Manual Forearm Palpation in Acute Forearm Compartment Syndrome Is Not Accurate: A Cadaveric Study

Area of Science:

• Orthopaedic Surgery
• Trauma Care
• Diagnostic Accuracy Studies

Background:

• Manual compartment palpation is a clinical tool for diagnosing acute compartment syndrome (ACS), especially in obtunded patients.
• The accuracy of manual palpation for ACS in the upper limb, specifically the forearm, remains largely uninvestigated.
• This study aimed to evaluate the diagnostic utility of manual palpation for forearm ACS.

Purpose of the Study:

• To assess the accuracy of manual compartment palpation in diagnosing acute compartment syndrome (ACS) of the forearm using a cadaveric model.
• To determine if clinician experience influences the accuracy of manual palpation for forearm ACS.

Main Methods:

• Elevated intracompartmental pressures (60 and 80 mm Hg) were created in 8 fresh upper-limb cadaveric specimens.
• Orthopaedic clinicians of varying experience levels (residents, registrars, consultants) palpated forearm compartments to assess for ACS.
• Examiners were blinded to compartment pressures and recorded their findings and management recommendations (fasciotomy or observation).

Main Results:

• Manual palpation demonstrated low diagnostic accuracy for forearm ACS, with an overall sensitivity of 70% and specificity of 56%.
• Positive predictive value was low (24%), while negative predictive value was high (90%).
• Clinician experience did not significantly improve the accuracy of palpation for diagnosing ACS.

Conclusions:

• Manual palpation of forearm compartment pressure exhibits low accuracy in diagnosing acute compartment syndrome.
• The diagnostic performance of manual palpation for ACS is not enhanced by the level of clinician experience.
• The use of manual palpation for diagnosing forearm ACS in obtunded patients is not recommended.