Survey

Acute Compartment Syndrome: An Expert Survey of Orthopaedic Trauma Association Members

Collinge, Cory A. MD^*; Attum, Basem MD^*; Lebus, George F.^†; Tornetta, Paul III MD^‡; Obremskey, William MD^*; Ahn, Jaimo MD^§; Mirick, Gudrun MD^‖; Schmidt, Andrew MD^‖; Spitler, Clay MD^¶; Coles, Chad MD^**; Krause, Peter MD^††; the Orthopaedic Trauma Association's Evidence-based Quality and Value Committee

Author Information

^*Vanderbilt University Medical Center, Nashville, TN;

^†Orthopedic Speciality Associates, Fort Worth, TX;

^‡Boston University Medical Center, Boston, MA;

^§University of Pennsylvania Medical Center, Philadelphia, PA;

^‖University of Minnesota/Hennepin County Medical Center, Minneapolis, MN;

^¶University of Mississippi Medical Center, Jackson, MS;

^**Dalhousie Orthopedics/Queen Elizabeth II Health Sciences Centre Halifax, NS, Canada; and

^††Louisiana State University Health Sciences Center, New Orleans, LA.

Reprints: Cory A. Collinge, MD, Vanderbilt University Medical Center Medical Center East, South Tower Suite 4200, Nashville, TN 37235 (e-mail: [email protected]).

The authors report no conflict of interest.

Journal of Orthopaedic Trauma 32(5):p e181-e184, May 2018. | DOI: 10.1097/BOT.0000000000001128

Abstract

Objectives:

The goal of this study was to describe current opinions of orthopaedic trauma experts regarding acute compartment syndrome (ACS).

Design:

Web-based survey.

Participants:

Active Orthopaedic Trauma Association (OTA) members.

Methods:

A 25-item web-based questionnaire was advertised to active members of the OTA. Using a cross-sectional survey study design, we evaluated the perceived importance of ACS, as well as preferences in diagnosis and treatment.

Results:

One hundred thirty-nine of 596 active OTA members (23%) completed the survey. ACS was believed to be clinically important and with severe sequelae, if missed. Responses indicated that diagnosis should be based on physical examination in an awake patient, and that intracompartmental pressure testing was valuable in the obtunded or unconscious patient. The diagnosis of ACS with monitoring should be made using the difference between diastolic blood pressure and intracompartmental pressure (ΔP) of ≤30 mm Hg. Once ACS is diagnosed, respondents indicated that fasciotomies should be performed as quickly as is reasonable (within 2 hours). The consensus for wound management was closure or skin grafting within 1–5 days later, and skin grafting was universally recommended if closure was delayed to >7 days.

Conclusions:

ACS is a challenging problem with poor outcomes if missed or inadequately treated. OTA members demonstrated agreement to many diagnostic and treatment choices for ACS.

Level of Evidence:

Therapeutic Level V. See Instructions for Authors for a complete description of the levels of evidence.

Article Keywords

Keywords
compartment syndrome, acute compartment syndrome, fasciotomy, missed compartment syndrome, OTA, EBQVS, expert, opinion, survey

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Acute Compartment Syndrome: An Expert Survey of Orthopaedic Trauma Association Members