Management of Acute Compartment Syndrome
Publication Date: December 7, 2018
Last Updated: March 14, 2022
RECOMMENDATIONS
BIOMARKERS
A. Limited evidence supports that myoglobinuria and serum troponin level may assist in diagnosing acute compartment syndrome in patients with traumatic lower extremity injury. (L)
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B. Moderate evidence supports that, in patients with acute vascular ischemia, femoral vein lactate concentration sampled during surgical embolectomy may assist in the diagnosis of acute compartment syndrome. (M)
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C. Limited evidence supports that myoglobinuria does not assist in diagnosing acute compartment syndrome in patients with electrical injury. (L)
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SERUM BIOMARKERS IN LATE/MISSED ACS
In the absence of reliable evidence, it is the opinion of the work group that serum biomarkers do not provide useful information to guide decision making when considering fasciotomy for a presumed late-presentation or missed acute compartment syndrome. (C)
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PRESSURE METHODS
A. Moderate evidence supports that intracompartmental pressure monitoring assists in diagnosing acute compartment syndrome. (M)
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B. Moderate evidence supports the use of repeated/continuous intracompartmental pressure monitoring and a threshold of diastolic blood pressure minus intracompartmental pressure >30 mmHg to assist in ruling out acute compartment syndrome. (M)
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PRESSURE MONITORING IN LATE/MISSED ACS
In the absence of reliable evidence, it is the opinion of the work group that compartment pressure monitoring does not provide useful information to guide decision making when considering fasciotomy for an adult patient with evidence of irreversible intracompartmental (neuromuscular/vascular) damage. (C)
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PHYSICAL EXAM (AWAKE)
Limited evidence supports using serial clinical exam findings to assist in ruling in acute compartment syndrome. (L)
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PHYSICAL EXAM (OBTUNDED)
In the absence of reliable evidence, it is the opinion of the work group that without a dependable clinical examination (e.g. in the obtunded patient), repeated or continuous intracompartmental pressure measurements are recommended until acute compartment syndrome is diagnosed or ruled out. (C)
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ALTERNATIVE METHODS OF DIAGNOSIS
In the absence of reliable evidence, it is the opinion of the work group that there are no reported diagnostic modalities, other than direct pressure monitoring or clinical exam findings, that provide useful information to guide decision making when considering fasciotomy for acute compartment syndrome. (C)
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FASCIOTOMY METHODS
In the absence of reliable evidence, it is the opinion of the work group that fasciotomy technique (e.g. one vs two incision, placement of incisions) is less important than achieving complete decompression of the compartments of the affected extremity. (C)
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FASCIOTOMY FOR LATE/MISSED ACS
In the absence of reliable evidence, it is the opinion of the work group that performing fasciotomy is not indicated in an adult patient with evidence of irreversible intracompartmental (neuromuscular/vascular) damage. Fracture stabilization, if warranted in these patients, should utilize a technique (external fixation/casting) that does not violate the compartment. (C)
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ASSOCIATED FRACTURE
In the absence of reliable evidence, it is the opinion of the work group that operative fixation (external or internal) should be performed for initial stabilization of long bone fractures with concomitant acute compartment syndrome requiring fasciotomy. (C)
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WOUND MANAGEMENT
Limited evidence supports use of negative pressure wound therapy for management of fasciotomy wounds with regard to reducing time to wound closure and reducing need for skin grafting. (L)
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PAIN MANAGEMENT EFFECTS ON DIAGNOSIS
In the absence of reliable evidence, it is the opinion of the work group that neuraxial anesthesia may complicate the clinical diagnosis of acute compartment syndrome. If neuraxial anesthesia is administered, frequent physical examination and/or pressure monitoring should be performed. (C)
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Recommendation Grading
Overview
Title
Management of Acute Compartment Syndrome
Authoring Organization
American Academy of Orthopaedic Surgeons
Endorsing Organization
American Orthopaedic Foot and Ankle Society
Publication Month/Year
December 7, 2018
Last Updated Month/Year
January 29, 2024
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Operating and recovery room, Outpatient
Intended Users
Physical therapist, occupational therapist, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis, Rehabilitation, Prevention, Management, Treatment
Diseases/Conditions (MeSH)
D003161 - Compartment Syndromes
Keywords
acute compartment syndrome (ACS)