The Analysis Study of Surgical Management of Acute Compartment Syndrome - An Orthopaedic Comprehensive Systematic Review

Abstract

Introduction: Acute compartment syndrome (ACS), first described in 1881 by Richard von Volkmann, remains a critical orthopedic emergency requiring timely diagnosis and intervention. Despite advancements, ACS poses significant clinical and economic challenges. It is commonly diagnosed through surrogate indicators like fasciotomy rates. The 2018 clinical practice guideline (CPG) by the American Academy of Orthopaedic Surgeons (AAOS) emphasized evidence-based practices for diagnosis and management. This systematic review synthesizes historical, current, and emerging evidence on ACS surgical management to improve clinical outcomes.

Method: This systematic review adheres to PRISMA 2020 guidelines, focusing on studies published between 2014–2024. Databases such as PubMed, ScienceDirect, Embase, and Cochrane Library were searched using terms like "Acute Compartment Syndrome," "Fasciotomy," and "Surgical Decompression." Inclusion criteria involved human studies on ACS surgical management, while reviews, non-peer-reviewed articles, and animal studies were excluded. Data extraction focused on intervention techniques, timing, outcomes, and complications. Quality assessment ensured robust methodological inclusion.

Results: Eight studies met the eligibility criteria. Findings revealed the importance of early fasciotomy (preferably within 6–12 hours) in preventing severe complications like ischemic contracture, infection, and amputation. Variations in surgical techniques, including single-incision vs. two-incision fasciotomy, were reported, showing flexibility in management approaches. Studies emphasized multidisciplinary care and tailored surgical approaches to optimize patient outcomes.

Discussion: ACS is characterized by a pathological rise in intracompartmental pressure leading to reduced tissue perfusion, ischemia, and potentially irreversible damage. Early intervention is crucial, with clinical symptoms such as severe pain being key diagnostic markers. Surgical decompression remains the cornerstone of treatment, supported by advances in wound management, such as negative pressure systems and skin grafting. Complications, including nerve damage and chronic functional deficits, underscore the need for timely diagnosis and intervention. Variability in study methodologies and healthcare settings highlights challenges in standardizing ACS management, warranting further research.

Conclusion:This review underscores the critical importance of early diagnosis, tailored surgical techniques, and multidisciplinary collaboration in managing ACS. Future research should address gaps in standardizing care, enhancing early detection, and reducing long-term complications.