Compartment Syndrome A Guide to Diagnosis and Management Cyril Mauffrey David J. Hak Murphy P. Martin III Editors Compartment Syndrome Cyril Mauffrey • David J. Hak Murphy P. Martin III Editors Compartment Syndrome A Guide to Diagnosis and Management Editors Cyril Mauffrey , MD, FACS, FRCS David J. Hak, MD, MBA, FACS Professor of Orthopedic Surgery Central Florida Regional Hospital Interim Director of Service Hughston Orthopedic Trauma Group Department of Orthopedics Sanford, FL Denver Health Medical Center USA Denver, CO USA Murphy P. Martin III, MD Assistant Professor Department of Orthopedic Surgery Tulane University School of Medicine New Orleans, LA USA This book is an open access publication. ISBN 978-3-030-22330-4 ISBN 978-3-030-22331-1 (eBook) https://doi.org/10.1007/978-3-030-22331-1 © The Editor(s) (if applicable) and The Author(s) 2019 Open Access This book is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The images or other third party material in this book are included in the book’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the book's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. 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This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface Despite the relatively high incidence of compartment syndrome and the fairly dis- mal outcomes, this condition remains poorly studied and understood. While the pathophysiology seems to be clear, an absolute diagnosis is at times virtually impos- sible. The conundrum of the timing of onset of symptoms and of the relationship between level of pain, symptoms, signs, and microscopic changes within the com- partment 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 acces- sible 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. Denver, CO, USA Cyril Mauffrey Sanford, FL, USA David J. Hak New Orleans, LA, USA Murphy P. Martin III v Acknowledgments We want to acknowledge our funding body AO North America for making this proj- ect possible. vii 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 ix x Contents 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 Index ������������������������������������������������������������������������������������������������������������������ 177 Contributors Amiethab Aiyer, MD University of Miami Hospital, Department of Orthopedic Surgery, Miami, FL, USA Derek Ball, BSc (Hons), PhD School of Medicine, University of Aberdeen, Medical Sciences and Nutrition, Aberdeen, Aberdeenshire, UK Jennifer L. Bruggers, MD Resurgens Orthopedics, Atlanta, GA, USA Salih Colakoglu, MD Plastic Surgery Department, University of Colorado, Aurora, CO, USA Charles M. Court-Brown, MD, FRCS (Ed), Orth University of Edinburgh, Edinburgh, UK Andrew D. Duckworth, Bsc, FRCS Edinburgh Orthopedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK Joshua L. Gary, MD University of Texas Health Science Center at Houston, McGovern Medical School, Department of Orthopedic Surgery, Houston, TX, USA Peter V. Giannoudis, BSc, 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. Hak, MD, MBA Hughston Orthopedic Trauma Group, Central Florida Regional Hospital, Sanford, FL, USA Sascha Halvachizadeh, MD University Hospital Zurich, Trauma Department, Zurich, Zurich, Switzerland Edward J. Harvey, MD, MSc, FRCSC McGill University, Michal and Renata Hornstein Chair in Surgical Excellence, Montreal General Hospital, Montreal, QC, Canada xi xii Contributors Vasilios G. Igoumenou, MD First Department of Orthopedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Attica, Greece Kyros Ipaktchi, MD, FACS Orthopedic Department, Denver Health Medical Center, Denver, CO, USA Kai Oliver Jensen, MD University Hospital Zurich, Trauma Department, Zurich, Zurich, Switzerland Alan J. Johnstone, MB, ChB, FRCSE (Orth) Aberdeen Royal Infirmary & University of Aberdeen, Orthopedic Trauma Unit, Aberdeen, Grampian Region, UK Anish R. Kadakia, MD University of Miami Hospital, Department of Orthopedic Surgery, Miami, FL, USA Northwestern University, Northwestern Memorial Hospital, Chicago, IL, USA Jonathan Kaplan, MD University of Miami Hospital, Department of Orthopedic Surgery, Miami, FL, USA Orthopedic Specialty Institute, Orange, CA, USA Zinon T. Kokkalis, MD Department of Orthopedics, University of Patras, Patras, Achaia, Greece Christopher Lee, MD 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. Lin, MD, MA Cedars-Sinai Medical Center, Department of Orthopedic Surgery, Los Angeles, CA, USA Milton T. M. Little, MD Cedars-Sinai Medical Center, Orthopedic Surgery Department, Cedars-Sinai Orthopedic Center, Los Angeles, CA, USA Julian G. Lugo-Pico, MD University of Miami Hospital, Department of Orthopedic Surgery, Miami, FL, USA University of Miami/Jackson Memorial Hospital, Miami, FL, USA Douglas W. Lundy, MD, MBA, FACS Resurgens Orthopedics, Atlanta, GA, USA Michael Maher, MD Denver Health Medical Center, Department of Orthopedic Trauma, Denver, CO, USA Cyril Mauffrey, MD, FACS, FRCS Department of Orthopedic Surgery, Denver Health Medical Center, Denver, CO, USA Andreas F. Mavrogenis, MD First Department of Orthopedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Attica, Greece Margaret M. McQueen, MD, FRCSEd(orth) University of Edinburgh, Edinburgh, UK Contributors xiii Geraldine Merle, PhD Montreal General Hospital, Montreal,