Compartment Syndrome Of Leg Research Articles

Study on the function of self-polymerizing peptide nanofiber material combined with nerve growth factor-mediated RNA repair for nerve injury treatment in rabbits with the osteofascial compartment syndrome

The present study aimed to establish an animal model of the osteofascial compartment syndrome (OFCS) in hind legs of rabbits, and to repair an early nerve injury using the self-polymerized peptide nanofiber material that was laced with nerve growth factors (NGFs). An animal model of the compartment syndrome was established using the tourniquet method. The intrafascial pressure of rabbit legs at different time points was measured after successful modeling. Western blotting was used to assess the proliferation of nerve cells after injury. After incision and decompression, the repair group was implanted with the self-polymerized peptide nanofiber material in combination with NGFs at the nerve injury sites for repair of the injured nerves. Rabbit hind leg nerve specimens were collected from experimental rabbits (control group), rabbits 5 days after injury (unrepaired group), and rabbits 5 days after injury (repaired group), and hematoxylin-eosin (HE) staining analysis and immunofluorescence experiments were also performed. After loosening the tourniquet, the intra-fascial pressure peaked on the 1st day after injury and then gradually decreased. A western blot showed low expression of the proliferating cell nuclear antigens (PCNAs) in the control group, as it began to increase 4 h after injury, peaked 5 days after injury (P < 0.05), and then gradually decreased. Meanwhile, the tissue morphology of the repair group was better than that of the non-repair group. Fluorescence double labeling results showed that the proliferation of nerve cells in the repair group increased significantly, and S100 and DAPI co-labeling intensities increased significantly. The early application of the self-polymerizing peptide nanofiber material combined with NGF exhibited evident effects on the nerve injury treatment in the osteofascial compartment syndrome.

Implementation of the three-dimensional printing technology in treatment of bone tumours: a case series

With the ability to overcome specific anatomical and pathological challenges, 3D printing technology is setting itself as an important tool in patient-specific orthopaedics, delivering anatomical models, patient-specific instruments, and custom-made implants. One of the most demanding procedures in limb salvage surgery is the reconstruction of bony defects after tumour resection. Even though still limited in clinical practice, early results of the use of 3D technology are gradually revealing its potentially huge impact in bone tumour surgery. Here, we present a case series illustrating our experience with the use of 3D printing technology in the reconstruction of bone defects after tumour resection, and its impact on cosmesis and quality of life. We performed a retrospective analysis of 11 patients in whom a custom-made 3D-printed prosthesis was used to reconstruct a bone defect after resection for a bone tumour. Ten out of 11 patients were children (aged between 5 and 16 years) with osteosarcoma or Ewing sarcoma of the pelvis (2 children) or the arm (8 children), and one patient was a 67-year-old lady with a chondrosarcoma of the pelvis. All underwent wide resections resulting in considerable bone defects necessitating further reconstruction. Custom-made implants were extremely useful both in reconstruction of bone defects and in terms of cosmesis, recovery facilitation, and quality of life. In this respect, pelvic and humeral reconstructions with 3D-printed custom implants particularly showed a great potential. The mean follow-up was 33 months. Four patients died of disease (36%) and overall the major and minor complication rate was 54% (6 out of 11 patients). Three patients had implant dislocation (27% [3/11 cases]), one had leg-compartment syndrome, and one patient reported limited range of motion. Only two out of 11 patients developed local recurrence. Use of 3D customized implant helped us achieve two major goals in orthopaedic oncology-clear surgical resection and functional recovery with a good quality of life. Large studies with long-term follow-up are needed to reveal the value and future of 3D printing in orthopaedic oncology.

A strategy to prevent complications of hyperextension type tibial plateau fracture.

