Compartment Syndrome

Medical Malpractice Lawsuits, Verdicts and Settlement Values

Many medical malpractice lawsuits result from delays in diagnosing and treating patients suffering acute compartment syndrome.  Compartment syndrome is an emergency medical condition that can result in paralysis, limb loss or death, if not treated in time.

This article explains:

1. What is Compartment Syndrome?
2. How is Compartment Syndrome Diagnosed and Treated?
3. Compartment Syndrome Medical Malpractice
4. Compartment Syndrome Lawsuit Value – Jury Verdicts and Settlements

What is Compartment Syndrome?

Compartment syndrome is a painful, emergency condition caused by bleeding or swelling within an enclosed bundle of muscles – known as a muscle compartment.

The muscle groups of the human limbs are divided into sections, or compartments, held together by strong membranes called fascia.  Increased pressure within a muscle compartment reduces the circulation of blood to the muscles and nerves within that space.  This decreased blood circulation leads to a lack of oxygen which leads to muscle and nerve death if not treated in time.

Compartment syndrome may occur suddenly, often following trauma, or as a chronic syndrome, frequently seen in athletes, that develops more gradually. Compartment syndrome usually occurs in the legs, feet, arms or hands, but can occur in any enclosed compartment of the body.

Acute compartment syndrome is a surgical emergency.  The medical standard of care requires that compartment syndrome be treated immediately.

Who is Most at Risk of Developing Compartment Syndrome?

Compartment syndrome can happen to anyone of any age.  While crush injuries and traumatic impacts can lead to compartment syndrome, bone fractures account for approximately 75 percent of cases of ACS. To make matters worse, fracture treatment (e.g., setting a displaced fracture) can increase compartment pressure and the risk for ACS.

What are the Signs and Symptoms of Acute Compartment Syndrome that Doctors Must Watch For?

The signs and symptoms of ACS generally appear in a stepwise fashion, but the order of specific findings varies from patient to patient.

Important clues for doctors to take note of, include rapid progression of symptoms and signs over a few hours and the presence of multiple findings consistent with the diagnosis in a patient at risk.

Repeat patient evaluation is important for patients at risk for compartment syndrome. When a doctor suspects a patient may suffering from a developing compartment syndrome, the doctor should confirm the condition by measuring the patient’s compartment pressures.

Classic symptoms of acute compartment syndrome include:

1. Pain out of proportion for the injury (early and common finding);
2. Severe pain with passive movement of the affected body part;
3. Paresthesias (abnormal sensation often described as “pins and needles”).

Examination findings suggestive of acute compartment syndrome include:

1. Pain with passive stretch of muscles in the affected compartment (early finding)
2. Tense compartment, sometimes described as a firm “wood-like” feeling
3. Pallor (pale discoloration of skin) from vascular insufficiency (uncommon)
4. Decreased sensation
5. Muscle weakness (onset within approximately two to four hours of ACS)
6. Paralysis (a late finding that may suggest irreversible nerve damage)

How is Compartment Syndrome Treated?

With timely diagnosis and appropriate treatment, the complications of compartment syndrome (paralysis, muscle death, and amputation) can be prevented or minimized.

As soon as a doctor suspects a patient is suffering from compartment syndrome, all external pressure sources should be relieved. Any dressing, splint, cast, or other restrictive covering should be removed.

Elevation of the effected limb should be avoided.  Instead, the limb should be placed level with the heart to help avoid reductions in blood flow into the compartment.

Pain medications may be given with caution, but excessive pain control can mask the signs of compartment syndrome.  Low blood pressure should be treated with IV fluids.

A fasciotomy (procedure where the fascia is cut to relieve pressure) of all involved compartments is the definitive treatment for ACS in the great majority of cases.

How Do Healthcare Providers Commit Medical Malpractice Related to Compartment Syndrome?

Medical malpractice arises when the patient’s medical providers fail to diagnose and treat the compartment syndrome before irreversible ischemia sets in despite obvious signs and symptoms of ACS.

There are various reasons why healthcare providers may negligently fail to timely diagnose and treat compartment syndrome including:

1. Failing to perform a proper differential diagnosis.
2. Wrongly concluding that a patient does not have enough signs and symptoms of ACS for the patient to have the condition.
3. Disregarding a patient’s complaints.
4. Failing to obtain a complete history from the patient and missing important information that may have led to a diagnosis.
5. Failure to perform a complete medical examination of the patient.
6. Failure to perform serial evaluations of the patient in a timely fashion to monitor the development of new and different signs and symptoms indicative of ACS.
7. Failing to consult with an appropriate specialist who may be better able to make the correct diagnosis.
8. Failing to obtain a compartment pressure measurement.
9. Failing to relieve external sources of pressure such as a cast or splint.
10. Overmedicating a patient with narcotics so as to mask the patient’s pain complaints.
11. Miscommunications between care providers within a hospital.

How Can Patients with Compartment Syndrome Know if they were Injured by Medical Malpractice?

If, as a result of compartment syndrome, the patient suffered paralysis, extensive muscle tissue death, amputation or died – there is a good chance these injuries were due to medical malpractice.

On the other hand, the mere fact that a patient developed compartment syndrome and needed a fasciotomy does not necessarily mean there was medical malpractice.

How do Doctors and Hospitals Defend Compartment Syndrome Medical Malpractice Lawsuits?

We usually see the same defenses raised by the defense in every compartment syndrome lawsuit we prosecute.

First, the defense will argue that the patient’s signs and symptoms were not consistent with or indicative of a compartment syndrome to justify why the diagnosis was not made in time.  This typically involves the defense focusing in on whatever sign or symptom of compartment syndrome the patient did not present with.  There are a constellation of signs and symptoms that can indicate a patient may be developing or suffering from a compartment syndrome.  For example, the “5 P’s” are often associated with compartment syndrome: pain, pallor (pale skin tone), paresthesia (numbness feeling), pulselessness (faint pulse) and paralysis (weakness with movements).  Though a patient does not need to have all of these signs for a doctor to properly form a differential diagnosis that includes compartment syndrome doctor (in fact it is unusual for a patient to manifest every single sign at the same time) – the defense will nevertheless harp on the one or two signs or symptoms the patient did not have to paint a picture that the patient’s presentation was not consistent with compartment syndrome.

Second, the defense will blame the outcome on the trauma that led to the compartment syndrome.  The defense will argue that the patient’s ultimate outcome – muscle death, paralysis or amputation – was going to happen regardless of the delayed or misdiagnosis i.e., nothing would have changed the outcome.  The defense will also argue that the preceding injury as the cause of the patient’s symptoms that happened to be similar to those of compartment syndrome or that would make it impossible to diagnose compartment syndrome.  For example, the defense will argue that because the key sign of compartment syndrome, extreme pain, could have been due to the initial injury the misdiagnosis was excusable.

Third, the defense will look for any angle to blame the ultimate outcome on a delay that was not the defendant’s fault i.e. the patient took too long to get to the hospital.