Mini-open Fasciotomy Research Articles

Mini Open Fasciotomy for Chronic Exertional Compartment Syndrome: A Prospective Case Series

Chronic exertional compartment syndrome (CECS) is a challenging pathology that causes pain and physical limitations. Fasciotomy is the gold standard and different techniques have been described. Techniques that allow a fast return to sports and low recurrence rates are of great interest for the athletic population. This is a prospective case series presenting a mini open surgical technique and its results regarding the level of return to sports and quality of life in 13 patients. A specific CECS questionnaire was applied and analyzed concerning the distance patients were able to run before and after treatment, Tegner score, Medical Outcomes Short-Form Health Survey (SF-36), and epidemiological measures. The minimum follow-up was 12 months. The mean distance the patients were able to run per week following the surgical treatment improved from 14.1 to 38.1 km (P = .042) and the mean Tegner score improved from 3.92 to 7.08 (P = .01). Notably, 12 out of 13 patients were satisfied or very satisfied with the outcome. In this sample, the mini open technique improved patients’ sports performance and quality of life and minimized pain. Chronic exertional compartment syndrome can be safely approached using a mini open technique with a good rate of satisfaction and return to sport. Levels of Evidence: IV

Mini open non vascularized fibula graft harvesting technique without any specialized instrumentation: A case report

Fibula graft harvesting is a common procedure in orthopedic practice. The common approach to the shaft of fibula is through long incision made over the fibula. This was fraught with complications including common peroneal nerve injuries, pain and significant graft site morbidity to patients. Techniques then came to describe harvesting fibula through minimal incisions. However these needed specialized circular harvesters and hence was difficult to perform in hospitals catering to poor socioeconomic strata. We have devised minimally invasive technique of fibula harvesting using a long 4.5 system narrow DCP (Dynamic compression plate) used as soft tissue stripper and have combined the procedure with mini open fasciotomy and compression dressing. Our patient did not have any postoperative common peroneal, superficial peroneal or deep peroneal nerve injury. Postoperative graft site pain was minimal.

Chronic Exertional Compartment Syndrome of the Forearm: Mini-invasive Technique Using an Endoscopic Soft Tissue Release System.

Chronic exertional compartment syndrome of the forearm is a rare disease characterized by the recurrent onset of forearm pain and progressive weakness during exertion. Over the years many surgical techniques have been reported in literature: wide-open fasciotomy, mini-open fasciotomy, fasciotomy associated with fasciectomy, and mini-invasive endoscopic fasciotomy. Compared with traditional open techniques, mini-invasive techniques are characterized by minimal tissue trauma, less postoperative pain, faster recovery to normal activity and better esthetical result. We describe a mini-invasive endoscopic technique for the treatment of forearm chronic exertional compartment syndrome using the SmartRelease endoscopic tissue release system (MicroAire).

Long term functional outcomes after minimally invasive surgical decompression in upper limb chronic exertional compartment syndrome in 30 patients

Chronic exertional compartment syndrome (CECS) of the upper limbs is less well known than its equivalent in the lower limbs, thus its diagnosis is often delayed. Our goals were to evaluate the impact of CECS on activities of daily living and work-related activities and to report the functional outcomes after minimally invasive fasciotomy. This was a retrospective study of patients with CECS of the upper limb who were operated at two hospitals between 2008 and 2019. Thirty patients were reviewed an average of 5 years after minimally invasive fasciotomy: 26 had CECS of the forearm, 3 of the thenar compartment and 1 of the first interosseous compartment. For the evaluation, patients were asked to assess their pain on a visual analog scale (VAS), complete the QuickDASH questionnaire and rate their satisfaction with the outcome. Preoperative pain on the VAS was 7.45/10 with a negative impact on activities of daily living in 97% of patients, and on work-related activities in 77% of patients with 17% requiring a career change. The mean time to surgical treatment was 5 years. The mean QuickDASH at the final assessment was 6.0 (0–31.8) with a significant decrease in pain on VAS of 1.9/10 (p < 0.01). Seventy-seven percent of patients had very good results while 13% had good results. Full healing was achieved in 63% of patients and physical performance improved in 50%. Seventy-seven percent of patients were either satisfied or very satisfied with the outcome. One patient had a recurrence requiring surgical revision. CECS affects athletes of all levels and impacts both activities of daily living and work-related activities. We need to greatly expand our education and prevention efforts for CECS. Mini-open fasciotomy yields good results.

