Polytrauma patients who are often obtunded, intubated, and unable to cooperate with an examination, combined with painful high-energy injury to the limbs, create a particularly problematic clinical scenario for recognition of compartment syndrome. Prompt diagnosis and surgical management are paramount in producing optimal outcomes in these patients. Physical examination is routinely inadequate, as participation in clinical examination is often limited due to mental status and distracting injuries. Furthermore, recognition of elevated compartment pressures by physicians has been found to be poor. It is therefore imperative to recognize at-risk patients and specific injuries when diagnosing compartment syndrome, including young males with high-energy proximal tibia fractures. Serum markers including greater base deficits, lactate levels, PRBC requirements, LDH, and CK values have also been associated with compartment syndrome, although their utility remains limited. Intracompartmental pressure monitoring in this patient population remains an appealing avenue, although not without its limitations. In particular, while clinical data seems to indicate that no compartment syndrome will be missed using a Δ P of ≤30 mm Hg as a threshold, this does not necessarily mean that this value indicates the presence of compartment syndrome. Future avenues in the diagnosis of compartment syndrome have included the use of a novel compartment monitoring system catheter, near-infrared spectroscopy to measure tissue oxygenation, and the use of decreasing glucose levels as a marker for compartment syndrome, although most remain far from clinical applicability. With varying conscious states, limited participation in clinical examination, and distracting injuries, it is imperative to identify high-risk injuries and patients and to maintain a high level of clinical suspicion in the polytrauma patient.
Copyright 2019, The Author(s).