Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 12, pp 1755–1762 | Cite as

Selective fasciotomy for acute traumatic lower leg compartment syndrome: is it feasible?

  • B. A. HatzEmail author
  • H. Frima
  • C. Sommer
Trauma Surgery
  • 102 Downloads

Abstract

Introduction

The standard treatment for an acute compartment syndrome (ACS) of the lower leg is a four compartment fasciotomy. It can be performed through either one lateral or a lateral and medial incision. Selective fasciotomy, only opening the compartments with elevated pressure, is a less invasive procedure. The aim of this study was to describe a procedure of selective fasciotomy after pressure measurement and to determine its feasibility in a retrospective cohort study.

Methods

All patients with an ACS of the lower leg due to a proximal or tibia shaft fracture (AO 41 or 42) who received either a four compartment fasciotomy or a selective fasciotomy after pressure measurement between 2006 and 2016 were included. Every compartment with an intracompartment pressure of more than 30 mmHg was opened. The primary outcome was any missed compartment syndrome after selective fasciotomy. Secondary outcomes were reoperations for completing four compartment fasciotomy and persistent sensomotoric deficits.

Results

Fifty-one patients with a mean age of 43 years (6–76) were included. Of these, 41 (80%) had a selective fasciotomy. There was no missed compartment syndrome. One patient had a reoperation 8 h after primary selective fasciotomy due to ACS of the superficial and deep flexor compartment. The anterior compartment had to be released in all patients. In 67%, the release of 2 compartments was sufficient. Six patients had postoperative sensomotoric deficits at discharge with full recovery during follow-up.

Conclusion

Selective fasciotomy is feasible and seems to be safe. Future comparative studies will have to focus on possible benefits of this less invasive treatment.

Keywords

Acute compartment syndrome Lower leg fracture Fasciotomy Selective fasciotomy Pressure measurement 

Notes

Acknowledgements

The authors thank Michelle Reynolds for the excellent copy-editing of this manuscript.

Funding

There was no external source of funding for this study.

Compliance with ethical standards

Conflict of interest

Basil Hatz, Herman Frima and Christoph Sommer declare that they have no conflict of interest.

