Compartment Syndrome

Medical Malpractice Lawsuits, Verdicts and Settlement Values

Many medical malpractice lawsuits result from delays in diagnosing and treating patients suffering acute compartment syndrome.  Compartment syndrome is an emergency medical condition that can result in paralysis, limb loss or death, if not treated in time.

This article explains:

  1. What is Compartment Syndrome?
  2. How is Compartment Syndrome Diagnosed and Treated?
  3. Compartment Syndrome Medical Malpractice
  4. Compartment Syndrome Lawsuit Value – Jury Verdicts and Settlements

What is Compartment Syndrome?

Compartment syndrome is a painful, emergency condition caused by bleeding or swelling within an enclosed bundle of muscles – known as a muscle compartment.

Anatomy of a leg - compartment syndromeThe muscle groups of the human limbs are divided into sections, or compartments, held together by strong membranes called fascia.  Increased pressure within a muscle compartment reduces the circulation of blood to the muscles and nerves within that space.  This decreased blood circulation leads to a lack of oxygen which leads to muscle and nerve death if not treated in time.

Compartment syndrome may occur suddenly, often following trauma, or as a chronic syndrome, frequently seen in athletes, that develops more gradually. Compartment syndrome usually occurs in the legs, feet, arms or hands, but can occur in any enclosed compartment of the body.

Acute compartment syndrome is a surgical emergency.  The medical standard of care requires that compartment syndrome be treated immediately.

Who is Most at Risk of Developing Compartment Syndrome?

Compartment syndrome can happen to anyone of any age.  While crush injuries and traumatic impacts can lead to compartment syndrome, bone fractures account for approximately 75 percent of cases of ACS. To make matters worse, fracture treatment (e.g., setting a displaced fracture) can increase compartment pressure and the risk for ACS.

 

What are the Signs and Symptoms of Acute Compartment Syndrome that Doctors Must Watch For?

The signs and symptoms of ACS generally appear in a stepwise fashion, but the order of specific findings varies from patient to patient. 

 

Important clues for doctors to take note of, include rapid progression of symptoms and signs over a few hours and the presence of multiple findings consistent with the diagnosis in a patient at risk.

Repeat patient evaluation is important for patients at risk for compartment syndrome. When a doctor suspects a patient may suffering from a developing compartment syndrome, the doctor should confirm the condition by measuring the patient’s compartment pressures.

Classic symptoms of acute compartment syndrome include:

  1. Pain out of proportion for the injury (early and common finding);
  2. Severe pain with passive movement of the affected body part;
  3. Paresthesias (abnormal sensation often described as “pins and needles”).

5 Symptoms Of Compartment SyndromExamination findings suggestive of acute compartment syndrome include:

  1. Pain with passive stretch of muscles in the affected compartment (early finding)
  2. Tense compartment, sometimes described as a firm “wood-like” feeling
  3. Pallor (pale discoloration of skin) from vascular insufficiency (uncommon)
  4. Decreased sensation
  5. Muscle weakness (onset within approximately two to four hours of ACS)
  6. Paralysis (a late finding that may suggest irreversible nerve damage)

 

How is Compartment Syndrome Treated?

With timely diagnosis and appropriate treatment, the complications of compartment syndrome (paralysis, muscle death, and amputation) can be prevented or minimized.

As soon as a doctor suspects a patient is suffering from compartment syndrome, all external pressure sources should be relieved. Any dressing, splint, cast, or other restrictive covering should be removed.

Elevation of the effected limb should be avoided.  Instead, the limb should be placed level with the heart to help avoid reductions in blood flow into the compartment.  

Pain medications may be given with caution, but excessive pain control can mask the signs of compartment syndrome.  Low blood pressure should be treated with IV fluids.

A fasciotomy (procedure where the fascia is cut to relieve pressure) of all involved compartments is the definitive treatment for ACS in the great majority of cases.

 

How Do Healthcare Providers Commit Medical Malpractice Related to Compartment Syndrome?

Medical malpractice arises when the patient’s medical providers fail to diagnose and treat the compartment syndrome before irreversible ischemia sets in despite obvious signs and symptoms of ACS.

There are various reasons why healthcare providers may negligently fail to timely diagnose and treat compartment syndrome including:

  1. Failing to perform a proper differential diagnosis.
  2. Wrongly concluding that a patient does not have enough signs and symptoms of ACS for the patient to have the condition.
  3. Disregarding a patient’s complaints.
  4. Failing to obtain a complete history from the patient and missing important information that may have led to a diagnosis.
  5. Failure to perform a complete medical examination of the patient.
  6. Failure to perform serial evaluations of the patient in a timely fashion to monitor the development of new and different signs and symptoms indicative of ACS.
  7. Failing to consult with an appropriate specialist who may be better able to make the correct diagnosis.
  8. Failing to obtain a compartment pressure measurement.
  9. Failing to relieve external sources of pressure such as a cast or splint.
  10. Overmedicating a patient with narcotics so as to mask the patient’s pain complaints.
  11. Miscommunications between care providers within a hospital.

