Benefit of the Protocol for Compartment Syndrome at Maharat Nakhon Ratchasima Hospital

Abstract

Background: Compartment syndrome is an emergency condition. Early detection and immediate fasciotomy determine good result and prevent serious complications. High-risk patients should be paid attention for the compartment syndrome. The specific protocol was developed in 2002 for closely observation and regular monitoring of clinical changes in those patients. Objective: To evaluate the benefit of the protocol for compartment syndrome. Patients & Methods: From May, 2002 to June, 2005, 667 patients who sustained limb injury were closely observed and regularly monitored the clinical changes of impending compartment syndrome by using the protocol. Compartment syndrome was detected in 23 cases and fasciotomy was done. The causes, associated injuries, duration to diagnosis, timing from diagnosis to fasciotomy, and complications were compared with 27 compartment syndrome cases that were treated without the protocol from September 1997 to February 2002. Results: Nineteen of 23 post-protocol patients had good result. Four cases had muscle necrosis and deep wound infection. At final follow up, 2 cases had Volkmann ischemic contracture. Median duration from onset of pain to diagnosis was 90 minutes (range 1-1080) and from diagnosis to fasciotomy was 230 minutes (range 60-1130). Compare to pre-protocol patients, only17 of 27 cases had good result. Ten cases had muscle necrosis and deep wound infection, 3 of these cases undergone amputation, one death from severe rhabdomyolysis. At final follow up, 2 had Volkmann ischemic contracture. Median duration from onset of pain to diagnosis was 525 minutes (range 1-1500) and from diagnosis to fasciotomy was 245 minutes (range 80-545).  Conclusion: The protocol is useful for early detection of the compartment syndrome and reduction of major complications but does not lead to earlier fasciotomy.