Zusammenfassung
Das akute posttraumatische Kompartmentsyndrom des Fußes ist Folge schwerer Fußverletzungen und führt unerkannt und unbehandelt regelhaft zu Deformitäten und unterschiedlich schweren funktionellen Defiziten, die Folgeeingriffe erforderlich machen. Wir können heute von 9 bzw. 10 klinisch relevanten anatomisch definierten Fußkompartimenten ausgehen. Die zeitgerechte Diagnosestellung kommt insbesondere am bewusstlosen Patienten nicht ohne die interstitielle Druckmessung aus. Eine ausreichend sichere Kompartmentspaltung bedarf je nach Verletzungsausmaß und Involvierung der unterschiedlichen Kompartimente 1–3 unterschiedliche Zugänge zur Entlastung. Ein komplexes Fußtrauma ist klar definiert (Zwipp-Score oder „Zones-of-injury-Konzept“) und hat nach wie vor eine relativ ungünstige Prognose, wenn nicht ein konsequentes Behandlungsregime verfolgt wird, das profunde Erfahrungen mit diesen variantenreichen Verletzungen und oftmals eine interdisziplinäre Kooperation erforderlich macht. Weder für die primäre Entscheidungsfindung zur Amputation noch für die Abschätzung der Prognose haben sich bislang die üblichen Scores als hilfreich erwiesen.
Abstract
Acute posttraumatic compartment syndrome of the foot is generally the consequence of a severe foot trauma. If the compartment syndrome is left unrecognized and untreated foot deformities and a variety of different functional impairments will follow, making secondary surgical interventions necessary. At present 9 or 10 clinically relevant compartments can be defined anatomically. The early diagnosis particularly in the unconscious patient is based essentially on measurement of the tissue pressure in the corresponding compartments. An effective compartment release depending on the extent of injury and involvement of the specific compartments needs knowledge of three different approaches. A complex foot trauma represents a clearly defined term (Zwipp score or zones-of-injury concept) which still has a quite ominous prognosis if it is not treated according to a stringent regime based on a profound expertise in this quite variable injury entity. An interdisciplinary approach is often deemed to be essential for a reasonable outcome. None of the accepted scores have proven to be useful for primary decision-making of amputation or for the assessment of the long-term prognosis.
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Mittlmeier, T. Akutes Kompartmentsyndrom und Komplextrauma des Fußes. Unfallchirurg 114, 893–900 (2011). https://doi.org/10.1007/s00113-011-1983-0
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DOI: https://doi.org/10.1007/s00113-011-1983-0
Schlüsselwörter
- Erworbene Fußdeformitäten
- Kompartmentsyndrom
- Komplextrauma des Fußes
- Knochenmanagement
- Weichteilmanagement