Editors

Cyril Mauffrey, David J. Hak and Murphy P. Martin III

Compartment Syndrome

A Guide to Diagnosis and Management

Editors

Cyril MauffreyMD, FACS, FRCS

Professor of Orthopedic Surgery, Interim Director of Service, Department of Orthopedics, Denver Health Medical Center, Denver, CO, USA

David J. HakMD, MBA, FACS

Central Florida Regional Hospital, Hughston Orthopedic Trauma Group, Sanford, FL, USA

Murphy P. Martin IIIMD

Assistant Professor, Department of Orthopedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA

ISBN 978-3-030-22330-4e-ISBN 978-3-030-22331-1

https://doi.org/10.1007/978-3-030-22331-1

This book is an open access publication.

© The Editor(s) (if applicable) and The Author(s) 2019

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Preface

Despite the relatively high incidence of compartment syndrome and the fairly dismal outcomes, this condition remains poorly studied and understood. While the pathophysiology seems to be clear, an absolute diagnosis is at times virtually impossible. The conundrum of the timing of onset of symptoms and of the relationship between level of pain, symptoms, signs, and microscopic changes within the compartment remains a mystery. The aim of our open-access text was to review this condition to answer simple questions pertinent to compartment syndrome. We have gathered a group of experts in the field to provide an easily downloadable and accessible series of chapters. The book covers topics ranging from diagnosis to treatment and outcomes. We use the same format in each chapter to enhance the readers’ experience. We hope that you will enjoy and learn. The open-access format will make this work available to low- and middle-income countries where surgeons do not always have the resources to fund such material.

We dedicate this work to our hardworking residents and fellows, without whom, our daily activities would not be as stimulating as they are.

Cyril Mauffrey

David J. Hak

Murphy P. MartinIII

Denver, CO, USASanford, FL, USANew Orleans, LA, USA

Acknowledgments

We want to acknowledge our funding body AO North America for making this project possible.

Contents

1 Diagnostic Dilemma for the Orthopedic Surgeon 1

Michael Maher and Cyril Mauffrey

2 Legal Aspects of Compartment Syndrome 9

Milton T. M. Little, Carol A. Lin and Mark S. Vrahas

3 Pathophysiology of Compartment Syndrome 17

Geraldine Merle and Edward J. Harvey

4 Determining Ischaemic Thresholds Through Our Understanding of Cellular Metabolism 25

Alan J. Johnstone and Derek Ball

5 Pressure Measurement:​ Surrogate of Ischaemia 35

Andrew D. Duckworth, Charles M. Court-Brown and Margaret M. McQueen

6 Limitations of Pressure Measurement 51

David J. Hak and Cyril Mauffrey

7 Fasciotomy:​ Upper Extremity 59

Kyros Ipaktchi, Jessica Wingfield and Salih Colakoglu

8 Compartment Syndrome of the Lower Extremity 67

Cody M. Tillinghast and Joshua L. Gary

9 Fasciotomy Wound Management 83

Vasilios G. Igoumenou, Zinon T. Kokkalis and Andreas F. Mavrogenis

10 Foot Compartment Syndrome Controversy 97

Julian G. Lugo-Pico, Amiethab Aiyer, Jonathan Kaplan and Anish R. Kadakia

11 Management of Missed Compartment Syndrome 105

Douglas W. Lundy and Jennifer L. Bruggers

12 Compartment Syndrome Due to Patient Positioning 113

Sascha Halvachizadeh, Kai Oliver Jensen and Hans-Christoph Pape

13 Acute Compartment Syndrome in Children 125

David J. Hak

14 Compartment Syndrome in Polytrauma Patients 133

Christopher Lee and Robert V. O’Toole

15 Unusual Presentation of Compartment Syndrome 145

Ioannis V. Papachristos and Peter V. Giannoudis

16 Common Misperceptions Among Health-Care Professionals 161

Joshua A. Parry

17 Novel Modalities to Diagnose and Prevent Compartment Syndrome 169

Andrew H. Schmidt

Corrections to:​ Fasciotomy Wound Management C1

Index 177

Contributors

Amiethab AiyerMD

University of Miami Hospital, Department of Orthopedic Surgery, Miami, FL, USA

Derek BallBSc (Hons), PhD

School of Medicine, University of Aberdeen, Medical Sciences and Nutrition, Aberdeen, Aberdeenshire, UK

