Compartment syndrome is a limb-threatening and ultimately a life-threatening condition that results from a fall in perfusion pressure below tissue pressure in a close anatomical space. Tissue perfusion is proportional to the difference between the capillary perfusion pressure and the interstitial fluid pressure. When the interstitial pressure exceeds the capillary perfusion pressure, capillary collapse occurs with decreased blood flow and resulting muscle and tissue ischemia. Prolonged tissue ischemia leads to muscle destruction (rhabdomyolysis) and subsequent renal failure. Compartment syndrome can affect the upper extremities as well as lower extremities or part of an extremity (hand, forearm). The most common causes of compartment syndrome include:
Long bone fracture
Compression secondary to a crush injury
Tight cast or dressing
Malposition on operating room table
The increase in compartment pressure results in decreased blood flow and resulting ischemia. Compartment pressures of 50 mm Hg to 80 mm Hg can only be tolerated for limited periods of time before muscle necrosis (death of muscle tissue) occurs. Sensory abnormalities can precede motor deficiencies. Common symptoms associated with compartment syndrome include:
Feeling of tightness and swelling
The last five symptoms also known as the 5Ps (pain, pallor, paresthesias, paralysis and pulselessness) are characteristic of compartment syndrome but because they are late signs, irreversible damage may have already occurred when they appear. A patient suffering from a compartment syndrome will typically complain of pain that appears to be out of proportion to the injury. A patient that suffers a compartment syndrome as a result of having been malpositioned on the operating room table (prolonged lithotomy position for gynecologic surgery) may not even be aware that an injury had occurred. Clinical presentation of pain out of proportion with an injury (or in the absence of an injury) should alert the medical provider to compartment syndrome as the underlying cause.
Measurement of compartment pressures is the standard method for diagnosis of a compartment syndrome. Failure to timely diagnose a compartment syndrome results in delayed treatment with consequential damages. In acute compartment syndrome, surgical fasciotomy to relieve the compartment pressure is indicated. Removal of a tight cast may relieve the offending cause. Failure to treat a compartment syndrome results in tissue necrosis that leads to permanent functional impairment which can produce renal failure and death. Timely diagnosis and treatment is essential to avoid loss of muscle function. Little or no muscle function can be expected if diagnosis and treatment are unduly delayed.
If you believe that you or your loved suffered an injury due to compartment syndrome following a surgical procedure, have been misdiagnosed, victims of a compartment syndrome complication or wrongly treated and suspect the complications may be the result of a medical provider’s error that was diagnosable, avoidable and/or preventable, you may have a valid cause of action. The injury may be the result of a medical provider's mistake in handling your condition and the result of medical negligence. Dr. Borten has over 35 years of experience as an obstetrician and gynecologic surgeon to fully evaluate the merits of your potential case. Allow the Boston area medical malpractice attorneys at Gorovitz & Borten help you assert your rights and get the compensation you deserve.
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