Lawyer Monthly - January 2022 Edition

EXPERT WITNESS 63 JAN 2022 | WWW.LAWYER-MONTHLY.COM extremity with little function and commonly in chronic pain. In the event of extensive muscle necrosis, neurologic compromise and the onset of complications often associated with trauma and infection, amputation of the affected limb is sometimes required. Occasionally, the compartment syndrome can cause multi-system organ failure and death of the patient. What circumstances might cause a person to develop ACS? ACS has been associated with a variety of situations which lead to a compromise in the blood flow within the osseous-fascial compartment(s) in question. The phrase “a chance to cut is a chance to cure” is no better exemplified than in the setting of an Acute Compartment Syndrome. ACSs are most associated with a traumatic injury (with or without a fracture). However, they have been known to develop because of significant swelling or bleeding into a fascial compartment(s) and significant external pressure (e.g. circumferential burns, casts, wraps) of a limb, particularly in the setting of limb swelling following injury or surgery. ACSs have also been known to occur because of the development of a space-occupying mass (e.g. infection, wayward infusion, bleeding) into a fascial compartment. A lesser recognised cause of compartment syndrome has been referred to as a “well-leg compartment syndrome” (WLCS). A WLCS develops in a previously uninjured extremity (most often the leg), commonly because of prolonged static positioning of a patient on an operating room table. This positioning is believed to negatively influence the perfusion of the limb, causing the development of increased intra- compartmental pressures and a WLCS. What complications does this cause in personal injury litigation? Unfortunately, ACSs have been shown to develop in a variety of clinical situations and therefore there is not a single common cause responsible for their development. Additionally, ACS may develop soon after an injury or they may develop gradually and sometimes up to 2-3 days after the injury. Also, although the signs and symptoms associated with an ACS are well-described, they do not always present themselves uniformly or in a well-defined order, leading to clinical confusion and uncertainty. When these factors are combined with a patient who has an altered mental status or is obtunded/unconscious with clinicians who are not familiar with ACS the diagnosis can be delayed, sometimes with disastrous results. These confounding factors, which delay the diagnosis of an ACS, speak to the need for all physicians to be aware of the signs and symptoms of an ACS and remain vigilant to the possibility of its development in just about any patient. How have you encountered ACS in your work as an expert witness? I have encountered ACS, as well as WLCS, in my work as an expert witness on multiple occasions. I have reviewed cases where the diagnosis of the ACS should have been straightforward for the treating physician(s)