The Authors Respond

We thank Dr. Webley for his insightful comments on the article. He brings to light several important considerations, including the need for early orthopedic involvement if compartment syndrome is suspected. Measurement of a compartment pressure is not necessary prior to orthopedic surgeon consultation. If the compartment pressure is assessed, the clinician obtaining the measurement must be familiar with the anatomy due to the differing compartments dependent on the specific location.

We also agree that fasciotomy is a difficult procedure, and most emergency clinicians are not trained to perform it. However, as Dr. Stuart Swadron says, “we need to know what we need to know, and one step further.” While rare, there are circumstances where an emergency clinician may need to perform this procedure, such as in an austere military setting with no surgical backup.

As Dr. Webley discusses, the key to diagnosis is clinical suspicion in the ED, as failure to consider the condition is why we often miss it. A patient with severe pain, recurrent need for analgesia, or objective evidence of neurovascular compromise warrants emergent discussion with the surgeon. Keep in mind that severe pain, which may be out of proportion to the exam or increase with passive stretch of the compartment, is often the only finding in acute compartment syndrome.

Brit Long, MD, FACEP; and
Alex Koyfman, MD, FACEP, FAAEM