Tibial plateau fractures (TPFs) are the most common among periarticular fractures. Mechanism of injuries is most from varus/valgus and flexion injury. Hyperextension type injuries are rare and easily to be overlooked. We reported 12 cases of this fracture type. Complications of early cases were reported, and treatment strategies of late cases were suggested. From 2010 to 2016, we performed a retrospective analysis of 248 cases of TPFs in our institute and 12 cases of hyperextension bicondylar TPFs were diagnosed. Diagnostic method is from both plain films and CT scans. The features of this injury included sagittal plane malalignment with loss of the normal posterior slope of the tibial plateau, tension failure of the posterior cortex, and compression of the anterior cortex. Surgical approach is predominantly via an anterolateral and/or posteromedial double incision at the first. Then anteromedial with adequate grafting to support the bone defect was modified. Postoperative radiographic analysis, physical examination findings, and complications were reported. Patient reported outcome scores from the Knee Injury and Osteoarthritis Outcome Score (KOOS) were recorded. Twelve patients were followed up for a mean period of 16.6months (range 12-26months). The mean time to radiographic bony union was 3.6months (range 3-9months, SD 8.5). About complications, the incidence of popliteal artery occlusion received PTA was 8% (1/12). And 3/12 (25%) patients had either partial or complete peroneal nerve injury. 2/12 (16%) patients developed a leg compartment syndrome. 33% (4/12) demonstrated associated injuries including posterolateral complex injuries mostly and posterior cruciate ligament avulsion fracture in one case. The average range of motion of the affected knees was 3.4-130° postoperatively. Analysis of complication about surgery included inadequate reduction and fixation in two cases, insufficient bone grafting in one case. The mean mPTA was significantly improved after fixation (preoperative 82° postoperative 3months 86°). The mean posterior slope (PTA) was preoperative -3° and postoperative 3months 3°. And mean KOOS was 80. Hyperextension bicondylar tibial plateau fractures show a special characteristic of changes in posterior tibial slope angle and are easy to be overlooked. Complication rate is high after injury and after ineffective fixation. Choosing correct approach with sufficient grafting and stable fixation for treatment of hyperextension bicondylar tibial plateau fractures should be used to improve patients' outcome.

Outcomes of Chimney or Snorkel Endovascular Repair for Symptomatic and Ruptured Abdominal Aortic Aneurysms

Symptomatic and ruptured abdominal aortic aneurysms (AAAs) are increasingly managed with endovascular aneurysm repair (EVAR). We aimed to identify the 30-day outcomes of symptomatic and ruptured AAAs that underwent EVAR with chimney or snorkel techniques (Ch-EVAR). A retrospective cohort study was performed using the Vascular Quality Initiative registry from March 2013 to July 2019. All patients with symptomatic and ruptured AAAs with proximal aortic zone of disease from 6 through 9 who underwent Ch-EVAR were included. Outcomes were analyzed per the Society for Vascular Surgery reporting standards for EVAR. Ch-EVAR was performed in 77 patients (35 [45.5%] ruptures, 42 [54.5%] symptomatic). Median age was 73 (interquartile range [IQR], 67-81) years, and 54 (70.1%) patients were male. Maximum aneurysm diameter was 67.5 (IQR, 54.5-83.3) mm. All patients were assigned to American Society of Anesthesiologists class 3 or above, with 56 (72.7%) class 4. Among ruptured AAAs, the mean lowest preoperative systolic blood pressure was 95.3 (±29.3) mm Hg. Fluoroscopy time was 57.4 (IQR, 41.2-79.0) minutes. The proximal aortic zone of disease was zone 6 in 9 (11.7%), zone 7 in 21 (27.3%), zone 8 in 36 (46.8%), and zone 9 in 11 (14.3%) patients. Ch-EVAR involved one vessel in 28 (36.4%) patients, two vessels in 22 (9.1%) patients, three vessels in 19 (24.7%) patients, and four vessels in 8 (10.4%) patients. Configurations of the Ch-EVAR are shown in Table I. Technical success was achieved in 67 (87.0%) patients. Outcomes of symptomatic and ruptured Ch-EVAR are summarized in Table II. Reintervention was required in 10 (13.0%) patients at a median time of 9 postoperative days. This involved the aorta/chimneys in five (6.5%) patients, access ischemia in one (1.3%), complete device removal in one (1.3%), new stent placement in two (2.6%), and glue repair of endoleak in one (1.3%). Postoperatively, 31 (40.3%) patients had a major complication, including 4 (5.2%) access site hematomas, 1 (1.3%) access site occlusion, 2 (2.6%) strokes, 2 (2.6%) pneumonias, 5 (6.5%) reintubations, 8 (10.4%) renal ischemia, 11 (14.3%) postoperative dialysis, 4 (5.2%) intestinal ischemia, 3 (3.9%) leg ischemia, and 1 (1.3%) leg compartment syndrome. Ch-EVAR for symptomatic and ruptured AAAs may be performed with acceptable rates of morbidity and mortality. Long-term data are needed to determine durability.Table IConfigurations of Ch-EVARConfigurationNumber of patients (n = 77) (%)Bilateral Renal10 (13.0)Left Renal11 (14.3)Right Renal10 (13.0)SMA, Bilateral Renal16 (20.8)SMA, Left Renal4 (5.2)SMA, Right Renal5 (6.5)SMA7 (9.1)Celiac, SMA3 (3.9)Celiac, SMA, Left Renal3 (3.9)Celiac, SMA, Bilateral Renal8 (10.4) Open table in a new tab Table IIComparison between ruptured and symptomatic Ch-EVAROutcomeRuptured (n = 35)Symptomatic (n = 42)Overall (n = 77)P-valueMortality4 (11.4%)3 (7.1%)7 (9.1%).695Converted to Open Procedure1 (2.9%)1 (2.4%)2 (2.6%)1.000Type 1 Endoleak7 (20.0%)2 (4.8%)9 (11.7%).071Type 2 Endoleak0 (0.0%)4 (9.52%)4 (5.2%).121Type 3 Endoleak0 (0.0%)1 (2.4%)1 (1.3%)1.000Postoperative length of stay (days)13.67.610.3.110Number of vessels stented1.82.32.1.038 Open table in a new tab

