Limited evidence supports that myoglobinuria and serum troponin level may assist in diagnosing acute compartment syndrome in patients with traumatic lower extremity injury.

Management of Acute Compartment Syndrome
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense. Endorsed by: ACS, AOFAS, and SOMOS
Limited Evidence LIMITED EVIDENCE
Rationale

One moderate quality study (Alamshah, 2016) showed that myoglobinuria had a moderate/strong relationship to the reference standard of fasciotomy, although surgery was performed based on unspecified pressure measurements and clinical criteria. This study also showed troponin levels to be a strong rule-in test (elevated values were associated with fasciotomy) but a poor rule-out test (normal values were not associated with absence of fasciotomy). This paper included 149 patients, of which 82% had trauma and the others had vascular injury. Patients with crush injury were excluded, which is of interest because this is the classic condition that causes myoglobinuria. Fasciotomy was performed in 14 cases, but the indications for fasciotomy are unclear. This paper does not provide enough data to support any specific role for myoglobinuria as a diagnostic indicator for when acute compartment syndrome is present, but suggests that myoglobinuria is more common in patients with leg trauma (but without crush injury) who undergo fasciotomy.

FUTURE RESEARCH

Future research examining the sensitivity and specificity of biomarkers compared to an appropriate reference standard (e.g. validated and/or comprehensive clinical and pressure diagnosis) in a population of patients suspected of ACS would be invaluable.

  1. Alamshah, S. M., Jahanshahi, A., Minaee, H., Nahidi, A., Dorestan, N., Kabiri, A., Sadat, S. A. Investigating correlation of lower extremity muscle compartment syndrome with muscle related serum enzyme tests: Is any reliable biomarker?. Biomedical and Pharmacology Journal 2016; 3: 1183-1188