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A Pressure Transducer for Diagnosing Compartment Syndrome

Posted in Research to Reality | Jan 2012 | Comments (0)

Tags: Featuredorthopaedic surgical devicesorthopaedic technologytechnologyclinical challenges

Background

An internet search for “compartment syndrome” will inevitably turn up a recent story about a soldier or young adult who sustains a leg injury and, after a stable period following initial treatment, develops compartment syndrome. In fortunate cases the complication is detected early, and serious consequences are avoided. Unfortunately, all too often an otherwise healthy young adult ends up with permanent nerve injury, contractures or worse, and the hospital and physician become embroiled in a lawsuit.

Missed or delayed diagnosis of compartment syndrome is one of the most common causes of litigation in orthopaedics.1 A study conducted in the early 1990s found that awards after missed compartment syndrome were just under $300,000.2 In all cases in the series, compartment pressures were never measured. In a more recent study, it was reported that the claims made of 16 patients in whom compartment syndrome was missed reached $3.8 million.3 Two factors were found to contribute most to the missed diagnosis: (1) the compartment pressure had not been measured, and (2) most patients had been evaluated by more than one physician as the syndrome evolved over a period of time. Clearly, failure to measure or document compartment pressure is an important factor in claims being awarded in compartment syndrome litigation.

The most important determinant of a poor outcome from acute compartment syndrome after injury is delay in diagnosis.4 For instance, in an oft cited work by Matsen et al., a delay in surgical decompression for 12 hours resulted in permanent disability in 80% of cases when compared with no apparent clinical defects in patients treated within 12 hours.5 Others have suggested that irreversible muscle damage begins as soon as three hours after the initial injury.6 A commonly cited reason for delayed or missed diagnosis is a failure to measure and/or document the compartment pressure, often because the appropriate pressure measurement equipment is not readily accessible. A recent survey in the UK noted that half of participating departments did not have tools capable of measuring compartment pressure.7

The validity of clinical findings in compartment syndrome has been a source of pointed debate, with some authors advocating that the diagnosis of compartment syndrome is purely clinical8 while others point to inconsistency of clinical findings amongst patients.9,10 Proponents of compartment pressure monitoring argue that monitoring patients at high risk for compartment syndrome during the first 12 to 24 hours decreases the chance of missed diagnosis, with very little risk of significant complications.11



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