Misdiagnosis of Compartment Syndrome Leads to Foot Drop


compartment syndromeThis case takes place in Maine and involves a patient who presented to the Emergency Room with swelling below the knee. The patient was kept in the hospital overnight for screening and monitoring. The patient was discharged the following day. The patient’s spouse called the hospital and indicated that the patient was still suffering from swelling that was only getting worse. The patient was seen by a physical therapist four days later, who referred the patient to the ER. The patient was diagnosed with compartment syndrome and underwent an emergency fasciotomy. The patient now has a permanent foot drop.

 

Question(s) For Expert Witness

  • 1. How often do you see patients with compartment syndrome?
  • 2. What is the standard work up for patients with these presenting complaints?

Expert Witness Response E-000626

I see patients with compartment syndrome about 3-6 times per year. Clinical history and physical exam usually demonstrate enough evidence to support the diagnosis and need for further evaluation to rule out the condition. This evaluation should include measurement of compartment pressures.

Expert Witness Response E-006765

I see 2-3 compartment syndromes a year. This is a surgical emergency. Most believe that in an awake patient, it is diagnosed by symptoms (severe pain out of proportion). There are small mobile devices that can be used to test the compartment pressures. The diagnosis is entertained by the patient’s clinical presentation (pain out of proportion and pain on passive range of motion).

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