Reducing the Risks of Compartment Syndrome

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Compartment syndrome accounts for 4% of medical malpractice claims among orthopedists insured by MagMutual. Compartment syndrome is a serious condition that can require surgery to prevent permanent injury, and therefore represents a serious liability risk for orthopedists.

To help orthopedists reduce the occurrence of compartment syndrome, MagMutual’s medical faculty and risk consultants have analyzed our claims data, determined the main causes of claims related to this injury and developed strategies to improve patient outcomes.

Top Risks

Top Strategies for Reduction

Based on these top risk drivers, implementing the following clinical and operational strategies can help you prevent unexpected outcomes and increase defensibility of a medical malpractice claim:

Clinical strategies

• Perform an in-person physical exam when a patient is experiencing significant pain or requesting additional pain medication, especially if they have a long bone fracture or significant trauma that increases their risk of compartment syndrome; their pain seems out of proportion to their injury; their pain is increasing or has a deep aching quality or is accompanied by a burning or numbness sensation.
• During the physical exam, unwrap dressings to fully expose the skin and examine the full extremity. Obtain compartment pressure measurements.
• If there is clinical suspicion for compartment syndrome, proceed to fasciotomy without delay. Casting, splinting or bandages that are overly constrictive can lead to compartment syndrome.

Operational strategies

• After the examination, immediately document findings and specifically comment on the patient’s demeanor and subjective pain, including the presence or absence of pain with passive extension of the joint distal to the compartment, swelling, compartment tautness, pallor, tenderness to palpation, pulse and circulatory exam and distal neurologic exam. Compartment pressures can be helpful, particularly for documentation purposes, but if there is suspicion of compartment syndrome, fasciotomies should be performed immediately.
• Document your medical decision-making, which should include an explicit statement that compartment syndrome is on the differential and the factors increasing and decreasing the likelihood of the condition. If compartment pressure measurement is not obtained, discuss the reasons for deferral. If surgical intervention is not going to be performed, document plan for monitoring the patient’s condition to evaluate for any changes in clinical condition. Failing to review studies ordered by an advanced practice provider is another defense weakness.
• Try to familiarize yourself with ED and floor staff to improve communication between departments. Have a low threshold for you or your staff to go and evaluate the patient in person.

Other Top Risks

Although compartment syndrome accounts for a significant number of claims among orthopedists according to our data, we’ve identified several other drivers of loss based on claims frequency:

Risk Drivers by Top Cause

Risk Drivers by Frequency

Data Collection & Methodology

Data is based on MagMutual closed claims from 2011-2021 and corresponding exposure data. Clinical and non-clinical loss drivers are based on an in-depth review of each claim by a medical professional or clinical risk consultant. Risk reduction strategies are based on input from practicing physicians.