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

Archives of Orthopaedic and Trauma Surgery volume 139, pages 1755–1762 (2019)Cite this article

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.

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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.

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Affiliations

  1. Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland

    B. A. Hatz, H. Frima & C. Sommer

  2. Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland

    B. A. Hatz

Authors
  1. B. A. Hatz
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  2. H. Frima
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  3. C. Sommer
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Correspondence to B. A. Hatz.

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

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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.

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Hatz, B.A., Frima, H. & Sommer, C. Selective fasciotomy for acute traumatic lower leg compartment syndrome: is it feasible?. Arch Orthop Trauma Surg 139, 1755–1762 (2019). https://doi.org/10.1007/s00402-019-03260-1

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  • DOI: https://doi.org/10.1007/s00402-019-03260-1

Keywords

  • Acute compartment syndrome
  • Lower leg fracture
  • Fasciotomy
  • Selective fasciotomy
  • Pressure measurement