Medical Negligence Compartment Syndrome Guide

What is a compartment?

The muscles in your legs, arms, and abdomen are arranged in different ‘compartments’. Consisting of muscles, nerves, blood vessels and adipose tissue, these compartments are surrounded by soft tissues, which also help to keep the compartment in place. The compartment is separated by fascia, which is a fibrous tissue.

What is compartment syndrome?

Compartment syndrome results from increased pressure in an anatomically-closed space, thereby compromising the circulation and function of the tissues within that area. This may result in permanent or temporary damage to nerves muscles and tissues present in the space.

There are two types of compartment syndrome; acute compartment syndrome and chronic (sometimes referred to as exertional) compartment syndrome. The key differences are as follows:

Acute compartment syndrome – considered a medical emergency which requires urgent treatment. This is usually brought on by a trauma injury and if it isn’t treated promptly, it can result in lasting muscle damage and limb loss.

Chronic compartment syndrome – happens gradually and is often brought on by repetitive exercise such as running or cycling. It is not considered an emergency and usually passes within minutes of stopping the activity.

Why is compartment syndrome considered a medical emergency?

Acute compartment syndrome is a medical emergency that happens suddenly, usually after a fracture or severe injury, and requires urgent treatment. It can lead to permanent muscle damage if not treated quickly. The patient presents with extreme pain and restriction of all movements within the affected area.

Acute compartment syndrome is typically present within 48 hours of its development. A high index of suspicion is necessary, particularly with an unconscious patient following significant trauma.

According to Elsevier Injury Journal, the most common fractures causing a limb compartment syndrome are those of the tibial shaft (40%) and of the forearm (18%). About 23% are caused by soft tissue injuries without fracture.

If surgery is delayed, the lack of oxygen will cause extensive tissue death. The dead/necrosed tissue will ultimately have to be excised and removed as it can cause complications. This can leave a significant deformity that causes severe dysfunction. In several severe cases, amputation of the limb could be necessitated.

What are the 6 Ps of compartment syndrome?

The symptoms of compartment syndrome are often referred to as the 6 Ps:

1. Pain – which is usually described as disproportionate to the injury sustained.
2. Pallor – this is an unusual paleness of skin colour, as a result of compression.
3. Paraesthesia – this is a feeling of numbness or a burning or prickling sensation.
4. Pulselessness – a really faint pulse.
5. Paralysis – the loss of ability to move the affected limb.
6. Poikilothermia – a change in temperature in the affected area, or the presence of coolness.

What are the causes of acute compartment syndrome?

Compartment syndrome is caused by swelling or bleeding inside a muscular compartment. This can occur due to:

• Trauma - e.g. especially fractures of the lower leg and forearm that have been internally fixed or infected. 

• Burns.

• Crush injury.

• Infection.

• Prolonged compression of limb - e.g. immobilisation in a tight plaster cast.

• Latrogenic causes, intramuscular injections, vascular puncture in anticoagulated patients.

• A tight plaste cast or bandage. 

• Sickle cell disease / carrier of sickle cell trait.

• Surgery for a blocked or damaged blood vessel repair.

What are the consequences of compartment syndrome?

Left untreated or unrecognised, the complications ensuing from acute compartment syndrome are irreversible. As swelling increases and the muscle loses its blood supply, cells eventually begin to die, and muscle necrosis results. Complications can range from:

• scarring of muscles, contracture and loss of movement in the limb;
• amputation;
• infection within the compartment;
• rhabdomyolysis (muscle breakdown);
• kidney damage/failure.

Can compartment syndrome cause permanent damage?

If there is a delay in diagnosis or treatment, acute compartment syndrome can cause permanent damage. This includes lasting damage to muscles, nerves and tissue in the affected compartment.

The basis for medical negligence claims

In cases of acute compartment syndrome, there may be grounds for compartment syndrome compensation if a medical professional fails to offer a reasonable standard of care. This could be in cases where there is:

1. A failure to diagnose and manage compartment syndrome within a clinically reasonable timeframe. It cannot be stressed enough that the diagnosis is made on clinical grounds which means the patient’s presentation, as observed by the doctors. Although there are formal biochemical and barometric tests that should be conducted, the treatment should not be delayed if there is a high suspicion index of compartment syndrome due to the symptoms and presentation of the patient.
    
2. A failure to prevent compartment syndrome when there was a clear risk for its development. This includes the development of this syndrome after limb surgery, infection, or patient who has suffered from burns.
    
3. A patient develops compartment syndrome within hospital settings, and medical professionals fail to recognise the condition. For example, if a surgical cast is applied to a broken limb too tightly or before the injured area has stopped swelling, and consequently medical staff fail to recognise the development of acute compartment syndrome. This negligence results in serious complications to the limb, so there may be grounds for compensation.

Timely Decompression Surgery

Necrosis (death) of the muscle cells develops within about 12 hours. Nerve function in several cases can be salvageable with time, but necrosed muscle results in permanent dysfunction. Therefore, time is of the utmost importance for the diagnosis of compartment syndrome so that decompression surgery can take place as soon as possible. If you feel you have received an adverse outcome due to negligent management of compartment syndrome, then we will be happy to investigate the medical circumstances for you.

Past successful compartment syndrome medical negligence cases

The following are just some examples of Medical Solicitors’ many successful medical negligence compartment syndrome claims for failure to treat, delay in treatment, and not anticipating the development of compartment syndrome:

1. C v ROYAL DEVON & EXETER NHS FOUNDATION TRUST (2012)

(2012) – £405,000 was awarded to this 72-year-old woman for her injuries and financial losses. She sustained an ischaemic right arm and compartment syndrome following an inadvertent intra-articular injection of undiluted intravenous antibiotic in December 2011. As a result, she required an above elbow amputation of the dominant arm.

2. McGREGOR V PARKWAY TRANSPORT (UK) LIMITED (2012)

(2012) – £165,000 was awarded to a 42-year-old man for his injuries and financial losses following a road traffic accident in October 2008. He suffered extensive crush injuries to his arm as well as psychological injuries, and was left with significant scarring and deformity. He suffered from compartment syndrome and he initially underwent a two-stage fasciotomy on his left forearm and further nerve release surgery approximately ten months later. He was left with significant scarring and deformity to the left forearm, together with impairment to the nerve function, causing him significant scarring, sensory impairment and neuropathic pain.

3. O v U NHS FOUNDATION TRUST (2009)

(2009) – £92,000 was awarded to a 67-year-old woman for her injuries and financial losses after a hospital had negligently misdiagnosed and treated a ruptured calf muscle as deep vein thrombosis in February 2005. She suffered compartment syndrome, underwent surgery and sustained nerve damage and permanent scarring and her mobility was limited. She underwent a fasciotomy and her calf was decompressed. She subsequently had to undergo further surgery to close the wound and extensive skin grafting. She later underwent physiotherapy and attended neurological consultations but was left with ongoing nerve damage and scarring.

Solicitors for medical negligence compartment syndrome cases

Medical Solicitors are highly experienced in medical negligence compartment syndrome claims. If you feel like you have suffered as a result of negligent medical care of compartment syndrome, please get in touch with our friendly and supportive team who will be happy to advise you.

Please Note: At Medical Solicitors, we specialise in handling compartment syndrome claims involving healthcare providers in England and Wales and will gladly assist you if your case is located in either of these regions. Unfortunately, we do not handle compartment syndrome claims outside of England and Wales.