title: A sneaky surgical emergency: Acute compartment syndrome. Retrospective analysis of 66 closed claims, medico-legal pitfalls and damages evaluation.
abstract: BACKGROUND
  Acute compartment syndrome (ACS) is a clinical condition with potentially dramatic consequences, therefore, it is important to recognise and treat it early. Good management of ACS minimises or avoids the sequelae associated with a late diagnosis, and may also reduce the risk of malpractice claims. The aim of this article was to evaluate different errors ascribed to the surgeon and to identify how the damage was evaluated.
  
  
  METHODS
  A total of 66 completed and closed ACS cases were selected. The following were analysed for each case: clinical management before and after diagnosis of ACS, imputed errors, professional fault, damage evaluation and quantification. Particular attention was paid to distinguishing between impairment because of primary injury and iatrogenic impairment. Statistical analyses were performed using Fisher's exact test and Pearson's correlation.
  
  
  RESULTS
  The most common presenting symptom was pain. Delay in the diagnosis, and hence delay in decompression, was common in the study. A total of 48 out of 66 cases resolved with the verdict of iatrogenic damage, which varied from 12% to 75% of global capability of the person. A total of $394,780 out of $574,680 (average payment) derived from a medical error.
  
  
  CONCLUSIONS
  ACS is a clinical emergency that requires continuous clinical surveillance from both medical and nursing staff. The related damage should be evaluated in two parts: damage deriving from the trauma, so that it is considered inevitable and independent from the surgeon's conduct, and damage deriving from a surgeon's error, which is eligible for an indemnity payment.
authors.affiliation: Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni, Italy. Electronic address: matteo.marchesi@unimi.it.
authors.forename: M
authors.initials: M
authors.lastname: Marchesi
authors.affiliation: Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Italy. Electronic address: ilmarchesiandrea@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Marchesi
authors.affiliation: Orthopaedic Reparative Surgery Department, Orthopaedic Institute Gaetano Pini, University of Milan, Italy. Electronic address: gmc@studiocalori.it.
authors.forename: G M
authors.initials: GM
authors.lastname: Calori
authors.affiliation: Vascular Surgery Service, Istituto Auxologico Italiano, Italy. Electronic address: lea.vale@fastwebnet.it.
authors.forename: L V
authors.initials: LV
authors.lastname: Cireni
authors.affiliation: Dipartimento di Medicina Sperimentale, Università degli Studi di Milano-Bicocca, Italy. Electronic address: sileogio92@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Sileo
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni, Italy. Electronic address: isabella.merzagora@unimi.it.
authors.forename: I
authors.initials: I
authors.lastname: Merzagora
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni, Italy. Electronic address: riccardo.zoia@unimi.it.
authors.forename: R
authors.initials: R
authors.lastname: Zoia
authors.affiliation: Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Italy. Electronic address: luca.vaienti@unimi.it.
authors.forename: L
authors.initials: L
authors.lastname: Vaienti
authors.affiliation: Dipartimento di Medicina Sperimentale - Cattedra di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano-Bicocca, Italy. Electronic address: osvaldo.morini@unimib.it.
authors.forename: O
authors.initials: O
authors.lastname: Morini
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003161:Compartment Syndromes / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D057210:Delayed Diagnosis / Q000191:economics / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007049:Iatrogenic Disease / Q000191:economics* / Q000453:epidemiology; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D007351:Insurance, Liability / Q000191:economics / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D008297:Male; D019300:Medical Errors / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors
keywords: ACS; Compartment syndrome; Impairment evaluation; Malpractice; Medico-legal considerations; Professional liability; Volkmann's contracture