Ethical approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    DeLee J, Stiehl J (1981) Open tibia fracture with compartment syndrome. Clin Orthop Relat Res 160:175–184Google Scholar
  2. 2.
    Blick SS, Brumback RJ, Poka A, Burgess AR, Ebraheim NA (1986) Compartment syndrome in open tibial fractures. J Bone Jt Surg Am 68(9):1348–1353.  https://doi.org/10.2106/00004623-198668090-00007 CrossRefGoogle Scholar
  3. 3.
    Park S, Ahn J, Gee AO, Kuntz AF, Esterhai JL (2009) Compartment syndrome in tibial fractures. J Orthop Trauma 23(7):514–518.  https://doi.org/10.1097/BOT.0b013e3181a2815a CrossRefPubMedGoogle Scholar
  4. 4.
    Stark E, Stucken C, Trainer G, Tornetta P 3rd (2009) Compartment syndrome in Schatzker type VI plateau fractures and medial condylar fracture-dislocations treated with temporary external fixation. J Orthop Trauma 23(7):502–506.  https://doi.org/10.1097/BOT.0b013e3181a18235 CrossRefPubMedGoogle Scholar
  5. 5.
    Elliott KG, Alan J (2003) Diagnosing acute compartment syndrome. J Bone Jt Surg Am 85(5):625–632CrossRefGoogle Scholar
  6. 6.
    McQueen MM, Gaston P, Court-Brown CM (2000) Acute compartment syndrome. Who is at risk? J Bone Jt Surg Am 82(2):200–203CrossRefGoogle Scholar
  7. 7.
    Hope MJ, McQueen MM (2004) Acute compartment syndrome in the absence of fracture. J Orthop Trauma 18(4):220–224CrossRefGoogle Scholar
  8. 8.
    Rorabeck CH (1984) The treatment of compartment syndromes of the leg. J Bone Jt Surg Am 66(1):93–97CrossRefGoogle Scholar
  9. 9.
    Matsen GSF (1976) Fasciotomy in the treatment of the acute compartment syndrome. J Bone Jt Surg Am 58(1):112–115CrossRefGoogle Scholar
  10. 10.
    Lagerstrom CF, Reed RL II, Rowlands BJ, Fischer RP (1989) Early fasciotomy for acute clinically evident posttraumatic compartment syndrome. Am J Surg 158:36–39CrossRefGoogle Scholar
  11. 11.
    Schmidt AH (2017) Acute compartment syndrome. Injury 48(Suppl 1):S22–S25.  https://doi.org/10.1016/j.injury.2017.04.024 CrossRefPubMedGoogle Scholar
  12. 12.
    McQueen MM, Court-Brown CM (1996) Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Jt Surg Br 78(1):99–104CrossRefGoogle Scholar
  13. 13.
    Ovre S, Hvaal K, Holm I, Strømsøe K, Nordsletten L, Skjeldal S (1998) Compartment pressure in nailed tibial fractures. A threshold of 30 mmHg for decompression gives 29% fasciotomies. Arch Orthop Trauma Surg 118(1–2):29–31PubMedGoogle Scholar
  14. 14.
    Schmidt AH (2013) Continuous Compartment Pressure Monitoring—Better Than Clinical Assessment?: commentary on an article by Margaret M. McQueen, MD, FRCSEd(Orth), et al. J Bone Jt Surg Am 95(8):e52CrossRefGoogle Scholar
  15. 15.
    Janzing HMJ, Broos PLO (2001) Routine monitoring of compartment pressure in patients with tibial fractures: beware of overtreatment! Injury 32(5):415–421CrossRefGoogle Scholar
  16. 16.
    Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audigé L (2007) Fracture and dislocation classification compendium—2007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma 21(10 Suppl):S1–133CrossRefGoogle Scholar
  17. 17.
    Shadgan B, Menon M, O'Brien PJ, Reid WD (2008) Diagnostic techniques in acute compartment syndrome of the leg. J Orthop Trauma 22(8):581–587.  https://doi.org/10.1097/BOT.0b013e318183136d CrossRefPubMedGoogle Scholar
  18. 18.
    Ulmer T (2002) The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder? J Orthop Trauma 16(8):572–577CrossRefGoogle Scholar
  19. 19.
    Schmidt AH (2016) Acute compartment syndrome. Orthop Clin N Am 47(3):517–525.  https://doi.org/10.1016/j.ocl.2016.02.001 CrossRefGoogle Scholar
  20. 20.
    Whitesides TE, Haney TC, Morimoto K, Harada H (1975) Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res 113:43–51CrossRefGoogle Scholar
  21. 21.
    Mubarak SJ, Owen CA, Hargens AR, Garetto LP, Akeson WH (1978) Acute compartment syndromes: diagnosis and treatment with the aid of the wick catheter. J Bone Jt Surg Am 60(8):1091–1095CrossRefGoogle Scholar
  22. 22.
    Matsen FA 3rd, Winquist RA, Krugmire RB Jr (1980) Diagnosis and management of compartmental syndromes. J Bone Jt Surg Am 62(2):286–291CrossRefGoogle Scholar
  23. 23.
    Heppenstall RB, Shenton DW, Chance B, Hazelgrove J (1984) Compartment syndrome: a bioenergetic study using 31P-NMR spectroscopy. Orthop Res 67:330Google Scholar
  24. 24.
    Heppenstall RB, Sapega AA, Scott R, Shenton D, Park YS, Maris J, Chance B (1988) The compartment syndrome. An experimental and clinical study of muscular energy metabolism using phosphorus nuclear magnetic resonance spectroscopy. Clin Orthop Relat Res 226:138–155Google Scholar
  25. 25.
    Mubarak SJ, Owen CA (1977) Double-incision fasciotomy of the leg for decompression in compartment syndromes. J Bone Jt Surg Am 59(2):184–187CrossRefGoogle Scholar
  26. 26.
    Masquelet AC (2010) Acute compartment syndrome of the leg: pressure measurement and fasciotomy. Orthop Traumatol Surg Res 96(8):913–917.  https://doi.org/10.1016/j.otsr.2010.08.001 CrossRefPubMedGoogle Scholar
  27. 27.
    Bible JE, McClure DJ, Mir HR (2013) Analysis of single-incision versus dual-incision fasciotomy for tibial fractures with acute compartment syndrome. J Orthop Trauma 27(11):607–611.  https://doi.org/10.1097/BOT.0b013e318291f284 CrossRefPubMedGoogle Scholar
  28. 28.
    Ritenour AE, Dorlac WC, Fang R, Woods T, Jenkins DH, Flaherty SF, Wade CE, Holcomb JB (2008) Complications after fasciotomy revision and delayed compartment release in combat patients. J Trauma 64(2 Suppl):S153–S161.  https://doi.org/10.1097/TA.0b013e3181607750 152) CrossRefPubMedGoogle Scholar
  29. 29.
    Maheshwari R, Taitsman LA, Barei DP (2008) Single-incision fasciotomy for compartmental syndrome of the leg in patients with diaphyseal tibial fractures. J Orthop Trauma 22(10):723–730.  https://doi.org/10.1097/BOT.0b013e31818e43f9 CrossRefPubMedGoogle Scholar
  30. 30.
    Blair JA, Stoops TK, Doarn MC, Kemper D, Erdogan M, Griffing R, Sagi HC (2016) Infection and nonunion after fasciotomy for compartment syndrome associated with tibia fractures: a matched cohort comparison. J Orthop Trauma 30(7):392–396.  https://doi.org/10.1097/Bot.0000000000000570 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Trauma SurgeryKantonsspital GraubündenChurSwitzerland
  2. 2.Department of TraumaUniversity Hospital ZurichZurichSwitzerland

Personalised recommendations