P1104THE ROLE OF THERAPEUTIC PLASMA EXCHANGE COMBINED WITH HEMODIALYSIS IN MANAGEMENT OF POISONING AND INTOXICATION

Abstract Background and Aims Background: Poisonings, intoxications, and drug overdoses are common occurrences and rapid lowering of the toxin level is key of all effective therapies. Therapeutic plasma exchange (TPE) has several unique characteristics that allow it to be a potentially effective therapy in rapidly achieving this goal with large molecular weight, protein-bound molecules that have a small volume of distribution. Ibuprofen is a commonly used anti-inflammatory, antipyretic, and analgesic drug. The number of reported ibuprofen overdoses (IO) has increased. Although the vast majority of IOs are not consequential, large ingestion can cause severe metabolic acidosis (MA) resulting in multi-organ failure and death. TPE has been reported as solo intervention in IO, however frequently with remaining renal dysfunction. We report two cases of massive IO that responded well to prompt combined TPE with continuous renal replacement therapy (CRRT). Method Literature and chart review of cases of IO in our institute treated with TPE+CRRT. Results Case 1: A 17 year old male presented to the Emergency Department (ED) following intentional IO in coma with serum pH of 7.09, cardiorespiratory failure and acute kidney injury (AKI). Urine drug screen was positive for only ibuprofen. He reportedly took 1381 mg/kg. Supportive care was unsuccessful, therefore TPE+CRRT was soon initiated. After two days of treatment the patient was able to be extubated, maintained normal cardiovascular status and renal function. The patient fully recovered. Case 2: A 17 year old female presented to the ED following intentional IO with serum pH of 6.9, cardiorespiratory failure, AKI, arrhythmia and bilateral leg compartment syndrome. Urine drug screen was positive for ibuprofen. The estimated ibuprofen exposure was above 2000 mg/kg. The initial ibuprofen serum plasma level was 330 µg/mL (therapeutic range is 10-50 µg/mL). Initial Supportive care was unsuccessful and TPE+CRRT was immediately started. Plasma ibuprofen level was normal after the 3rd TPE+CRRT. The patient fully recovered. Conclusion Intentional IO may result in major morbidity and mortality. TPE is more efficient in removing drugs with a high protein binding and/or a low volume of distribution, such as ibuprofen. In settings of massive overdose, hemodialysis may provide additional removal of unbound portion, as well corrects acidosis and allows provision of optimal nutrition. Combined TPE+CRRT is beneficial and may facilitate recovery. To our knowledge this is the first pediatric report of severe IO successfully treated with combined therapy.

Demographic Characteristics Among Patients With Chronic Exertional Compartment Syndrome of the Lower Leg.

