Assessment and diagnosis of acute limb compartment syndrome: A literature review

Ali, Parveen; Santy-Tomlinson, Julie; Watson, Roger

Abstract

Background: Compartment syndrome is a collection of symptoms that signal increased pressure in the muscle compartment and results in compromised tissue perfusion. Failure to diagnose and treat the condition can result in permanent neurovascular deficit, tissue ischaemia, limb amputation and rhabdomyolysis. Aims: The aim of the review was to determine the strength of the evidence regarding risk reduction and early detection of ALCS and to identify the gaps in the evidence. Methods: Following a systematic search, literature about patient risk, risk reduction, clinical observation and compartment monitoring was identified and the methodological quality of studies was considered. Findings: Diaphyseal fractures of the tibia are the most significant risk factor for compartment syndrome followed by fracture of the distal radius. The anterior compartment of the leg and the flexor compartment of the forearm are most affected. Other factors include calcaneal fractures, male gender, age <35 years, high energy trauma, soft tissue injuries (especially in patients with bleeding disorders), open fracture, limb compression due to traction, padding and casts and surgical management of fractures. Males aged below 35 years who sustain a fracture of the lower leg or forearm should be monitored most carefully. Clinical observations, together with compartment pressure monitoring, in patients at risk appears to be the best method of diagnosing the condition. Pain out of proportion to the injury and pain on passive muscle stretch are the most effective clinical observation in conscious patients. Paresis/paralysis, parasthesia and pallor may help in diagnosis but are late signs. The sensitivity and specificity of these symptoms in diagnosing ALCS is unclear and the approach to pain assessment is not considered in detail.

Citation

Ali, P., Santy-Tomlinson, J., & Watson, R. (2014). Assessment and diagnosis of acute limb compartment syndrome: A literature review. International Journal of Orthopaedic and Trauma Nursing, 18(4), 180-190. https://doi.org/10.1016/j.ijotn.2014.01.002

• Acceptance Date: Jul 8, 2013
• Online Publication Date: Jan 27, 2014
• Publication Date: 2014-11
• Deposit Date: Jun 29, 2016
• Publicly Available Date: Jun 29, 2016
• Journal: International journal of orthopaedic and trauma nursing
• Print ISSN: 1878-1241
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 18
• Issue: 4
• Pages: 180-190
• DOI: https://doi.org/10.1016/j.ijotn.2014.01.002
• Keywords: Acute limb compartment syndrome
• Public URL: https://hull-repository.worktribe.com/output/440529
• Publisher URL: http://www.sciencedirect.com/science/article/pii/S1878124114000045
• Additional Information: This is the accepted manuscript version of an article published in International journal of orthopaedic and trauma nursing, 2014, v.18 issue 4.
• Contract Date: Jun 29, 2016