Compartment Syndrome
What is it?
Compartment syndrome is a condition characterised by swelling and consequent increase of pressure within a closed physiological structure (i.e., a compartment). If left untreated, this swelling will eventually cause a pressure overload within the compartment, which can distort some or all the structures within it - effectively, the pressure 'squashes' everything within the compartment over a period of time. Blood vessels, tendons and nerves running through the affected compartment may all be damaged. If blood vessels supplying the area are injured, then wider damage to the tissues which those vessels supplied with oxygenated blood is likely.
Compartment syndromes can occur in all limbs, although most occur in legs. There are very many causes of compartment syndrome, ranging from trauma and bleeding, to local inflammation, to the application of very tight wound dressings or casts.
Compartment syndrome is not a clinically 'silent' phenomenon. Sufferers will frequently experience numbness, coldness, pins and needles, pain or loss of movement either in the affected area or the extremity below (thus, a person suffering from compartment syndrome at right calf level might well not be able to feel his right foot). Depending on the structures which have been compressed or otherwise damaged, the lasting effects can be extremely serious: paralysis, extensive surgical debridement of dead muscle tissue from the affected area, contracture or even death may result.
Logically enough, the aim of treatment is to relieve the pressure. If, for example, a cast has been applied very tightly indeed, compartment syndrome might be prevented simply by removing the cast; however, there is normally a "window of opportunity" of only hours in which to avoid permanent damage to tissue in the affected area. If the symptoms are severe or are left untreated for any length of time, surgery may be mandated. Therefore, if a patient complains of any of the above symptoms, and is known to be suffering from a condition which might predispose him or her to a compartment syndrome, the area must be checked quickly and thoroughly.
How do we investigate the claim?
In order to win a compartment syndrome claim, we need to prove that contemporaneous clinical guidelines were not followed (breach of duty), and that if they had been, then on the balance of probabilities the condition would not have developed (causation). It follows from this that we need to find out what was most likely to have caused the condition, and whether the relevant guidelines were followed.
In our experience, these claims often require at least two experts. Because the condition can stem from trauma and its treatment, patients who have suffered compartment syndrome will frequently have been treated either in an Accident & Emergency or an Orthopaedics hospital department (or both). Consequently, it is usually necessary to instruct independent experts in the fields of either or both Accident & Emergency medicine, or Orthopaedics, to help us assess whether there has been a breach of the hospital's duty of care. We would normally expect to ask these practitioners whether care was appropriate and whether it was given within an acceptable timeframe: this latter judgement could well depend largely upon the symptoms the patient was experiencing, and also the clinical picture he or she presented at the time: a patient with both a plaster cast on his lower leg, and a blue foot that feels cold to the touch would present a highly suggestive picture for a developing compartment syndrome. In order to assess what damage has been caused by the compartment syndrome, we would probably instruct an expert in Vascular medicine. If favourable evidence is received on breach of duty and causation, we would then need to assess the patient's present condition and prognosis. Again, it is likely that this exercise would in the first instance be undertaken by a vascular specialist.
Contact
Steve Duddell Head of Medical Negligence
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