Compartment Syndrome: An Overlooked Surgical Emergency
A brief case review of acute compartment syndrome, a high-risk surgical condition. Delayed diagnosis often leads to permanent disability.
Expert Witness Case Review: Compartment Syndrome
Case:
A 17-year-old was injured while playing indoor soccer. He presented to the ER with a broken left and underwent surgery the same night. He began complaining of pain, numbness, and burning to the leg after discharge but was discharged home. Six days later he returned to the hospital with worsening symptoms including extreme pain, and tenderness to the leg, and was diagnosed with acute compartment syndrome. The plaintiffs suffered a complicated course due to the delay in diagnosis, required twelve additional surgeries, and were left with permanent disabilities.
Verdict:
$111 million dollar total verdict
$1 million in past and future medical expenses
$10 million for past pain and suffering
$100 million for future pain and suffering
Pearls:
20–27% of compartment syndrome cases are in pediatric patients
27–38% of cases are in female patients
Men aged 11–30 were the highest group of patients presenting with compartment syndrome
Common Surgeries Associated with ACS:
Total hip/knee arthroplasty
Osteomy
Grafts/Fistula repair
Abdominal Aortic Aneurysm repair
42% of compartment syndrome occur in the setting of trauma
More than 70% of trauma-related cases are due to acute tibial fractures
Symptoms:
The most common initial symptom of patients with compartment syndrome is severe pain out of proportion to physical findings. Other symptoms include — numbness, paresthesia, or increased compartment tension. Compartment syndrome is a medical emergency requiring a surgical procedure called fasciotomy to release the pressure in the affected compartment.
Misses Diagnoses:
Delays in diagnosis and treatment are the most common reason for long-term disabilities. Over 30% of patients with acute compartment syndrome have a delayed diagnosis, resulting in a delayed surgical fasciotomy (more than 8 hours after the onset of symptoms). Over 77% of patients report a permanent disability as a result of delayed compartment ent syndrome diagnosis. Common disabilities include permanent weakness, contractors, chronic pain, and difficulty walking
Case Statistics
Historically plaintiffs have been successful in 56–77% of claims, with 27–56% of claims resulting in settlement over the trial.
68% of trials were won by the defendant.
ABOUT THE AUTHOR: Vipul Kella, MD MBA FACEP
Dr. Kella is a board-certified emergency medicine physician who practices in the D.C area. In his eighteen years of practice, he has worked both clinically and as a hospital executive in large hospital systems. Experience in hospital administration reviewing standards of care and implementing numerous quality of care and utilization programs. Board-certified in Emergency Medicine, and highly experienced expert witness, having reviewed over 200 cases and having testified in 4 depositions in the past 3 years.
Copyright Vipul Kella, M.D., MBA. FACEP
Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer.For specific technical or legal advice on the information provided and related topics, please contact the author.
