. Diagnosis and treatment of acute extremity compartment syndrome. Lancet. 2015;386(10000):1299–1310.
    1. Ulmer T. The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder? J Orthop Trauma. 2002;16(8):572–577.
    1. Via AG, Oliva F, Spoliti M, Maffulli N. Acute compartment syndrome. Muscles Ligaments Tendons J. 2015;5(1):18–22.
    1. Wright J, Griffiths DE, Nwaboku HC. Acute compartment syndrome with an atypical presentation: a useful clinical lesson. JRSM Short Rep. 2011;2(4):30.
    1. Beniwal RK, Bansal A. Osteofascial compartment pressure measurement in closed limb injuries – Whitesides’ technique revisited. J Clin Orthop Trauma. 2016;7(4):225–228.
    1. 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(8):673–677.
    1. Schmidt AH, Bosse MJ, Frey KP, O’Toole RV, Stinner DJ, Scharfstein DO, Zipunnikov V, MacKenzie EJ. Predicting acute compartment syndrome (PACS): the role of continuous monitoring. J Orthop Trauma. 2017;31(Suppl 1):S40–S47.
    1. Tian S, Lu Y, Liu J, Zhu Y, Cui Y, Lu J. Comparison of 2 available methods with Bland-Altman analysis for measuring intracompartmental pressure. Am J Emerg Med. 2016;34(9):1765–1771.
    1. Garner MR, Taylor SA, Gausden E, Lyden JP. Compartment syndrome: diagnosis, management, and unique concerns in the twenty-first century. HSS J. 2014;10(2):143–152.
    1. Whitney A, O’Toole RV, Hui E, Sciadini MF, Pollak AN, Manson TT, Eglseder WA, Andersen RC, Lebrun C, Doro C, Nascone JW. Do one-time intracompartmental pressure measurements have a high false-positive rate in diagnosing compartment syndrome? J Trauma Acute Care Surg. 2014;76(2):479–483.
    1. Large TM, Agel J, Holtzman DJ, Benirschke SK, Krieg JC. Interobserver variability in the measurement of lower leg compartment pressures. J Orthop Trauma. 2015;29(7):316–321.
    1. Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S. Compartment syndrome of the lower leg and foot. Clin Orthop Relat Res. 2010;468(4):940–950.
    1. Weick JW, Kang H, Lee L, Kuether J, Liu X, Hansen EN, Kandemir U, Rollins MD, Mok JM. Direct measurement of tissue oxygenation as a method of diagnosis of acute compartment syndrome. J Orthop Trauma. 2016;30(11):585–591.
    1. Doro CJ, Sitzman TJ, O’Toole RV. Can intramuscular glucose levels diagnose compartment syndrome? J Trauma Acute Care Surg. 2014;76(2):474–478.
    1. Hansen EN, Manzano G, Kandemir U, Mok JM. Comparison of tissue oxygenation and compartment pressure following tibia fracture. Injury. 2013;44(8):1076–1080.
    1. Mok J, Hansen E, H K, Kandemir U. Diagnosis of acute compartment syndrome. Tech Orthop. 2012;27(1):22–29.
    1. Reisman WM, Shuler MS, Roskosky M, Kinsey TL, Freedman BA. Use of near-infrared spectroscopy to detect sustained hyperaemia following lower extremity trauma. Mil Med. 2016;181(2):111–115.
    1. Shuler MS, Reisman WM, Kinsey TL, Whitesides TE, Jr, Hammerberg EM, Davila MG, Moore TJ. Correlation between muscle oxygenation and compartment pressures in acute compartment syndrome of the leg. J Bone Joint Surg Am. 2010;92(4):863–870.
    1. Shuler MS, Reisman WM, Cole AL, Whitesides TE, Jr, Moore TJ. Near-infrared spectroscopy in acute compartment syndrome: case report. Injury. 2011;42(12):1506–1508.
    1. Lee SH, Padilla M, Lynch JE, Hargens AR. Noninvasive measurements of pressure for detecting compartment syndromes. J Orthop Rheumatol. 2013;1(1):5.
    1. Jobsis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science. 1977;198(4323):1264–1267.
    1. Budsberg SC, Shuler MS, Hansen M, Uhl E, Freedman BA. Comparison of NIRS, serum biomarkers, and muscle damage in a porcine balloon compression model of acute compartment syndrome. J Trauma Acute Care Surg. 2016;81(5):876–881.
    1. Tobias JD, Hoernschemeyer DG. Near-infrared spectroscopy identifies compartment syndrome in an infant. J Pediatr Orthop. 2007;27(3):311–313.
