The Weight of Doubt: Acute Compartment Syndrome, Dogma, and Diagnostic Uncertainty

The Weight of Doubt: Acute Compartment Syndrome, Dogma, and Diagnostic Uncertainty

Acute compartment syndrome is one of the most feared diagnoses in orthopaedic trauma, yet despite decades of teaching, controversy and uncertainty remain. In this episode, Dr. Andrew Schmidt joins us for a thoughtful and refreshingly candid discussion on why compartment syndrome continues to generate anxiety among surgeons, the limitations of traditional diagnostic thinking, and how dogma, research challenges, and medicolegal pressures have shaped the field. We explore what fasciotomy truly represents, why defining a diagnostic “gold standard” remains elusive, and what the future of multimodal treatment strategies might look like. ________________ Visit our landing page! [www.underpressure.fm]

After the Fasciotomy: Recovery, Function, and the Long Road Back

When surgeons talk about compartment syndrome, the focus is often on diagnosis and surgical urgency. Far less attention is given to what happens next for the patient. In this episode, Dr. Christopher Doro joins us for a conversation on the downstream realities of acute compartment syndrome, recovery timelines, functional challenges, and the physical and psychological hurdles patients face following fasciotomy or limb loss. We also discuss real cases, the implications of false-positive pressure findings in ACS, and how multidisciplinary care impacts patients’ lives. _____________________ * Do one-time intracompartmental pressure measurements have a high false-positive rate in diagnosing compartment syndrome? [https://pubmed.ncbi.nlm.nih.gov/24458053/] * Intracompartmental Pressure Monitoring Using a Handheld Pressure Monitoring System [https://pmc.ncbi.nlm.nih.gov/articles/PMC6221417/#:~:text=steps%20listed%20above.-,Results,errors%20and%20measurement%20errors%20decreased.] _____________________ Visit our landing page! [https://www.underpressure.fm/]

Beyond the X-Ray: Where Trauma Care, DNA, and Reality Meet

Trauma care doesn’t happen in a vacuum, and neither does innovation. In this episode, Dr. Jonathan Sackier sits down with Dr. Sandip Tarpada, orthopaedic trauma surgeon at Harlem Hospital Center, to explore how cutting-edge science meets real-world constraints. From his work on DNA methylation as a predictor of trauma outcomes to implementing new technologies in underserved communities, Dr. Tarpada shares what it actually takes to move the needle on patient care. Blood and Bone-Derived DNA Methylation Ages Predict Mortality After Geriatric Hip Fracture: A Pilot Study [https://pubmed.ncbi.nlm.nih.gov/39509524/] Visit our landing page! [https://www.underpressure.fm/]

Growing Bones, Subtle Signs: The Complexities and Quiet Clues of Pediatric Trauma Care

Pediatric trauma brings a unique set of challenges, from subtle clinical signs to children who can’t always articulate what hurts, and injury patterns that behave differently than those of adults. In this episode, Dr. Jonathan Sackier sits down with Dr. Kristin Livingston, pediatric orthopaedic surgeon at Boston Children’s Hospital and faculty at Harvard Medical School, to explore the complexity of acute compartment syndrome in kids, why it’s so different, and what makes timely diagnosis so difficult. Visit our landing page! [http://underpressure.fm/]

Beyond the OR: How Big Trials Are Rewriting Orthopaedic Trauma Protocols

In this episode of Under Pressure, Dr. O’Toole takes us inside landmark studies like VANCO and PREVENT CLOT, explaining what they mean for infection prevention, VTE prophylaxis, and real-world surgical protocols. He also shares why research consortia like METRC are so critical for answering big clinical questions and discusses emerging topics like continuous compartment pressure monitoring, perfusion data, and evolving tools for trauma decision-making. VANCO Trial [https://pubmed.ncbi.nlm.nih.gov/33760010/] PREVENT CLOT [https://pubmed.ncbi.nlm.nih.gov/33762229/] _______________ Visit our landing page! [http://underpressure.fm/]