 

How Can Patients with Compartment Syndrome Know if they were Injured by Medical Malpractice?

If, as a result of compartment syndrome, the patient suffered paralysis, extensive muscle tissue death, amputation or died – there is a good chance these injuries were due to medical malpractice.

On the other hand, the mere fact that a patient developed compartment syndrome and needed a fasciotomy does not necessarily mean there was medical malpractice.   

How do Doctors and Hospitals Defend Compartment Syndrome Medical Malpractice Lawsuits?

We usually see the same defenses raised by the defense in every compartment syndrome lawsuit we prosecute.

First, the defense will argue that the patient’s signs and symptoms were not consistent with or indicative of a compartment syndrome to justify why the diagnosis was not made in time.  This typically involves the defense focusing in on whatever sign or symptom of compartment syndrome the patient did not present with.  There are a constellation of signs and symptoms that can indicate a patient may be developing or suffering from a compartment syndrome.  For example, the “5 P’s” are often associated with compartment syndrome: pain, pallor (pale skin tone), paresthesia (numbness feeling), pulselessness (faint pulse) and paralysis (weakness with movements).  Though a patient does not need to have all of these signs for a doctor to properly form a differential diagnosis that includes compartment syndrome doctor (in fact it is unusual for a patient to manifest every single sign at the same time) – the defense will nevertheless harp on the one or two signs or symptoms the patient did not have to paint a picture that the patient’s presentation was not consistent with compartment syndrome.

Second, the defense will blame the outcome on the trauma that led to the compartment syndrome.  The defense will argue that the patient’s ultimate outcome – muscle death, paralysis or amputation – was going to happen regardless of the delayed or misdiagnosis i.e., nothing would have changed the outcome.  The defense will also argue that the preceding injury as the cause of the patient’s symptoms that happened to be similar to those of compartment syndrome or that would make it impossible to diagnose compartment syndrome.  For example, the defense will argue that because the key sign of compartment syndrome, extreme pain, could have been due to the initial injury the misdiagnosis was excusable. 

Third, the defense will look for any angle to blame the ultimate outcome on a delay that was not the defendant’s fault i.e. the patient took too long to get to the hospital.

 

How Much Money is a Compartment Syndrome Medical Malpractice Lawsuit Worth?

Because every case is different – degree of negligence and injuries – there is no single answer for what your case may be worth for settlement or jury verdict. It is helpful, however, to look at the facts of other compartment syndrome lawsuits that have resolved through settlement or jury verdict to get a sense of what your case may be worth.

Compartment Syndrome Case #1

In a case handled by our office, a 7-year-old female broke her arm at home practicing gymnastics.  On presentation to the hospital, the patient was noted to have suffered a severe fracture to her right arm just above the elbow that required surgery.  Over the course of several hours leading to surgery, the patient slow lost sensation and motor function in her right hand.  The pulses in her wrist were diminished as well.

Following surgery, the surgeon noted that the child’s pulses in her right wrist had not returned nor had her motor or sensory function.  Despite this concerning presentation, no other treatment was provided to the patient, and she was discharged home the next day, with instruction to return for follow up in 2 weeks. 

At her 2 week follow up, the surgeon discovered that the patient remained without any motor function or feeling in her right hand.  The surgeon diagnosed her with suffering from a subacute compartment syndrome.  The child went on to develop contractures in her injured hand that caused her fingers to curl up.  The child’s family sought a second opinion from a different surgeon who quickly discovered the child had sustained a vascular injury from the original fracture which led to a compartment syndrome in her right arm that was not timely diagnosed.  The second surgeon took the patient back to the operating room and discovered that much of the tissue in her patient’s forearm had died.  Ultimately, the child was left with a non-functional hand that will have stunted growth in the future.

We filed a medical malpractice lawsuit against the original hospital and surgeon.  We alleged that the child had obvious signs of compartment syndrome before and after her initial surgery that were neither diagnosed nor treated.  This delay led to irreversible damages to our client’s right forearm.

The defendants contended that the child’s presentation because highly unusual, especially, given her lack of pain out of proportion.

The case settled without a trial for $4,500,000.

Compartment Syndrome Case #2

In the case of People v. Harper, filed in Michigan, the plaintiff was a woman in her 40s who presented to the hospital with signs and symptoms (left sided body weakness) consistent with a stroke.  In response to her possible stroke, the patient was treated with blood thinners. 

During her hospital admission, the patient developed compartment syndrome that was not treated in time.  The patient ultimately had to have her arm amputated.

