AAOS researchers, military surgeons and a volunteer workgroup of musculoskeletal trauma surgery experts analyzed more than 10,000 studies on upper and lower extremity ACS to develop the guideline.
Four highlights:
1. There is limited evidence for the effectiveness of a reliable clinical exam.
2. There is moderate evidence that continuous compartment pressure measurements assist in diagnosing ACS when using a perfusion pressure less than 30 mmHg.
3. There are no specific evidence-based recommendations that can be made for any distinct method of compartment pressure measurement. Laboratory biomarkers remain unproven in discerning ACS from other causes of muscle injury.
4. A fasciotomy is necessary to achieve complete decompression of the affected compartment. However, AAOS does not recommend performing a fasciotomy in late stage ACS when there is evidence of irreversible muscle and nerve damage.
Orthopedic surgeon and co-chair of the guideline workgroup Andrew Schmidt, MD, concluded that while there is no strong literature that supports any specific approach to diagnosing and treating ACS, clinicians should look out for warning signs like limb swelling and be prepared to act immediately.
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