7,9,16,17 For more, see this video from EM:RAP on using the Stryker monitor TM and this EPMonthly article for a step-by-step guide. 7,16,17,59 The most common method is an STC device such as the Stryker monitor TM, or using an arterial line transducer system. 7,9,16,59 There are a variety of invasive methods for measuring pressures, including needle manometry, the wick catheter, the Whitesides method, and the solid-state transducer intracompartmental catheter (STC) device (Table 3). Once ACS is suspected, definitive diagnosis involves obtaining the intracompartmental pressure, which is most commonly assessed with direct, invasive monitoring. 7,9,15,56 X-rays of the affected extremity are usually obtained to look for fractures and other potential underlying causes. 56-58 Renal injury can occur, usually due to rhabdomyolysis. 7,9,15,56 Rhabdomyolysis is present in > 40% of traumatic ACS cases. 5 The RisksĪCS is most common in patients 1000 units/mL or myoglobinuria suggest ACS, and CK levels will continue to increase during the course of ACS. 4 In fact, 23% of medicolegal cases are due to misdiagnosis, and 32% of cases are due to delay to definitive treatment. 2 Failure to treat ACS can cause long-term neurovascular deficits, and ACS is associated with significant medicolegal risk. 1-3 Incidence varies but is close to 0.7-7.3 cases per 100,000 people. What could be going on? The Dreaded Compartment Syndrome…Ī surgical emergency, acute compartment syndrome (ACS) is the result of excessive pressure within a fascial compartment, leading to decreased perfusion. His right leg pain continues to increase despite multiple doses of hydromorphone IV and what appears to be a great reduction based on post-splinting films. He was recently splinted after evaluation by orthopedics, and the results of several CT’s are still pending. He suffered right comminuted tibia and fibula fractures, but fortunately, his only other injuries were some extremity abrasions and road rash. Nearly half of all service members undergoing fasciotomy reported persistent symptoms, and one in five individuals had unsuccessful surgical treatment.Authors: Brit Long, MD Attending Emergency Physician, San Antonio, TX) and Michael Gottlieb, MD, RDMS (Attending Emergency Physician and Ultrasound Director, Rush Medical Center, Chicago, IL) // Edited by: Alex Koyfman, MD Attending Emergency Physician, UTSW, Dallas, TX) CaseĪ 24-year-old male presents with severe right lower leg pain after a motorcycle accident. Multivariable analysis confirmed significant associations between surgical failure and perioperative complications (OR, 1.72), activity limitations (OR, 2.23), and persistence of preoperative symptoms (OR, 5.47), whereas other factors were not significantly associated with surgical failure.Ĭhronic exertional compartment syndrome is a substantial contributor to lower-extremity disability in the military population. Univariate analysis of prognostic factors revealed that surgical failure was associated with bilateral involvement (odds ratio, 1.64), perioperative complications (OR, 2.12), activity limitations (OR, 4.41), and persistence of preoperative symptoms (OR, 8.46). Surgical complications were documented for 15.7% of the patients, 5.9% underwent surgical revision, and 17.3% were referred for medical discharge because of chronic exertional compartment syndrome. Symptom recurrence was reported by 44.7% of the patients, and 27.7% were unable to return to full activity. Of the surgical procedures, 77.4% involved only anterior and lateral compartment releases 19.4% addressed the anterior, lateral, and posterior compartments and 2.2% addressed the posterior compartments alone. The average patient age was 28.0 years, and 91.8% of the patients were male. Army Physical Disability Agency database.Ī total of 611 patients underwent 754 surgical procedures. Demographic variables including age, sex, and rank were extracted, and rates of postoperative complications, activity limitations, and revision surgery or medical discharge were obtained from the electronic medical record and U.S. Individuals who had undergone surgical fasciotomy of the anterior, lateral, and/or posterior compartments (current procedural terminology codes 27600, 27601, and 27602) for nontraumatic compartment syndrome of the lower extremity (International Classification of Diseases, Ninth Revision code 729.72) between 20 were identified from the Military Health System Management Analysis and Reporting Tool (M2). We are not aware of any previous study in which the authors rigorously evaluated the rates of return to full activity, persistent disability, and surgical revision after operative management of chronic exertional compartment syndrome of the leg in a large, physically active population. Chronic exertional compartment syndrome of the leg is a frequent source of lower-extremity pain in military personnel, competitive athletes, and runners.
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