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AAOS releases new clinical practice guideline on acute compartment syndrome in adults
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The American Academy of Orthopaedic Surgeons released a new clinical practice guideline to help physicians develop an evidence-based approach for the diagnosis and treatment of adult patients with traumatic injuries and who are at risk for acute compartment syndrome.
According to a press release from the AAOS, more than 10,000 published studies on the management of acute compartment syndrome of the upper or lower extremity in adults were considered by a collaboration of volunteer workgroup of musculoskeletal trauma surgery experts, military surgeons and AAOS research staff in the development of the clinical practice guidelines. The release noted that highlights of the clinical practice guideline include the following:
- limited evidence for the effectiveness of a reliable clinical, physical exam;
- moderate evidence that continuous or repeated compartment pressure measurements using a perfusion pressure of less than 30 mmHg assist in the diagnosis of acute compartment syndrome;
- ·no specific evidence-based recommendations for any particular method of compartment pressure measurement; and
- fasciotomy should be done in a manner that results in complete decompression of the affected compartment but is not recommended in late-stage acute compartment syndrome when there is evidence of irreversible muscle and nerve damage in the extremity.
“There is no strong literature to support any specific approach to the diagnosis and management of [acute compartment syndrome] ACS. Clinicians need to remain vigilant for the onset of ACS in any patient presenting with limb swelling and be prepared to act immediately when the clinical situation demands,” Andrew Schmidt, MD, chief of the department of orthopedics at Hennepin Healthcare and co-chair of the guideline workgroup, said in the release. “In the absence of any sort of evidence-based standards, any and all clinical decisions regarding assessment and/or treatment of presumed ACS should be carefully documented in the patient’s medical record.”
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