Lawyer Monthly - January 2022 Edition

n brief, what is acute compartment syndrome (ACS)? An acute compartment syndrome (ACS) is a condition characterised by increased intra-compartment pressure within an osseous- fascial muscle compartment. This increased tissue pressure causes decreased blood flow and oxygen perfusion within the compartment and, if left untreated, this compromised blood flow threatens the viability of the resident muscle and nerve often leading to long- term musculoskeletal dysfunction of the limb. Generally, an ACS follows a blunt injury to a portion of the body resulting in swelling, tissue damage, inflammation, and local ischemia. This typical body’s reaction to injury can lead to patchy oxygen metabolism deficiencies within the injured compartment, which accelerates the cycle to further increase intra- compartment tissue pressures, leading to worsening of the ACS. Acute compartment syndromes are one of the truly time- sensitive, limb-threatening, and life-threatening diagnoses in orthopaedic surgery. The diagnosis of an ACS is typically based on i Acute Compartment Syndrome One of the most dangerous and urgent diagnoses in orthopaedic surgery, acute compartment syndrome carries significant consequences for afflicted patients. Dr Joseph Borrelli shares an overview of ACS below, along with useful tips on what litigants, counsel and expert witnesses should know about the condition. 62 WWW.LAWYER-MONTHLY.COM | JAN 2022 EXPERT INSIGHT clinical symptoms and physical findings and can be difficult to make, particularly when they arise in unusual circumstances or in obtund and multiple injured patients. As a result of these factors, the development of acute compartment syndrome places the treating physician – commonly a primary care physician, including orthopaedic surgeons – at high risk of litigation, particularly in instances of delayed diagnosis or effective treatment. Can the condition cause death or lasting disability? The consequences of an acute compartment syndrome can be significant and typically correlate with the timing of diagnosis and the timing and adequacy of the treatment. The treatment for an ACS is fasciotomy, a surgical release of the enveloping muscle fascia, generally performed through long incisions along the length of the muscle compartment. Once an ACS has developed, “time is tissue” – that is once the ACS reaches a critical point muscle and nerves begin to die. If the ACS is allowed to progress to the point where there is widespread muscle and nerve necrosis (death), the subsequent function of the limb will be significantly compromised. If there is enough residual perfusion to maintain the viability of the limb and the systemic sequelae are not of sufficient severity to warrant amputation, the contracted state of the affected limb combined with the changes in sensation within the limb will leave the Acute compartment syndromes are one of the truly time- sensitive, limb- threatening, and life- threatening diagnoses in orthopaedic surgery. The Dangers of