Clinical Scenario: Chronic exertional compartment syndrome (CECS) is a condition related with ischemia of the body's tissue due to increases in intracompartmental pressures, which involves, among other symptoms, pain with exertion. CECS is often overlooked or misdiagnosed due to an ambiguous presentation. Diagnostic accuracy of CECS and subsequent management can be improved when contributing factors are known. Research is lacking on the type of patient most likely to experience CECS, highlighting the need for identification of common demographic characteristics among affected individuals. Clinical Question: What are the common demographic characteristics among patients exhibiting CECS of the lower leg? Summary of Key Findings: Four studies were identified (1 prospective consecutive study, 2 retrospective reviews, and 1 retrospective cohort study) that examined common characteristics among patients with CECS. Conflicting evidence exists on whether CECS is more commonly seen in men or in women. CECS has often been reported in young, active individuals but may present in older populations as well. Soccer, field hockey, lacrosse, competitive running, and speed skating have been associated with an increased likelihood of CECS development. Clinical Bottom Line: Current evidence has identified commonalities in sex, age, and sport participation as characteristics often present among individuals experiencing lower leg CECS. Other factors, such as overuse, trauma, diabetes, and gait mechanics, have also been identified in association with CECS. Further data through future prospective studies will help confirm the type of patient mostly likely to experience CECS. Strength of Recommendation: Grade B evidence exists that certain sex, age, and sport participation demographic characteristics are common among patients with CECS of the lower leg.

A case of well leg compartment syndrome after prolonged lateral decubitus position

A case of well leg compartment syndrome after prolonged lateral decubitus position

Factors associated with myonecrosis at time of fasciotomy in acute leg compartment syndrome.

The objective of this study is to determine factors associated with myonecrosis at the time of fasciotomy in patients with acute leg compartment syndrome. A retrospective cohort study was conducted of 546 patients with acute leg compartment syndrome treated with fasciotomies from January 2000 to June 2015 at two tertiary trauma centers. The main outcome measurement was clinical myonecrosis diagnosed by the treating surgeon at the time of fasciotomy. Eighty-two patients (15.0%) with acute leg compartment syndrome had myonecrosis at time of fasciotomy. Multivariable logistic regression analyses showed that younger age (p = 0.004) and diabetes mellitus (p < 0.001) were associated with myonecrosis at time of fasciotomy in acute leg compartment syndrome. Serum creatine kinase at presentation greater than 2405 U/L was found to be associated with myonecrosis at time of fasciotomy in post hoc analysis (p < 0.001). Myonecrosis is associated with patient-related factors. Younger age by 10years is associated with a 1.3 times increase and diabetes mellitus with a 3-time increase in the odds of myonecrosis. Serum creatine kinase at presentation greater than 2405 U/L denotes an almost 3 times increase in odds of myonecrosis and may be useful for preoperative counseling.

Single-Incision 4-Compartment Fasciotomy of the Lower Leg: Safe, Effective, and Advantageous.

The optimal surgical approach for acute compartment syndrome (ACS) of the lower leg remains debatable. Although a majority of surgeons tend to use a 2-incision approach to 4-compartment fasciotomies, the authors have used a single-incision technique followed by protocolized, staged skin closure. The purpose of this study was to determine the safety, efficacy, and complication rate of this strategy. This retrospective study included all patients treated for ACS by a single surgeon during a 3-year period. A protocol was used including a single-incision technique followed by vacuum-assisted wound-closure dressing, periodic return to the operating room at 48- to 72-hour intervals, and sequential wound closure with vertical mattress sutures. Complications associated with this protocol were analyzed. Eleven patients were included in the study. Average length of follow-up was 12 months (range, 2-35 months). There were no instances of malunion, deep or superficial infection, intraoperative neurovascular injury, or progressive neurologic deficits-indicating adequate release of all 4 compartments through a single incision. All patients were closed primarily without need for skin grafting. Average time to primary closure was 4.5 days. One patient had a tibial fracture nonunion and 1 had distal wound breakdown, which healed by secondary intention. A single-incision approach to 4-compartment fasciotomies followed by protocolized skin closure is safe and effective and may reduce the need for skin grafting. [Orthopedics. 2020;43(4):e225-e230.].

