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Diagnostic Techniques in Acute Compartment Syndrome of the Leg

Shadgan, Babak MD, MSc*†; Menon, Matthew MD, FRCSC, MHSc; O'Brien, Peter J MD, FRCSC; Reid, W Darlene BMR (PT) PhD†§

doi: 10.1097/BOT.0b013e318183136d
Current State of the Art

Objectives: To review the efficacy of the current diagnostic methods of acute compartment syndrome (ACS) after leg fractures.

Data Sources: A Medline (PubMed) search of the English literature extending from 1950 to May 2007 was performed using “compartment syndromes” as the main key word. Also a manual search of orthopaedic texts was performed.

Study Selection and Extraction: The results were limited to articles involving human subjects. Of 2605 primary titles, 489 abstracts limited to compartment syndromes in the leg and 577 articles related to the diagnosis of compartment syndromes were identified and their abstracts reviewed. Further articles were identified by reviewing the references. Sixty-six articles were found to be relevant to diagnostic techniques for compartment syndrome in the leg and formed the basis of this review.

Conclusions: Early diagnosis of an ACS is important. Despite its drawbacks, clinical assessment is still the diagnostic cornerstone of ACS. Intracompartmental pressure measurement can confirm the diagnosis in suspected patients and may have a role in the diagnosis of this condition in unconscious patients or those unable to cooperate. Whitesides suggests that the perfusion of the compartment depends on the difference between the diastolic blood pressure and the intracompartmental pressure. They recommend fasciotomy when this pressure difference, known as the Δp, is less than 30 mm Hg. Access to a precise, reliable, and noninvasive method for early diagnosis of ACS would be a landmark achievement in orthopaedic and emergency medicine.

From the *Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada; †Muscle Biophysics Laboratory, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; ‡Trauma Orthopaedic Division, Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada; and §Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.

Accepted for publication January 12, 2008.

Reprints: Babak Shadgan, MD, MSc, Muscle Biophysics Laboratory, VGH Research Pavilion, 617-828 W. 10th Avenue, Vancouver, British Columbia, Canada V5Z 1L8 (e-mail: shadgan@interchange.ubc.ca).

The authors did not receive grants or outside funding in support of their research or preparation of the manuscript.

© 2008 Lippincott Williams & Wilkins, Inc.