Changes in leg pain after bilateral fasciotomy to treat chronic compartment syndrome: a case series study

Jan Roar Orlin,John Roger Andersen,Jarle Øen

doi:10.1186/1749-799x-8-6

Jan Roar Orlin, John Roger Andersen + Show 1 more

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https://doi.org/10.1186/1749-799x-8-6

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Abstract

BackgroundIntracompartmental pressure (ICP) as the diagnostic gold standard in the management of chronic compartment syndrome (CCS) is debated. We present a diagnostic protocol in which the decision to operate can be based upon clinical findings alone. The aim of this study was to examine whether patients who underwent surgery for CCS based on clinical findings experienced significant long-term pain relief.MethodsA standardized clinical examination, including skin sensitivity, was performed in patients with bilateral leg pain and/or cramps. Before and after a symptom-provoking step test, ICPs were measured. The primary outcome was self-reported leg pain measured on a visual analogue scale. Secondary outcomes were satisfaction with the treatment result and health-related quality of life (HRQL) measured with the SF-8 questionnaire. Postoperative data were collected after 2 years.ResultsFollow-up was completed for 37 of 40 patients. ICP was increased in 80.5% of the compartments examined before surgery, but did not correlate with the degree of leg pain. The remaining compartments were diagnosed as CCS based on clinical findings, despite ICPs below the threshold. Leg cramps occurred in 32 of 37 (86.5%) patients during physical activity and at night. Leg pain improved from a score of 8.0 ± 1.5 to 2.3 ± 2.1, P < 0.001. Satisfaction with the treatment result was reported by 81.1% of the patients, accompanied by normalized HRQL.ConclusionsThe diagnostic protocol led to a fasciotomy in all compartments of both legs, which was associated with substantial and sustained relief of leg pain, improved HRQL, and patient satisfaction.

Highlights

Chronic compartment syndrome is a disorder that is most often encountered and described in soldiers and athletes [1,2,3,4,5], but it has been reported in nonathletes [6]
The remaining compartments were diagnosed as chronic compartment syndrome (CCS), even if the Intracompartmental pressure (ICP) was below the thresholds
Clinical examinations revealed symptoms of CCS in all four compartments of both legs, while elevated pressures were found in 80.5% of the compartments measured

Summary

Introduction

Chronic compartment syndrome ( known as chronic exertional compartment syndrome) is a disorder that is most often encountered and described in soldiers and athletes [1,2,3,4,5], but it has been reported in nonathletes [6]. A diagnosis of CCS that requires fasciotomy may be based on clinical findings only [1], but minimal or comprehensive ICP testing is usually performed [9,10]. Results after fasciotomy are often good, but for lasting pain relief, decompression of an increasing number of leg compartments may be necessary, paralleling the complete compartmental decompression recommended for acute cases. Poor long-term results may be related to incorrect diagnosis or failure to address multiple compartments in the leg simultaneously [11]. Intracompartmental pressure (ICP) as the diagnostic gold standard in the management of chronic compartment syndrome (CCS) is debated. The aim of this study was to examine whether patients who underwent surgery for CCS based on clinical findings experienced significant long-term pain relief

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