External pressure at calf region in low lithotomy position is higher in men and increases proportionately with height, weight, lower leg size, and foot length

ObjectivePatients placed in lithotomy position (LP) with a leg holder during surgical procedures have been at particular risk of developing well leg compartment syndrome (WLCS). A commonly considered contributing factor of WLCS is obesity. LP is mainly divided into the following four types by the degree of hip angulation and height of lower leg placement relative to the heart: low, standard, high, and exaggerated. We have reported that the external pressure at the calf region in standard LP is independent of weight. In the present study, we investigated the relationship between the external pressure in low LP and physical characteristics, such as body, leg, and foot sizes. MethodsFifty-five volunteers, 27 men and 28 women, participated in this study. They were placed in low LP with the boot-support-type leg holder, with the hip joints flexed at 170° from the trunk and abducted at 45°, and with the knee joints flexed at 120°. Peak contact pressure (PCP) at the calf region was measured as representative external pressure by using the pressure distribution measurement system, BIG-MAT®. ResultsThe mean PCPs at the left and right calf regions in men (37.6 and 39.3 mmHg, respectively) were significantly higher than those in women (31.5 and 33.6 mmHg [P = 0.014 and 0.001], respectively). The left PCPs correlated positively with height (P = 0.003), weight (P = 0.001), body mass index (BMI) (P = 0.037), tibial length (TL) (P < 0.001), bimalleolar breadth (BB) (P = 0.046), maximum calf girth (MCG) (P = 0.035), and foot length (FL) (P = 0.001); and the right PCPs correlated positively with height (P < 0.001), weight (P < 0.001), BMI (P = 0.063), TL (P < 0.001), BB (P = 0.001), MCG (P = 0.005), and FL (P = 0.001). ConclusionThe external pressure at the calf region in low LP is higher in men and increases proportionately with height, weight, lower leg size, and FL, which may contribute to the risks of inducing WLCS during surgeries performed in low LP.

Chronic Exertional Compartment Syndrome in ­Athletes: A narrative Review

Chronic exertional compartment syndrome of the lower leg accounts for approximately 75% of sports-related chronic leg pain. Nevertheless, the exact and timely recognition in athletes might pose a great challenge to sports physicians. Among a variety of possible differential diagnoses such as tenosynovitis, stress fractures, periostalgia, or popliteal artery entrapment syndrome the physician has to be able to identify the correct entity as promptly as possible. Consequently, profound knowledge about exercise-associated pathologies of the musculoskeletal, nervous and vascular system, as well as the capability of interdisciplinary thinking are critical.

Chronic Exertional Compartment Syndrome of the Lower Leg: a Case Series of Six Patients

Chronic Exertional Compartment Syndrome of the Lower Leg: a Case Series of Six Patients

Compartment syndrome of the lower leg caused by a stingray injury

Compartment syndrome of the lower leg caused by a stingray injury

Lower limb (healthy leg) compartment syndrome after the patient was in the lithotomy position during the operation: a case study

In this case report, we describe compartment syndrome of the lower extremities that occurred during and after the operation in a patient with a gynecologic tumor who underwent minimally invasive surgery in the lithotomy position to prevent venous thrombosis. Lower limb compartment syndrome has also been reported in a number of other similar cases. The use of sequential compression stockings for deep venous thrombosis prophylaxis in patients in the lithotomy position is inappropriate. We expect to have a complete set of guidelines or expert consensus to guide the prevention of venous thrombosis in minimally invasive surgery for patients with gynecologic tumors.

Peripheral nerve block for pain control in lower leg compartment syndrome after relaxing incision and acute lower limb arterial occlusion

Peripheral nerve block for pain control in lower leg compartment syndrome after relaxing incision and acute lower limb arterial occlusion

Dosing of Antimycotic Treatment in Sepsis–Induced Liver Dysfunction by Functional Liver Testing with LiMAx®

Background Sepsis-treatment is one of the major challenges in our time. Especially fungal infections play an important role in patient's morbidity and mortality. In patients with septic shock, liver function is often significantly impaired and therefore also hepatic drug metabolism is altered. Case Presentation We report about a 56-year-old man suffering from invasive fungal infection with multiorgan failure, after complicated medical history due to symptomatic infrarenal aortic aneurysm. On the first postoperative day, a CT scan was undertaken due to massive back pain showing renal infarction on both sides. As qualitative and quantitative renal function was impaired, hemodialysis was started immediately. Subsequently, the patient developed a compartment syndrome of the left leg and underwent fasciotomy. On admission day 7, the patient presented with hematochezia leading to colonoscopy. During this procedure, an ischemic colitis was observed. As conservative treatment failed, the patient underwent Hartmann's procedure due to progredient ischemia followed by a worsening of the clinical status due to sepsis. The patient suffered from an invasive fungal infection with Candida spp. and Aspergillus spp. Systemic antifungal treatment was initiated. Although azoles are considered first-line treatment in these cases we chose the echinocandin caspofungin for its presumed lower impact on liver function compared to azoles like voriconazole or Amphothericin B. However, caspofungin is also metabolised in the liver and can cause hepatotoxic effects. Therefore we measured metabolic liver function capacity using LiMAx®and adapted the patient's dose of caspofungin to the evaluated liver function capacity to achieve an effective and liver-protective level of the active drug. After complicated medical history with 15 weeks of hospital stay, the patient was discharged in general good condition. Conclusions To our knowledge, this is the first report that relates antimycotic drug dosing to a functional liver test. We provide a new approach for sepsis treatment considering liver function capacity to optimize dosage of hepatically metabolised drugs with potential hepatotoxic effects.

