Compartment Syndrome in the Leg
Compartment syndrome is an urgent condition and requires rapid treatment to release the affected compartment or compartments. If pressure is released in time, it can prevent injury and allow a full recovery. But if there is a delay in emergency surgery, the muscles will die and the patient will be left with long-term damage.
If opportunities to treat your compartment syndrome were missed, you could be entitled to pursue a medical compensation claim. Contact us at Glynns Solicitors for more information.
What is compartment syndrome?
To understand compartment syndrome, it is necessary to understand the anatomy of the lower limb:
- Underneath the skin there is a layer of fatty tissue, then there is a layer of thick fibrous tissue which forms like an internal stocking. The fibrous tissue attaches to the bones and covers the muscle, and in doing so divides the lower limb into four muscular compartments.
- If there is any cause for pressure to increase inside a compartment, the problem is that it is bound by the bone and the fascial tissue. This means there is nowhere for the increasing pressure to escape. Consequently the pressure will continue to build until it goes beyond a level where the blood can supply the muscles.
- As with other parts of the body, oxygen is carried to the muscles via the bloodstream. The muscles cannot live without oxygen, and in the absence of blood the muscles will begin to die. This will cause considerable pain to the individual concerned. As the pressure continues to increase, the arteries and nerves can also become injured.
Causes of compartments syndrome
There are many potential causes of compartment syndrome in the leg. One of the most common is a fracture of the long bones in the leg, which in turn causes bleeding in the compartment. This would typically affect several compartments.
Other causes do occur. For example, a muscular infection can create compartment syndrome. It can also happen because of a re-perfusion injury, which is when the blood supply to the compartment is cut off, resulting in muscle death. This might arise if a patient remains in the same position on the operating table for too long.
Compartment syndrome that occurs due to a re-perfusion injury is often very damaging, because the problem does not become apparent until the pressure is released and the blood supply is allowed to return. In these situations, the blood supply goes back into what is effectively dead muscle and causes rapid swelling, leading to a compartment syndrome. There is typically a poor recovery if the blood supply has been cut off for a prolonged period of time.
There are also cases of chronic compartment syndromes associated with runners, often termed 'shin splints'. In these cases the problem never quite damages the muscles but rather just creates pain so that the runner has to rest, which allows the muscles to relax and the pain to subside.
Diagnosing compartment syndrome
Compartment syndrome is a medical emergency, so it needs to be diagnosed and treated immediately.
Initially there may be some uncertainty as to an exact diagnosis, and there may be a list of differential diagnoses for calf/leg pain. As with any situation like this, medical practitioners must assess the list and consider which one is the most urgent diagnosis to exclude. Compartment syndrome will almost certainly be the most urgent, above other potential causes such as deep vein thrombosis.
To confirm compartment syndrome, a pressure monitoring device is attached to the limb using needles. This reveals the pressure inside a muscle compartment. This must be done, even if medical practitioners are concerned about introducing a possible infection – for instance, cellulitis. If one needs to exclude compartment syndrome, this needs to be excluded irrespective of the status of the skin.
Treating compartment syndrome
To save the muscles, the pressure inside the compartment needs to be released before any significant muscle death takes place. Therefore the sooner the pressure is released, the better. This can be achieved with a surgical procedure called a fasciotomy. For a near full recovery, the expected timeframe for surgery is within six hours of the onset of symptoms. Once beyond this timeframe of six hours, there will never be a full recovery.
There are different opinions amongst medical practitioners as to the timing of treatment. Some believe that undertaking a compartment release at up to 24 hours can have the benefit of salvaging some tissue. Nevertheless, it is rare that recovery is anywhere near as full.
Prognosis after fasciotomy
A fasciotomy that is carried out in time can have an excellent outcome. Further procedures may be needed to stabilise the limb, and there may be a less satisfactory cosmetic outcome, but the functional outcome with early treatment is usually very good.
But if surgery is performed more than six hours after the onset of symptoms, too much time will have passed for any successful function to be retained. The muscles may already be dead and the nerves may already be compromised. The patient will therefore be left with permanent damage.
Missed opportunities to treat compartment syndrome
If medical practitioners fail to recognise compartment syndrome, delaying fasciotomy surgery with adverse consequences, there could be a case of medical negligence. The same will apply if medical practitioners diagnosed the condition but failed to proceed straight to emergency fasciotomy surgery.
If opportunities to treat your compartment syndrome at an earlier stage were missed, please get in touch with our team at Glynns Solicitors. You could be the victim of medical negligence, meaning you are entitled to claim compensation for the injuries you have wrongfully endured.
The effects of compartment syndrome can have a devastating impact upon someone's life, hindering their independence, mobility and earning capacity. If this has happened to you, contact us to find out what action you can take.
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