Acute Compartment Syndrome: A Short Narrative Review of the Risk Factors, Complications, and Medicolegal Impact of a Missed Diagnosis

Acute compartment syndrome (ACS) is a frequently encountered surgical emergency in trauma and orthopaedics. Timely diagnosis and prompt surgical fasciotomy of the involved compartments prevent complications, which can cause long-term morbidity, rehabilitation, renal failure, multiorgan failure, and even death if management is delayed or diagnosis is missed. The aim of this review was to identify and summarise existing literature on ACS, its complications, and the medicolegal impact when a diagnosis is delayed or missed. A narrative review was conducted using evidence from EMBASE, PubMed, and Google Scholar. There is extensive literature on the diagnosis and presenting signs and symptoms of ACS. However, not the same can be said about the effect of ACS on kidney function, rhabdomyolysis, multiorgan failure, and death. ACS is associated with a multitude of complications and has systemic effects, including electrolyte imbalance, rhabdomyolysis, and renal failure. Overall, ACS is one of the most common causes of litigation in trauma and orthopaedics, and care must be taken to remember that not all ACS is associated with trauma and fractures, resulting in higher rates of delayed diagnosis. To avoid litigation and morbidity to patients, timely diagnosis of ACS is essential, combined with avoiding delays to fasciotomy. Overall, ACS can cause devastating effects to patients, even without a missed diagnosis, as its complications can range from toe clawing and Volkmann contractures to muscle necrosis, which develops into sepsis and can cause multiorgan failure and death.