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      Acute Compartment Syndrome of the Limbs: Current Concepts and Management

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          Abstract

          Acute compartment syndrome (ACS) of the limb refers to a constellation of symptoms, which occur following a rise in the pressure inside a limb muscle compartment. A failure or delay in recognising ACS almost invariably results in adverse outcomes for patients. Unrecognised ACS can leave patients with nonviable limbs requiring amputation and can also be life–threatening. Several clinical features indicate ACS. Where diagnosis is unclear there are several techniques for measuring intracompartmental pressure described in this review. As early diagnosis and fasciotomy are known to be the best determinants of good outcomes, it is important that surgeons are aware of the features that make this diagnosis likely. This clinical review discusses current knowledge on the relevant clinical anatomy, aetiology, pathophysiology, risk factors, clinical features, diagnostic procedures and management of an acute presentation of compartment syndrome.

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          Most cited references80

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          Acute compartment syndrome. Who is at risk?

          We have analysed associated factors in 164 patients with acute compartment syndrome whom we treated over an eight-year period. In 69% there was an associated fracture, about half of which were of the tibial shaft. Most patients were men, usually under 35 years of age. Acute compartment syndrome of the forearm, with associated fracture of the distal end of the radius, was again seen most commonly in young men. Injury to soft tissues, without fracture, was the second most common cause of the syndrome and one-tenth of the patients had a bleeding disorder or were taking anticoagulant drugs. We found that young patients, especially men, were at risk of acute compartment syndrome after injury. When treating such injured patients, the diagnosis should be made early, utilising measurements of tissue pressure.
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            The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder?

            Todd Ulmer (2002)
            To assess whether published studies support basing the diagnosis of compartment syndrome of the lower leg on clinical findings. A MEDLINE search of the English literature from 1966 to 2001 was performed using "compartment syndromes" as the subject. A manual search of the bibliographies of retrieved articles and of major orthopaedic texts was also performed. Of 1,932 titles identified, 433 abstracts of potential relevance were reviewed, and 104 articles from relevant abstracts were examined in their entirety. Four studies met all eligibility criteria. Criteria for inclusion included the following: (a) target population, traumatic or iatrogenic tibia injuries; (b) diagnostic test, presence of data needed to calculate both the sensitivity and specificity of clinical findings; (c) outcome, the presence or absence of compartment syndrome; and (d) methodologic criteria, prospective study design. The likelihood ratio form of Bayes' theorem was used to assess the discriminatory ability of the clinical findings as tests for the compartment syndrome. There are limited data from which to define the usefulness of clinical findings for the diagnosis of compartment syndrome. Data from eligible studies suggest that the sensitivity of clinical findings for diagnosing compartment syndrome is low (13% to 19%). The positive predictive value of the clinical findings was 11% to 15%, and the specificity and negative predictive value were each 97% to 98%. These findings suggest that the clinical features of compartment syndrome of the lower leg are more useful by their absence in excluding the diagnosis than they are when present in confirming the diagnosis. Likelihood ratio calculations found that the probability of compartment syndrome with one clinical finding was approximately 25%, and the probability was 93% with 3 clinical findings present. However, these findings are based on limited information; because of the paucity of data available, the predictive value of the clinical findings for the diagnosis of compartment syndrome has yet to be defined.
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              Diagnosing acute compartment syndrome.

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                Author and article information

                Journal
                Open Orthop J
                Open Orthop J
                TOORTHJ
                The Open Orthopaedics Journal
                Bentham Open
                1874-3250
                30 November 2012
                2012
                : 6
                : 535-543
                Affiliations
                [1 ]Brighton and Sussex Medical School, Brighton, BN25XL, UK
                [2 ]Department of Plastic Surgery, Good Hope Hospital, Rectory road, West Midlands B75 7RR, UK
                [3 ]Department of Plastic Surgery, Whiston Hospital, Warrington Road, L355DR, UK
                [4 ]University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA74LP, UK
                [5 ]Department of Plastic Surgery, Countess of Chester Hospital, Liverpool Road, Chester, CH21UL, UK
                Author notes
                [* ]Address correspondence to this author at the Department of Plastic Surgery, Whiston Hospital, Warrington Road, L355DR, UK; Tel: 01244366265; Fax: 01244366265; E-mail: hindocha2001@ 123456yahoo.com
                Article
                TOORTHJ-6-535
                10.2174/1874325001206010535
                3522209
                23248724
                196ae023-271a-4754-96ae-c1e5d2559b23
                © Mabvuure et al.; Licensee Bentham Open.

                This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                : 14 August 2012
                : 7 September 2012
                : 19 September 2012
                Categories
                Article
                Suppl 3

                Orthopedics
                pathophysiology,fasciotomy,myofascial compartment,acute compartment syndrome,intracompartmental pressure,review.

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