Patients frequently visit the Emergency Department with musculoskeletal injuries, including fractures. The standard practice is for the doctors to obtain radiographic images (X-rays), then reduce and immobilize the fracture. If the fracture is fairly simple to reduce, without the need for neurovascular injury, then the patient is generally referred to an orthopedic surgeon, a doctor who deals specifically with bone and joint injuries, for a thorough follow-up.
People typically don’t realize that when they sustain a fracture, they are at risk for a number of more serious complications. One of the most feared complications is known as compartment syndrome.
Compartment syndrome is the result of a buildup of pressure within one of the enclosed spaces of the body known as a compartment. A compartment contains a group of muscles, blood vessels, ligaments, tendons, and nerves, surrounded by a strong connective tissue known as fascia.
After an injury, blood may accumulate within the compartment. Fluid that is caused by inflammation may also leak and accumulate, causing the type of swelling known as edema. Because the walls of the compartment are inelastic, the excess blood or fluid will cause pressure within the compartment to rise. When the pressure within the compartment rises above the level of the blood pressure, preventing blood flow into the compartment, tissues within the compartment no longer receive oxygen, and they die. This can mean loss of nerve function or death of muscles within a compartment, resulting in life-long damage or loss of function. With significant compartment syndrome, toxins are released from muscles and may cause renal (kidney) failure if they accumulate in the kidneys.
Acute compartment syndrome usually is related to a fracture of the extremities, and it develops rapidly. It can be the result of bleeding, edema, fracture, and may even occur as the result of the treatment (cast or surgical repair.) Compartment syndrome may also result from crush injuries that do not result in fractures. Circumferential burns of an extremity can cause compartment pressures to rise. Prolonged compression, vascular surgeries, and blood clots in an extremity are other causes of compartment syndrome.
Abdominal compartment syndromes develop more chronically, and injure abdominal organs. However, this article will focus on acute compartment syndrome.
The 6 “P’s”: Signs of Compartment Syndrome
After an injury to the extremity, compartment syndrome may develop over several hours. The symptoms are easy to recognize, if the physician is looking for them and knows the signs!
There are 6 “P’s” that represent signs and symptoms of compartment syndrome, and when a patient presents with one of these signs or symptoms, the physician should look carefully for other indications of compartment syndrome.
Pain out of proportion is the first symptom of compartment syndrome. Pain is always present in compartment syndrome. Although pain is usually present with a fracture, pain that is out of proportion to the injury, or pain that increases rather than decreases with therapy and analgesics should prompt a closer investigation. The pain may be deep and dull, and it is increased with stretching movements of the muscle.
Paresthesia refers to a “pins and needles” sensation or numbness in the injured extremity, and is indicative of nerve damage or progression of rising compartment pressures.
Pallor refers to pale skin distal to the site of the injury, and is the result of diminished blood flow due to increased compartment pressures.
Paralysis refers to the inability to move the extremity distal to the injury, resulting from significant damage to muscle and nerve.
Pulselessness (or pulse present) is another sign of reduced blood flow from rising pressures. However, a good pulse distal to the injury does not rule out compartment syndrome, since the artery may not necessarily run through the affected compartment.
Poikilothermia, the final P, refers to the difference in temperature between the injured and uninjured extremity, and is a sign of advanced compartment syndrome.
When the diagnosis of compartment syndrome is suspected, the physician can measure the pressure of the compartment by inserting a needle attached to a pressure monitor into the compartment. The treatment for compartment syndrome may range from removal of a tight cast or dressing to surgery for a “fasciotomy,” in which the compartment is surgically opened to reduce intracompartmental pressure. This is performed by making long incisions through skin and fascia around the compartment.
Failure to Diagnose Compartment Syndrome in Hospital is Medical Negligence
The consequences of undiagnosed compartment syndrome include loss of function of the nerves in the compartment, death of muscle and other tissues, and buildup of byproducts of muscular destruction in the kidneys, causing kidney failure. Patients diagnosed with compartment syndrome should be treated immediately, as the condition only progresses. Failure to diagnose and treat can result in complete loss of function of the extremity.
Sometimes, a patient may be discharged without clear instructions about the signs and symptoms of compartment syndrome. Other times, a patient may not have adequate follow-up scheduled from the ED. All patients diagnosed with a fracture should be thoroughly educated about the potential development of this serious complication. Follow-up appointments should be made in the ED. The patient should be instructed to return immediately if signs and symptoms of compartment syndrome should develop. The most obvious form of medical malpractice is where a patient develops compartment syndrome in the hospital without a timely diagnosis by the trained medical professionals.
If you or a loved one has developed a harmful form of compartment syndrome, which you suspect was caused by the negligence of medical professionals, you must contact an experienced attorney as soon as possible to preserve your rights. Call Passen & Powell at 312-527-4500 for a Free Consultation.