Novel Modalities to Diagnose and Prevent Compartment Syndrome

Abstract

Acute compartment syndrome (ACS) of an extremity following trauma is a diagnostic challenge. The clinical signs and symptoms of ACS are variable and unreliable, also being commonly present in patients without ACS. Objective diagnostic tests based on the measurement of muscle pressure are sensitive, but not specific, with a high false-positive rate that leads to overtreatment. Clinicians have to rely as much on their clinical judgment to determine when fasciotomy is necessary as on the values of any specific test. There is currently little that can be done to alter the natural history of ACS: it either develops or it does not, and clinicians observe and try to intervene when needed, at just the right moment. Improved understanding of the pathophysiology of ACS and new thinking about the diagnosis of ACS may soon lead to new methods of diagnosis and possibly even ways to prevent or treat ACS without the morbidity of fasciotomy. This chapter reviews the latest literature regarding novel methods of diagnosing and treating patients at risk of ACS following extremity injury.