Minimally invasive fasciotomy using a lighted retractor in the treatment of chronic exertional compartment syndrome.

Chronic exertional compartment syndrome can be a debilitating cause of lower leg pain that typically affects young, healthy people during a variety of aerobic activities. Conservative management has produced a poor success rate and numerous techniques for surgical decompression have been described. Many of these, however, involve blind fascial dissection which increases the risk of direct nerve injury or insufficient fascial release. We describe a novel technique of mini-open fasciotomy using a lighted retractor which enables direct visualization of the fascia and the superficial peroneal nerve using a single, small incision. By the use of a 3- to 4-cm laterally based incision, a lighted retractor with fiber-optic illumination is introduced into the subcutaneous plane and advanced distally and proximally. The retractor gently elevates the subcutaneous tissues while focusing light directly into the surgical area and a long Metzenbaum scissors is then used to release the fascia under direct vision. Fasciotomy using this technique avoids the risks of blind fascial release and is a straightforward, safe, and effective method for compartment decompression.

Long-Term Outcome of Mini-Open Surgical Decompression for Chronic Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Riders.

To evaluate results of mini-open fasciotomy (MOF) in high-level motorcycling or motocross riders with chronic exertional compartment syndrome (CECS) at long-term follow-up (minimum 5 years). Case series. IV. University Hospital/Private Practice. Fifty-four professional motorcycling riders treated with MOF for a CECS of the forearm from January 2006 to June 2011. Inclusion criteria comprised: high-level motorcycling or motocross riders, clinical symptoms of CECS for at least 6 months, diagnosis confirmed using preoperative compartment hydrostatic pressure measurement and/or magnetic resonance imaging of the forearm, minimum follow-up of 5 years. A MOF to obtain decompression of all compartments was performed in all patients. Visual analog scale; a subjective scale to measure strength; QuickDash functional scores. Time to resume full riding capacities as short-term evaluation. A total of 54 patients who underwent 77 MOF procedures overall (23 bilateral) were included. The mean age was 23.6 ± 5.2 years. Mean Visual Analog Scale decreased from a preoperative value of 68.2 to a 3-month postoperative value of 26 (P < 0.001). Mean QuickDash scale was 84 at preoperative registration, falling to 20, 3 months after surgery (P < 0.001) and down to 12 at 1-year follow-up (P = 0.017). The average time to return to full riding capacities was 3.5 ± 1 week. Mini-open fasciotomy resulted safe and effective for the treatment of chronic exertional compartment syndrome in high-level motorcycling or motocross riders. The good outcome at follow-up resulted stable at 5 years and the incidence of complications remained low. Our data demonstrate that the resolution of symptoms is reliable and durable. Pain recovery was immediate after surgery, instead functional scores showed a more gradual recovery throughout the 12 months after surgery. Mini-open fasciotomy is a reliable treatment for CECS of the forearm in professional motorcycling riders. This treatment should also be considered in young riders due to the absence of tardive relapse reported in this study.

Mini-Open Surgical Fasciotomy for Chronic Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Adolescents.

Evaluate treatment and outcome of mini-open fasciotomy (MOF) in a population of adolescent motorcycling racers affected by forearm chronic exertional compartment syndrome (CECS). Prospective case series. University hospital/private practice. Nine professional motorcycling adolescents were diagnosed with forearm CECS. All were treated with MOF between 2007 and 2012 and followed for a minimum of 5 years (range 5-10 years). Age, sex, body mass index, laterality, and profession were recorded. A MOF to obtain decompression of all compartments was performed in all patients. Visual analog scale; a subjective scale to measure strength; and Quick-DASH functional scores. Time to resume full riding capacities as the short-term evaluation. A significant decrease in visual analog scale (P < 0.001) and Quick-DASH (P < 0.001) scores was observed in the first 3 months, stabilizing during follow-up (P = 0.521; P = 0.217). Average time to return to sport was 2.8 ± 1 week. No symptom recurrence was reported, but one patient suffered a minor complication. There were no cases of infection, hematoma, or peripheral nerve injury. We assess that MOF can be a valid alternative for the treatment of forearm CECS in adolescent competitive motorcycling racers, as demonstrated by the good success rate and minimal incidence of complications during follow-up. IV, case series.