Jennifer L. BruggersMD

Resurgens Orthopedics, Atlanta, GA, USA

Salih ColakogluMD

Plastic Surgery Department, University of Colorado, Aurora, CO, USA

Charles M. Court-BrownMD, FRCS (Ed), Orth

University of Edinburgh, Edinburgh, UK

Andrew D. DuckworthBsc, FRCS

Edinburgh Orthopedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK

Joshua L. GaryMD

University of Texas Health Science Center at Houston, McGovern Medical School, Department of Orthopedic Surgery, Houston, TX, USA

Peter V. GiannoudisBSc, MB, MD, FRCS, FACS

Academic Department of Trauma and Orthopedics, School of Medicine, University of Leeds, NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK

David J. HakMD, MBA

Hughston Orthopedic Trauma Group, Central Florida Regional Hospital, Sanford, FL, USA

Sascha HalvachizadehMD

University Hospital Zurich, Trauma Department, Zurich, Zurich, Switzerland

Edward J. HarveyMD, MSc, FRCSC

McGill University, Michal and Renata Hornstein Chair in Surgical Excellence, Montreal General Hospital, Montreal, QC, Canada

Vasilios G. IgoumenouMD

First Department of Orthopedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Attica, Greece

Kyros IpaktchiMD, FACS

Orthopedic Department, Denver Health Medical Center, Denver, CO, USA

Kai Oliver JensenMD

University Hospital Zurich, Trauma Department, Zurich, Zurich, Switzerland

Alan J. JohnstoneMB, ChB, FRCSE (Orth)

Aberdeen Royal Infirmary & University of Aberdeen, Orthopedic Trauma Unit, Aberdeen, Grampian Region, UK

Anish R. KadakiaMD

University of Miami Hospital, Department of Orthopedic Surgery, Miami, FL, USA

Northwestern University, Northwestern Memorial Hospital, Chicago, IL, USA

Jonathan KaplanMD

University of Miami Hospital, Department of Orthopedic Surgery, Miami, FL, USA

Orthopedic Specialty Institute, Orange, CA, USA

Zinon T. KokkalisMD

Department of Orthopedics, University of Patras, Patras, Achaia, Greece

Christopher LeeMD

R Adams Cowley Shock Trauma Center, Department of Orthopedic Surgery, Baltimore, MA, USA

Virginia Commonwealth University, Department of Orthopedic Surgery, Trauma, Richmond, VA, USA

Carol A. LinMD, MA

Cedars-Sinai Medical Center, Department of Orthopedic Surgery, Los Angeles, CA, USA

Milton T. M. LittleMD

Cedars-Sinai Medical Center, Orthopedic Surgery Department, Cedars-Sinai Orthopedic Center, Los Angeles, CA, USA

Julian G. Lugo-PicoMD

University of Miami Hospital, Department of Orthopedic Surgery, Miami, FL, USA

University of Miami/Jackson Memorial Hospital, Miami, FL, USA

Douglas W. LundyMD, MBA, FACS

Resurgens Orthopedics, Atlanta, GA, USA

Michael MaherMD

Denver Health Medical Center, Department of Orthopedic Trauma, Denver, CO, USA

Cyril MauffreyMD, FACS, FRCS

Department of Orthopedic Surgery, Denver Health Medical Center, Denver, CO, USA

Andreas F. MavrogenisMD

First Department of Orthopedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Attica, Greece

Margaret M. McQueenMD, FRCSEd(orth)

University of Edinburgh, Edinburgh, UK

Geraldine MerlePhD

Montreal General Hospital, Montreal, QC, Canada

Sean MorellMD

Orthopedic Department, University of Colorado, Aurora, CO, USA

Robert V. O’TooleMD, MS

R Adams Cowley Shock Trauma Center, Department of Orthopedic Surgery, Baltimore, MA, USA

Ioannis V. PapachristosMD, MSc

Leeds Teaching Hospitals NHS Trust, Department of Trauma and Orthopedics, Leeds General Infirmary, Leeds, UK

Hans-Christoph PapeMD, FACS

University Hospital Zurich, Trauma Department, Zurich, Zurich, Switzerland

Joshua A. ParryMD, MS

Denver Health Medical Center, Department of Orthopedics, Denver, CO, USA

Andrew H. SchmidtMD

University of Minnesota, Minneapolis, MN, USA

Department of Orthopedic Surgery, Hennepin Healthcare, Minneapolis, MN, USA

Cody M. TillinghastMD

University of Texas Health Science Center at Houston, McGovern Medical School, Department of Orthopedic Surgery, Houston, TX, USA

Mark S. VrahasMD, MHCDS

Cedars-Sinai Medical Center, Department of Orthopedic Surgery, Los Angeles, CA, USA

Jessica WingfieldMD

Orthopedic Department, University of Colorado, Aurora, CO, USA