Failure to Diagnose and Treat Compartment Syndrome

Failure to Diagnose and Treat Compartment Syndromes can be medical malpractice.  Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment.  http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002204/  It can lead to muscle and nerve damage and problems with blood flow. Early diagnosis and treatment is key to preventing serious permanent injury.  Physicians need to be aware of the presenting signs and symptoms and must maintain a hightened level of suspicion when compartment syndrome is a possibility.  This is definitely one of those medical conditions which frequently do not follow the classic picture. Disporportionate pain unreleaved by narcotics is the hallmark symptom.  Definitive diagnosis can only be made by measurement of compartment pressure.  In cases where compartment syndrome is a the most likely diagnosis the patient should be taken immediately to surgery.  When there is some doubt, compartment pressures need to be measured.  This can be done relatively easily and harmlessly with a portable medical devise that should be available in the ER. 

I'm currently working on a case involving a young teenager, operated on for recurrent ankle sprain 5 days earlier, who suddenly developed severe pain not releaved by the oral narcotics (Percocet and Oxycodone) she had been perscribed.   http://www.scottlawks.com/  Her parents took her to the ER where her pain persisted despite her having received several IV doses of even stronger narcotics.   The ER physicians consulted by phone with her orthopedic surgeon who then asked one of the orthopedic residents to examine her.  Her compartment pressures were not measured and instead it was decided she would be admitted for overnight observation.  When her orthopedic surgeon say her the next day he ordered that she be taken immediately to surgery.  It was still another 4 hours before surgery was begun.  Unfotunately the compartment syndrome was allowed to persist for a long enough period of time that it resulted in muscle and nerve tissue damage and premanent severe disability and disfigurement.  The young lady has now had several reconstructive surgeries in an effort to resolve some of her claw foot. 

I litigation is just getting started and I doubt that her orthopedic surgeon will admit it, but I am fairly certain she would have a normal foot today had he been the one who examined her in the ER the day before.  I doubt that he would have made the mistake that the ER physician and the orthopedic resident had made.  All three physicians should have been suspected compartment syndrome and her compartment pressures should have been measured shortly after her parents took her to the ER.