Percutaneous mini open fasciotomy for impending acute compartment syndrome of leg: A study of 25 patients

Background: Compartment syndrome can complicate any fracture and is a challenge for orthopedic surgeons. It is an emergency condition which can lead to profound functional disability, ischemia and gangrene of limb if not promptly diagnosed and treated early. The fasciotomy procedure used widely for compartment syndrome of leg fracture is an open fasciotomy. Delay in fasciotomy wound healing, infection, need of secondary procedures may delay definite fracture fixations. Materials and Methods: We performed a prospective study of post traumatic tibia fractures with impending compartment syndrome treated by mini open percutaneous compartment fasciotomy. Results in terms of arrest of progression of the condition, wound complications, need for secondary procedure for wound healing and cosmetic appearance were evaluated Twenty five patients who were operated between 2010 and 2015 were selected for the study. 25 patients with fracture leg with impending compartment syndrome were treated with mini-open fasciotomy. Patients were reviewed post surgically and data was collected regarding symptoms and outcome assessment using specific parameters. Results: In all of our patients we were able to relieve the compartment pressure by this mini-open approach with pain relief in all (n=25) the patients within 6 hours. Mean healing time of the wound was 7 days and there was no wound infection. Percutaneous mini-open fasciotomy can arrest the progression of compartment syndrome. Need for secondary wound procedure like flap cover, skin grafting, vacuum assisted closure is not required. Definitive management of fracture can be done early with less hospital stay with good cosmetic results. Conclusion: Percutaneous mini-open fasciotomy can be used as a definitive procedure for impending compartment syndrome of leg with minimum surgical complications.

Chronic exertional compartment syndrome of the forearm in elite rowers: a technique for mini-open fasciotomy and a report of six cases.

Chronic exertional compartment syndrome (CECS) of the forearm may occur in sports requiring prolonged grip strength. CECS is a function of increasing pressure following muscle expansion within an inelastic tissue envelope resulting in compromise of perfusion and tissue function. Typical symptoms are pain, distal paraesthesia and loss of function. The condition is self-limiting and resolves completely between periods of activity. With no effective medical treatment, the gold standard remains four compartment open fasciotomy (Söderberg, J Bone Joint Surg Br 78(5):780-2, 1996; Wasilewski and Asdourian, Am J Sports Med 19(6):665-7, 1991). Minimally invasive techniques have been described (Croutzet et al., Tech Hand Up Extrem Surg 13(3):137-40, 2009) but have a risk of neuro-vascular injury, especially to the ulnar nerve while releasing the deep flexor compartment. We present a safe technique used with six elite rowers for mini-open fasciotomy to minimise scarring and time away from training while reducing the risk of neurovascular injury.

Mini-invasive Surgery for Chronic Exertional Compartment Syndrome of the Forearm

Chronic exertional compartment syndrome is now easily identified among the athletic population. It remains common in motorcyclists. The only treatment is the fasciotomy of the compartments and the gold standard procedure is still the open-invasive surgery. The authors describe a new mini-invasive surgical procedure to perform a 4-compartment fasciotomy of the forearm, and expose their results. Over a 3-year period, we reviewed 16 cases of forearm compartment fasciotomy for 8 patients with bilateral chronic exertional compartment syndrome of the forearm who had been operated on. All 8 were males, with an average age of 23 years. All were competition motorcyclists, either in cross-country or speed competitions. They were all treated with the same bilateral procedure: a mini-open fasciotomy of the 4 forearm compartments using the Knifelight, which is a sharp blade between 2 plastic blunt skids originally designed for carpal tunnel release. All patients had resumed their sport in the 6 weeks after the surgery. They were back to their previous level in 3 cases, and improved their level in 5 cases. No complications and no recurrences were reported during an average 2-year follow-up. The mini-invasive technique for fasciotomy seems to be as efficient as the open technique procedure, which is still the gold standard. But the length of surgery, recovery time, and scar sequelae are much better. Mini-invasive surgery is simple, efficient, and the results are reproducible.