Compartment syndrome develops when swelling or bleeding occurs within a “compartment” in the body. It is a painful condition that results when pressure within the muscles builds to dangerous levels and does not subside. Often it occurs after a a traumatic event, such as a fractured limb.
The connective tissue inside a limb, known as fascia, does not expand, so an injury to this area will cause swelling that presses on the blood vessels, nerves and muscle, potentially disrupting blood flow to the arms or legs, resulting in serious damage.
Unrecognized and untreated, compartment syndrome may lead to muscle and tissue death and even amputation. Compartment syndrome is caused by decreased blood flow to the affected limb. Decreased blood flow results in lack of oxygen and nourishment reaching nerve and muscle cells.
Compartment syndrome is a medical emergency. Heath care providers are required to recognize patients who are at risk for developing compartment syndrome, to intervene to prevent it from developing, and to take action to treat it once it develops.
Conditions that may result in compartment syndrome include:
- Muscle injury and swelling.
- Post-operative swelling especially following orthopedic surgery.
- Crush injuries.
- Constricting bandages such as casts and tight bandages.
A compartments refers to the collection of muscles, nerves, and blood vessels in the arms, legs, and elsewhere. The body’s muscles, nerves, and blood vessels are covered or encased in a tough membrane called the fascia. The role of fascia is to keep the these tissues in place. Fascia does not stretch or expand easily.
The drawing below depicts the “compartment” area between the knee and ankle where there are four major muscle compartments: anterior, lateral, superficial posterior, deep posterior.
Treatment for Acute Compartment Syndrome
Once compartment syndrome develops the treatment is surgery, an operation known as a fasciotomy. A fasciotomy is an operation where the surgeon opens the fascia to allow the muscles to swell thus relieving the pressure within the compartment.
The goal of the operation is relieve the built up pressure and impaired circulation to the affected area. Fasciotomy is a limb-saving procedure. In acute compartment syndrome, unless the pressure is relieved quickly, permanent disability and tissue death may result in as little as 2 hours. There is no non-surgical alternative.
In the lower leg, one, or more of the four muscle compartments is involved. With an acute compartment syndrome, it is safest to release all four compartments. Without a steady supply of oxygen and nutrients, nerve and muscle cells can be damaged.
Medical Malpractice and Compartment Syndrome
Treatment delays may cause permanent injury. Delays in diagnosis and surgery to release the pressure in the affected body part may lead to permanent muscle and nerve damage and resulting functional deficits. The longer the delay the worse the outcome. Amputation may result if the condition is not recognized in a timely fashion.
Because prognosis depends on timely diagnosis and treatment, delays in treatment may constitute medical malpractice. The earlier surgical treatment is provided, the earlier blood flow restored, and the greater likelihood of complete recovery will be achieved. The longer the delay the worse the outcome. Studies indicate that only 8% of patients had normal limb function after critical diagnostic and treatment delays.
If you believe that a loved one’s compartment an amputation was preventable and was due to another’s negligence or malpractice contact an experienced malpractice lawyer.
Call Patrick J. Filan.