Compartment syndrome: the importance of heeding early warning signs

Posted: 04/09/2017

Compartment syndrome is a painful and potentially serious condition caused by bleeding or swelling within an enclosed bundle of muscles, known as a ‘compartment’. It occurs when the pressure within a compartment increases, restricting the blood flow to the area and potentially damaging the muscles and nearby nerves. Although it is most common in the legs, feet, arms or hands, it can arise wherever there is an enclosed compartment inside the body.

Failure to identify and treat compartment syndrome can lead to severe and permanent damage to the muscles and nerves. Few people break a limb, for example, and anticipate losing that limb, but if compartment syndrome is not diagnosed and treated promptly, that can happen.

Penningtons Manches LLP’s clinical negligence team has represented a number of clients who have suffered permanent injury due to a negligent failure by medical staff to recognise the symptoms of compartment syndrome and to act quickly enough to treat it successfully.

Associate director Alison Johnson has recently advised two clients whose clinical negligence claims coincidentally arose from virtually identical situations, just a short period of time apart. Both cases involved the misdiagnosis in A&E of calf tears as deep vein thromboses (DVT), and the erroneous decision to treat patients with Heparin, an anticoagulant to thin the blood, before scanning had been performed to check that DVT was in fact the correct diagnosis. As a result, the bleeding and pressure within the claimants’ calves was permitted to increase, leading to compartment syndrome and significant pain, nerve dysfunction and hypersensitivity.

Although the extensive surgery, known as a fasciotomy, the claimants required to release that pressure was successful in saving their limbs, they both needed skin grafting and were left with scarring. One of the clients was particularly unhappy about this, as she understandably saw it as a cosmetic disability. Both claims settled following investigations even though initially liability was denied and litigation was required. Damages of more than £100,000 were recovered for each claimant, reflecting the severity of the permanent injury and residual pain, and the impact on day to day life, including loss of earnings.

In another case Alison acted for a high-earning IT director, who was admitted to hospital after breaking his leg. He began to develop compartment syndrome after surgery, but again the medical team was slow to recognise what was happening, representing a breach of the duty of care owed to him. The claimant required significant surgery to save his leg, including muscle transfer, which thankfully was successful, but he was left with a debilitating foot drop and permanent leg nerve pain, affecting his mobility and his ability to perform his job. Ultimately he felt forced to accept redundancy and made a career change, which resulted in a drop in his income. Again liability was initially denied but the claim settled for £400,000 in damages prior to trial.

Thankfully compartment syndrome is a relatively rare condition but, as the case studies above illustrate, without prompt treatment, it can be very serious. If you have suffered complications due to delayed diagnosis or are concerned about negligent treatment, Penningtons Manches’ specialist team may be able to help you.

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