The plaintiff’s experts argued that vascular surgery doctors who had been called upon to assess plaintiff’s arm for possible compartment syndrome were professionally negligent because they failed to recognize and appreciate signs of compartment syndrome.  Specifically, the doctors failed to measure the patient’s compartment pressures in the arm and failed to closely monitor the patient’s arm. The plaintiff proved that due to the defendants’ negligence, her arm deteriorated until she lost full function of the arm. The tissue damage was too extensive to save the arm and, ultimately, plaintiff suffered an amputation of her left arm.

The Defendants argued that the plaintiff did not have typical signs of compartment syndrome and that pressure measurements were not required. The Defendants also asserted that the patient had an underlying blood disorder that was so extensive that even prompt identification of compartment syndrome would not have changed the outcome.

The jury returned a verdict of $1,500,000.

Compartment Syndrome Case #3

In a Massachusetts medical malpractice lawsuit, the plaintiff contended she lost her leg due to a negligent delay in treating her compartment syndrome. 

 In June 2004, the plaintiff, a 72-year-old woman with a history of diabetes, hypertension, vascular disease and carotid artery surgery, underwent a right knee replacement performed by two of the defendant surgeons.

Following her surgery, the plaintiff complained of decreased sensation in her right leg, swelling in her knee, and weakness, numbness and pain in her knee, hamstring, thigh and foot. She continued to have persistent unrelieved right leg and foot complaints, which progressed to complete foot drop and impaired blood flow in her leg.

After the plaintiff developed the foot drop, the defendant neurologist examined her and considered a diagnosis of compartment syndrome, but no further work-up was initiated at that time.

For the next two days, the defendant surgeons failed to perform surgery to relieve the compartment pressure in the plaintiff’s leg.

Ten days after the initial surgery, the defendant surgeons brought the patient back to the operating room for surgery to relieve the pressure in her anterior and deep posterior compartments.  Unfortunately, the compartment syndrome had caused irreversible tissue, muscle and nerve death, as well as extensive vascular compromise, making it impossible to save the patient’s leg.

The patient underwent an above-the-knee amputation of her right leg.

The plaintiff’s experts contended the defendants were negligent for failing to timely recognize and treat the plaintiff’s signs and symptoms of compartment syndrome and vascular compromise, despite her complaints of numbness, pain, weakness, loss of sensation and foot drop in the days following her surgery.  The plaintiff experts also opined that her right leg could have been successfully treated and salvaged had she received the proper surgical care and treatment.

In their defense, the surgeons denied that the plaintiff had developed compartment syndrome and argued that the tissue, nerve and vascular compromise in the plaintiff’s right leg was caused by a rare vascular condition that had developed post-operatively as a result of her history of vascular disease.

This lawsuit settled for $1,500,000 before trial.

Compartment Syndrome Case #4

In another medical malpractice case filed in Michigan, the plaintiff, a 52-year-old married female dental hygienist, claimed permanent disability and deformity as a result of her doctors’ alleged failure to diagnose compartment syndrome following surgery. Defendants disputed the claim but settled the case for $738,000 prior to trial.

The defendant surgeon performed open reduction surgery for a tibial plateau fracture on plaintiff at defendant hospital. The plaintiff complained of severe pain after the surgery, even though she was receiving morphine. It was noted in her hospital records that she had loss of motor function following surgery. Defendants diagnosed her with tourniquet palsy, a condition related to the surgery, and she was released. Plaintiff presented at a follow-up appointment with complaints of pain and was diagnosed with compartment syndrome.

The plaintiff alleged that the defendants failed to diagnose compartment syndrome and failed to timely perform an immediate decompression by a fasciotomy, which is the standard of care. The plaintiff’s expert testified that defendants missed the 8- to 12-hour window of opportunity to correct the compartment syndrome. The plaintiff claimed the defendants should have removed the dressing and taken a pressure reading on the interior anterior compartment when the muscles that dorsiflex the foot were not working following surgery. She also maintained that she was examined only once after surgery by defendant’s resident and the attending physician did not properly supervise the resident or perform his own exam. Plaintiff claimed permanent disability and disfigurement and her spouse sought damages for loss of consortium.

The defendants contended the plaintiff did not have the classic signs and symptoms of compartment syndrome and it was appropriate to assume that her pain was the result of tourniquet palsy. They argued that they met the standard of care and defendant resident was appropriately monitored.

Though the compartment syndrome lawsuits described above all resulted in substantial settlements or verdicts, most reported compartment syndrome lawsuits resulted in a defense verdict or zero recovery for the plaintiff. 

The medical malpractice lawyers of Lupetin and Unatin focus much of their practice on helping patients injured by medical malpractice, including compartment syndrome, get the justice and compensation they deserve.  If you or a loved one has suffered a catastrophic injury caused by compartment syndrome, we encourage you to call us to find out if you have a medical malpractice case.  We will speak with you and investigate your case at no charge.  We will provide you answers to your questions.  We only get paid if we take your case and make a recovery.

All articles in this blog are the collaborative effort of Lupetin & Unatin, LLC.

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