Acute compartment syndrome of the lower leg causing cardiac arrest after resection of the right external iliac vein for autologous graft: a case report

BackgroundThe right external iliac vein (REIV) is often used for portal vein reconstruction in patients undergoing pancreatoduodenectomy with portal-superior mesenteric vein resection. We report a case of cardiac arrest caused by acute lower leg compartment syndrome as a result of REIV resection.Case presentationA 53-year-old man underwent pancreatoduodenectomy with portal vein resection. Hyperkalemia progressed during surgery due to intestinal reperfusion injury, which caused recurrent ventricular arrhythmia required for cardio-pulmonary resuscitation. The surgery was discontinued after resuscitation, and portal vein reconstruction using the REIV was performed 2 days post-operatively. Acute compartment syndrome was diagnosed immediately following the surgery. Hyperkalemia progressed, causing pulseless ventricular tachycardia. Emergent fasciotomy was performed, but right leg dysfunction persisted after discharge.ConclusionREIV resection can cause lower-extremity acute compartment syndrome. The status, including intracompartmental pressure, of the lower extremity should be carefully observed after REIV resection during and after surgery.

Well Leg Compartment Syndrome After Prolonged Pelvic Surgery

Department of Colorectal and Intestinal Failure Surgery, Salford Royal National Health Service Foundation Trust, University of Manchester, Manchester, United Kingdom Funding/Support: None reported. Financial Disclosure: None reported. Correspondence: Gordon L. Carlson, M.D., F.R.C.S., Department of Colorectal and Intestinal Failure Surgery, Salford Royal National Health Service Foundation Trust, University of Manchester, Manchester M6 8HD, United Kingdom. E-mail: [email protected]

Risk factors for death and amputation in acute leg compartment syndrome

The primary objective of this study is to determine whether time from injury to fasciotomy is associated with increased risk for death or limb amputation in patients with acute leg compartment syndrome. The secondary objective of this study is to identify other risk factors for death or limb amputation in patients with acute leg compartment syndrome. In an institutional review board approved retrospective study, we identified 546 patients with acute compartment syndrome of 558 legs treated with fasciotomies from January 2000 to June 2015 at two Level I trauma centers. Our primary outcome measures were death and limb amputation during inpatient hospital admission. Electronic medical records were analyzed for patient-related factors and treatment-related factors. Bivariate analyses were used to screen for variables associated with our primary outcome measures, and explanatory variables with a p value below 0.05 were included in our multivariable logistic regression analyses. In-hospital death occurred in 6.6% and in-hospital limb amputation occurred in 9.5% of acute leg compartment syndrome patients. Neither death nor limb amputation was found to be associated with time from injury to fasciotomy. Multivariable logistic regression analyses showed that older age (p = 0.03), higher modified Charlson Comorbidity Index (p = 0.009), higher potassium (p = 0.02), lower hemoglobin (p = 0.002), and higher lactate (p < 0.001) were associated with death, and diabetes mellitus (p = 0.05), no compartment pressure measurement (p = 0.009), higher PTT (p = 0.03), and lower albumin (p = 0.01) were associated with limb amputation. Time to fasciotomy is not found to be associated with death or limb amputation in acute leg compartment syndrome. Death and limb amputation are associated with patient-related factors and injury severity. Level III Prognostic.

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

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. 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 30mmHg 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. Fifty-one patients with a mean age of 43years (6-76) were included. Of these, 41 (80%) had a selective fasciotomy. There was no missed compartment syndrome. One patient had a reoperation 8h 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. Selective fasciotomy is feasible and seems to be safe. Future comparative studies will have to focus on possible benefits of this less invasive treatment.