Litigation Patterns of Acute Compartment Syndrome: Distinctions Between Orthopaedic and Non-Orthopaedic Cases and Factors Predicting Successful Defense.

Abstract

BACKGROUND Acute compartment syndrome (ACS) is a medical emergency and a cause of medical litigation across multiple specialties. We sought to compare the characteristics and outcomes of ACS-related litigation levied against surgeons in orthopaedics compared with other specialties. METHODS The Westlaw database was queried for ACS-related cases filed within the United States between 1980 and 2023 using the search term "compartment syndrome." Inclusion criteria were defined as all jury verdicts or settlements tied to alleged medical malpractice concerning ACS of the spine and extremities. ACS cases of the abdomen were excluded. RESULTS Of 755 cases, 358 cases met inclusion criteria, 150 (42%) of which listed an orthopaedic surgeon as a defendant. A defendant verdict was reached in 203 cases (57%), a plaintiff verdict was reached in 88 cases (25%), and 67 cases (19%) were settled. The mean payout in orthopaedic cases was $3,219,519. Compared with non-orthopaedic practitioners, orthopaedic surgeons were significantly more likely to be named in cases in which ACS was due to surgery or fracture (both, p < 0.001) and in which the basis of litigation was alleged improper cast or splint application (p < 0.001). Orthopaedic surgeons were significantly less likely to be named in ACS cases when the basis of litigation was alleged negligent medication administration (p < 0.001). Only 3 cases (0.8%) mentioned documentation of compartment checks and intracompartmental pressures, and no cases were levied because of unnecessary fasciotomy. Two cases described the use of postoperative regional anesthesia for pain control. CONCLUSIONS ACS-related litigation is associated with a considerable financial burden in the wake of substantial morbidity and mortality. Lawsuits against orthopaedic surgeons more commonly involve fractures and cast or splint application, whereas those against non-orthopaedists more commonly involve medication or fluid infiltration. Documentation of close monitoring for symptoms specifically related to ACS and intracompartmental pressure measures may be a valid method to mitigate associated medicolegal risk. Prophylactic fasciotomies have not historically been a source of litigation. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.