    1. Shuler MS, Roskosky M, Kinsey T, Glaser D, Reisman W, Ogburn C, Yeoman C, Wanderman NR, Freedman B. Continual near-infrared spectroscopy monitoring in the injured lower limb and acute compartment syndrome. Bone Joint J. 2018;100-b(6):787–797.
    1. Schmidt A, Bosse M, O’Toole R, Obremskey W, Zipunnikov V, Dunrui D, Frey K, MacKenzie E. Continuous near-infrared spectroscopy monitoring in the injured lower limb and compartment syndrome. Bone Joint J. 2018;100-B(6):787–797.
    1. Jerosch J, Geske B, Sons HU, Winkelmann W. The value of sonography in assessing intracompartmental pressure in the anterior tibial compartment. Ultraschall Med. 1989;10(4):206–210.
    1. Sellei RM, Hingmann SJ, Kobbe P, Weber C, Grice JE, Zimmerman F, Jeromin S, Hildebrand F, Pape HC. Compartment elasticity measured by pressure-related ultrasound to determine patients “at risk” for compartment syndrome: an experimental in vitro study. Patient Saf Surg. 2015;9(1):4.
    1. Sellei RM, Hingmann SJ, Weber C, Jeromin S, Zimmermann F, Turner J, Hildebrand F, Pape HC. Assessment of elevated compartment pressures by pressure-related ultrasound: a cadaveric model. Eur J Trauma Emerg Surg. 2015;41(6):639–645.
    1. Lynch JE, Heyman JS, Hargens AR. Ultrasonic device for the noninvasive diagnosis of compartment syndrome. Physiol Meas. 2004;25(1):N1–N9.
    1. Wiemann JM, Ueno T, Leek BT, Yost WT, Schwartz AK, Hargens AR. Noninvasive measurements of intramuscular pressure using pulsed phase-locked loop ultrasound for detecting compartment syndromes: a preliminary report. J Orthop Trauma. 2006;20(7):458–463.
    1. Challa ST, Hargens AR, Uzosike A, Macias BR. Muscle microvascular blood flow, oxygenation, pH, and perfusion pressure decrease in simulated acute compartment syndrome. J Bone Joint Surg Am. 2017;99(17):1453–1459.
    1. Abraham P, Leftheriotis G, Saumet JL. Laser Doppler flowmetry in the diagnosis of chronic compartment syndrome. J Bone Joint Surg Br. 1998;80(2):365–369.
    1. Edwards PD, Miles KA, Owens SJ, Kemp PM, Jenner JR. A new non-invasive test for the detection of compartment syndromes. Nucl Med Commun. 1999;20(3):215–218.
    1. Takano K, Yosii S, Hosaka S, Hashimoto R, Matsukawa T, Tada Y. Muscle pH/PCO2 monitoring. J Pediatr Surg. 1993;28(10):1376–1379.
    1. Johnstone AJ, Elliott KG. Acute compartment syndrome: intramuscular pH supersedes pressure in making the diagnosis. Orthop Proc. 2013;95-B(SUPP 16):38.
    1. Lampert R, Weih EH, Breucking E, Kirchhoff S, Lazica B, Lang K. Postoperative bilateral compartment syndrome resulting from prolonged urological surgery in lithotomy position serum creatine kinase activity (CK) as a warning signal in sedated, artificially respirated patients. Anaesthesist. 1995;44(1):43–47.
    1. Gunduz A, Mentese A, Turedi S, Karahan SC, Mentese U, Eroglu O, Turkmen S, Turan I, Ucar U, Russell R, Balaban F. Serum ischaemia-modified albumin increases in critical lower limb ischaemia. Emerg Med J. 2008;25(6):351–353.
    1. Gardner AM, Fox RH, Lawrence C, Bunker TD, Ling RS, MacEachern AG. Reduction of post-traumatic swelling and compartment pressure by impulse compression of the foot. J Bone Joint Surg Br. 1990;72(5):810–815.
    1. Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am. 2000;82(2):225–250.
    1. Odland RM, Schmidt AH. Compartment syndrome ultrafiltration catheters: report of a clinical pilot study of a novel method for managing patients at risk of compartment syndrome. J Orthop Trauma. 2011;25(6):358–365.
    1. Francis A, Baynosa R. Ischaemia-reperfusion injury and hyperbaric oxygen pathways: a review of cellular mechanisms. Diving Hyperb Med. 2017;47(2):110–117.

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